Exploring HRD in two Welsh NHS Trusts: analysing the discursive resources used by senior managers.

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Sambrook, Sally

2007-01-01

The purpose of this paper is to examine human resource development (HRD) in the UK National Health Service (NHS), and particularly in two Welsh NHS Trusts, to help illuminate the various ways in which learning, training and development are talked about. The NHS is a complex organisation, not least with its recent devolution and separation into the four distinct countries of the UK. Within this, there are multiple and often conflicting approaches to human resource development associated with the various forms of employee, professional (nursing, medical etc.), managerial and organisational development. How people are developed is crucial to developing a modern health service, and yet, with the diverse range of health workers, HRD is a complex process, and one which receives little attention. Managers have a key role and their perceptions of HRD can be analysed through the discursive resources they employ. From an interpretivist stance, the paper employs semi-structured interviews with seven Directorate-General Managers, and adopts discourse analysis to explore how HRD is talked about in two Welsh NHS Trusts. The paper finds some of the different discourses used by different managers, including those with a nursing background and those without. It examines how they talk about HRD, and also explores their own (management) development and the impact this has had on their sense of identity. The paper highlights some of the tensions associated with HRD in the NHS, including ambiguities between professional and managerial development, the functional and physical fragmentation of HRD, conflict between a focus on performance/service delivery and the need to learn, discursive dissonance between the use of the terms training and learning, a delicate balance between "going on courses" and informal, work-related learning, inequities regarding "protected time" and discourses shifting between competition and cooperation. These tensions are exposed to help develop a shared

Medical leadership arrangements in English healthcare organisations: findings from a national survey and case studies of NHS trusts.

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Dickinson, Helen; Ham, Chris; Snelling, Iain; Spurgeon, Peter

2013-11-01

This project sought to describe the involvement of doctors in leadership roles in the NHS and the organisational structures and management processes in use in NHS trusts. A mixed methods approach was adopted combining a questionnaire survey of English NHS trusts and in-depth case studies of nine organisations who responded to the survey. Respondents identified a number of challenges in the development of medical leadership, and there was often perceived to be an engagement gap between medical leaders and doctors in clinical roles. While some progress has been made in the development of medical leadership in the NHS in England, much remains to be done to complete the journey that started with the Griffiths Report in 1983. We conclude that a greater degree of professionalism needs to be brought to bear in the development of medical leadership. This includes developing career structures to make it easier for doctors to take on leadership roles; providing training, development and support in management and leadership at different stages of doctors' careers; and ensuring that pay and other rewards are commensurate with the responsibilities of medical leaders. The time commitment of medical leaders and the proportion of doctors in leadership roles both need to increase. The paper concludes considering the implications of these findings for other health systems. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Are NHS foundation trusts able and willing to exercise autonomy? 'You can take a horse to water...'.

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Exworthy, Mark; Frosini, Francesca; Jones, Lorelei

2011-10-01

Foundation trusts (FTs) have been a central part of the government's National Health Service (NHS) reforms in England since 2004. They illustrate the government's claim to decentralization, by granting greater autonomy to high performing organizations. The number of FTs has grown steadily, reaching 131 in September 2010, over 50% of eligible trusts. Despite this growth, and notwithstanding the fact that organizations which initially became FTs were previously high performing, doubts remain about the implementation of the FT policy. This article examines the implementation of FTs in the NHS and focuses on the nature and exercise of autonomy by FTs. It argues that the ability of FTs to exercise autonomy is in place, but the (relatively limited) extent of implementation may be explained by trusts' lack of willingness to exercise such autonomy. Such unwillingness may be because of continued centralization, unclear policy and financial regimes, fear of negative impacts on relations with other local organizations, and awareness of greater risk to the FT, among others. Addressing the tension between FTs' ability and willingness to exercise autonomy will largely explain the extent to which the government's provider side reforms will be implemented.

Impact of a COPD discharge care bundle on readmissions following admission with acute exacerbation: interrupted time series analysis.

Directory of Open Access Journals (Sweden)

Anthony A Laverty

Full Text Available We evaluated the impact of a COPD discharge care bundle on readmission rates following hospitalisation with an acute exacerbation.Interrupted time series analysis, comparing readmission rates for COPD exacerbations at nine trusts that introduced the bundle, to two comparison groups; (1 other NHS trusts in London and (2 all other NHS trusts in England. Care bundles were implemented at different times for different NHS trusts, ranging from October 2009 to April 2011.Nine NHS acute trusts in the London, England.Patients aged 45 years and older admitted to an NHS acute hospital in England for acute exacerbation of COPD. Data come from Hospital Episode Statistics, April 2002 to March 2012.Annual trend readmission rates (and in total bed days within 7, 28 and 90 days, before and after implementation.In hospitals introducing the bundle readmission rates were rising before implementation and falling afterwards (e.g. readmissions within 28 days +2.13% per annum (pa pre and -5.32% pa post (p for difference in trends = 0.012. Following implementation, readmission rates within 7 and 28 day were falling faster than among other trusts in London, although this was not statistically significant (e.g. readmissions within 28 days -4.6% pa vs. -3.2% pa, p = 0.44. Comparisons with a national control group were similar.The COPD discharge care bundle appeared to be associated with a reduction in readmission rate among hospitals using it. The significance of this is unclear because of changes to background trends in London and nationally.

Overseeing oversight: governance of quality and safety by hospital boards in the English NHS.

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Mannion, Russell; Davies, Huw; Freeman, Tim; Millar, Ross; Jacobs, Rowena; Kasteridis, Panos

2015-01-01

To contribute towards an understanding of hospital board composition and to explore board oversight of patient safety and health care quality in the English NHS. We reviewed the theory related to hospital board governance and undertook two national surveys about board management in NHS acute and specialist hospital trusts in England. The first survey was issued to 150 trusts in 2011/2012 and was completed online via a dedicated web tool. A total 145 replies were received (97% response rate). The second online survey was undertaken in 2012/2013 and targeted individual board members, using a previously validated standard instrument on board members' attitudes and competencies (the Board Self-Assessment Questionnaire). A total of 334 responses were received from 165 executive and 169 non-executive board members, providing at least one response from 95 of the 144 NHS trusts then in existence (66% response rate). Over 90% of the English NHS trust boards had 10-15 members. We found no significant difference in board size between trusts of different types (e.g. Foundation Trusts versus non-Foundation Trusts and Teaching Hospital Trusts versus non-Teaching Hospital Trusts). Clinical representation on boards was limited: around 62% had three or fewer members with clinical backgrounds. For about two-thirds of the trusts (63%), board members with a clinical background comprised less than 30% of the members. Boards were using a wide range and mix of quantitative performance metrics and soft intelligence (e.g. walk-arounds, patient stories) to monitor their organisations with regard to patient safety. The Board Self-Assessment Questionnaire data showed generally high or very high levels of agreement with desirable statements of practice in each of its six dimensions. Aggregate levels of agreement within each dimension ranged from 73% (for the dimension addressing interpersonal issues) to 85% (on the political). English NHS boards largely hold a wide range of attitudes and

Improving service quality in NHS Trust hospitals: lessons from the hotel sector.

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Desombre, T; Eccles, G

1998-01-01

This article looks to review recent practice undertaken within the UK hotel sector to improve customer service, and suggests ideals that could be implemented within National Health (NHS) Trust hospitals. At a time of increasing competition, hotel firms are using service enhancement as a means to gain competitive advantage, and therefore developing a range of techniques to measure levels of service quality improvement. With continued change in the health service, where greater focus now lies with patient satisfaction, so there is a requirement for managers to adapt techniques presently being offered in other service industries to improve levels of customer service and ensure patients are targeted to define their levels of satisfaction.

Continuous Improvement Implementation in the Nottingham University Hospitals NHS Trust: A Case Study of a Continuous Improvement Programme & Project

OpenAIRE

Velzen, Jeena

2012-01-01

This paper aims at identifying the extent to which the Nottingham University Hospitals NHS Trust has fulfilled literature requirements for successful continuous improvement as exemplified by its Better for You programme and chemotherapy service improvement project. Both the theory and ideals of the continuous improvement programme, along with the actualization of these philosophies and methodologies in the context of the particular project,were compared against a framework for the enabling...

Addressing Library Anxiety (LA) in student nurses: a study in an NHS Foundation Trust Hospital library and information service.

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Still, Madeleine

2015-12-01

Library anxiety is a concept which has been recognised in academic library circles since the early 1990s. It can result in students actively avoiding the library for the duration of their studies. Madeleine Still is Trust Librarian at North Tees & Hartlepool NHS Foundation Trust and while studying for an MSc, recognised that some student nurses were exhibiting signs of library anxiety. She decided to make it the focus of her MSc dissertation, and this article discusses her research project as well as highlighting the measures she has taken to address the issues she uncovered. Madeleine graduated in July 2013 with an MSc in Information & Library Studies from Robert Gordon University. © 2015 Health Libraries Group.

Benchmarking clinical photography services in the NHS.

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Arbon, Giles

2015-01-01

Benchmarking is used in services across the National Health Service (NHS) using various benchmarking programs. Clinical photography services do not have a program in place and services have to rely on ad hoc surveys of other services. A trial benchmarking exercise was undertaken with 13 services in NHS Trusts. This highlights valuable data and comparisons that can be used to benchmark and improve services throughout the profession.

Standards for gene therapy clinical trials based on pro-active risk assessment in a London NHS Teaching Hospital Trust.

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Bamford, K B; Wood, S; Shaw, R J

2005-02-01

Conducting gene therapy clinical trials with genetically modified organisms as the vectors presents unique safety and infection control issues. The area is governed by a range of legislation and guidelines, some unique to this field, as well as those pertinent to any area of clinical work. The relevant regulations covering gene therapy using genetically modified vectors are reviewed and illustrated with the approach taken by a large teaching hospital NHS Trust. Key elements were Trust-wide communication and involvement of staff in a pro-active approach to risk management, with specific emphasis on staff training and engagement, waste management, audit and record keeping. This process has led to the development of proposed standards for clinical trials involving genetically modified micro-organisms.

Grimstone v Epsom and St Helier University Hospitals NHS Trust: (It's Not) Hip To Be Square.

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Austin, Louise V

2017-11-24

In Montgomery v Lanarkshire Health Board [2015] UKSC 11 the Supreme Court redefined the standard of disclosure in informed consent to medical treatment, rejecting the application of the doctor-focused Bolam standard in favour of one focused on what was significant to patients. In Grimstone v Epsom and St Helier University Hospitals NHS Trust [2015] EWHC 3756 (QB), despite acknowledging a new standard now applied, McGowan J nevertheless used the Bolam test to determine liability for non-disclosure. This illustrates ongoing judicial deference to the medical profession and this case commentary explores that decision and its implications. © The Author 2017. Published by Oxford University Press.

Provider diversity in the English NHS: a study of recent developments in four local health economies.

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Allen, Pauline; Turner, Simon; Bartlett, Will; Perotin, Virginie; Matchaya, Greenwell; Zamora, Bernarda

2012-01-01

To assess the impact of provider diversity on quality and innovation in the English NHS by mapping the extent of diverse provider activity and identifying the differences in performance between Third Sector Organisations (TSOs), for-profit private enterprises, and incumbent organizations within the NHS, and the factors that affect the entry and growth of new providers. Case studies of four local health economies. Data included: semi-structured interviews with 48 managerial and clinical staff from NHS organizations and providers from the private and third sector; some documentary evidence; a focus group with service users; and routine data from the Care Quality Commission and Companies House. Data collection was mainly between November 2008 and November 2009. Involvement of diverse providers in the NHS is limited. Commissioners' local strategies influence degrees of diversity. Barriers to entry for TSOs include lack of economies of scale in the bidding process. Private providers have greater concern to improve patient pathways and patient experience, whereas TSOs deliver quality improvements by using a more holistic approach and a greater degree of community involvement. Entry of new providers drives NHS trusts to respond by making improvements. Information sharing diminishes as competition intensifies. There is scope to increase the participation of diverse providers in the NHS but care must be taken not to damage public accountability, overall productivity, equity and NHS providers (especially acute hospitals, which are likely to remain in the NHS) in the process.

Self-rostering can improve work-life balance and staff retention in the NHS.

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Barrett, Renee; Holme, Annie

2018-03-08

Renee Barrett, Staff Nurse, ITU, Great Ormond Street Hospital NHS Trust, renee.barrett@gosh.nhs.uk , and Annie Holme, Lecturer, King's College London, look at how e-rostering can benefit health organisations and staff.

Staff perceptions of quality of care: an observational study of the NHS Staff Survey in hospitals in England.

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Pinder, Richard J; Greaves, Felix E; Aylin, Paul P; Jarman, Brian; Bottle, Alex

2013-07-01

There is some evidence to suggest that higher job satisfaction among healthcare staff in specific settings may be linked to improved patient outcomes. This study aimed to assess the potential of staff satisfaction to be used as an indicator of institutional performance across all acute National Health Service (NHS) hospitals in England. Using staff responses from the NHS Staff Survey 2009, and correlating these with hospital standardised mortality ratios (HSMR), correlation analyses were conducted at institutional level with further analyses of staff subgroups. Over 60 000 respondents from 147 NHS trusts were included in the analysis. There was a weak negative correlation with HSMR where staff agreed that patient care was their trust's top priority (Kendall τ = -0.22, psatisfaction with the quality of care delivered by oneself and institutional HSMR. In the context of the continued debate about the relationship of HSMR to hospital performance, these findings of a weak correlation between staff satisfaction and HSMR are intriguing and warrant further investigation. Such measures in the future have the advantage of being intuitive for lay and specialist audiences alike, and may be useful in facilitating patient choice. Whether higher staff satisfaction drives quality or merely reflects it remains unclear.

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

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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

Designing and implementing a trust-wide quality assurance programme.

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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.

Improving clinical leadership and management in the NHS

Directory of Open Access Journals (Sweden)

Nicol ED

2012-08-01

Full Text Available Edward D Nicol1,21Department of Cardiology, Royal Brompton Hospital and Harefield NHS Trust, London, United Kingdom; 2Clinical Leadership Academy, School of Medicine, Keele University, Staffordshire, United KingdomAbstract: The National Health Service (NHS is one of the UKs most cherished but political public institutions, providing healthcare, free at the point of delivery. The English NHS must make £20bn efficiency savings in the next 3 years whilst in the midst of fundamental structural change outlined in the government's Health and Social Care Bill. This paper will explore the history of leadership and management in the NHS; the evolution of clinical leadership; national strategies to improve NHS clinical and managerial leadership and Lord Darzi's pivotal NHS review. It defines the kind of leadership and management required for today's NHS, looking to overcome some of the main challenges such as improving healthcare quality whilst making efficiency savings and engaging grass roots workers to deliver sustainable, long term improvements. Finally this manuscript makes suggestions as to where future investment is required to improve clinical leadership and management in the NHS.Keywords: clinical leadership, healthcare management, national health service

Investigating the efficacy of a whole team, psychologically informed, acute mental health service approach.

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Araci, David; Clarke, Isabel

2017-08-01

Service user demand and service changes, from hospital based, to community and hospital mix, within acute adult mental health services, focus the need for psychologically informed, holistic, approaches. (1) Describe and report feasibility of a psychologically led Intensive Support Programme (ISP) to meet this need. (2) Present results of a pilot evaluation of this programme. ISP was implemented in four acute mental health services of the Southern Health NHS Trust, available to both inpatient and outpatient acute services. Evaluation of the service one month after data collection, illustrates operation and level of uptake across different professional roles. The programme was evaluated by assessing psychological distress (CORE-10) and confidence in self-management (Mental Health Confidence Scale) of participating service users before and after intervention. The service evaluation demonstrated extensive roll out of this programme across acute services of an extensive NHS Trust. Repeated measure t-tests demonstrated significant decrease in distress (p mental health (p mental health service and results in improvement in self management skills and facilitation of recovery.

Barking, Havering and Redbridge University Hospitals NHS Trust Fellowships in Clinical Leadership Programme

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Miani, Celine; Marjanovic, Sonja; Jones, Molly Morgan; Marshall, Martin; Meikle, Samantha; Nolte, Ellen

2013-01-01

Abstract Leadership is seen to be central to improving the quality of healthcare and existing research suggests that absence of leadership is related to poor quality and safety performance. Leadership training might therefore provide an important means through which to promote quality improvement and, more widely, performance within the healthcare environment. This article presents an evaluation of the Fellowships in Clinical Leadership Programme, which combines leadership training and quality improvement initiatives with the placement of temporary external clinical champions in Barking, Havering and Redbridge University Hospitals NHS Trust. We assessed impacts of the Programme on individual and organisational change, alongside core enablers and barriers for Programme success. Analyses drew on the principles of a theory-of-change-led realist evaluation, using logic modelling to specify the underlying causal mechanisms of the Programme. Data collection involved a stakeholder workshop, online questionnaires of programme participants, senior managers and support staff (n=114), and follow-up in-depth semi-structured interviews with a subsample of survey participants (n=15). We observed that the Programme had notable impacts at individual and organisational levels. Examples of individual impact included enhanced communication and negotiation skills or increased confidence as a result of multi-modal leadership training. At the organisational level, participants reported indications of behaviour change among staff, with evidence of spill-over effects to non-participants towards a greater focus on patient-centred care. Our findings suggest that there is potential for combined leadership training and quality improvement programmes to contribute to strengthening a culture of care quality in healthcare organisations. Our study provides useful insights into strategies seeking to achieve sustainable improvement in NHS organisations. PMID:28083304

International patients within the NHS: a case of public sector entrepreneurialism.

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Lunt, Neil; Exworthy, Mark; Hanefeld, Johanna; Smith, Richard D

2015-01-01

Many public health systems in high- and middle-income countries are under increasing financial pressures as a result of ageing populations, a rise in chronic and non-communicable diseases and shrinking public resources. At the same time the rise in patient mobility and concomitant market in medical tourism provides opportunities for additional income. This is especially the case where public sector hospitals have a reputation as global centres of excellence. Yet, this requires public sector entrepreneurship which, given the unique features of the public sector, means a change to professional culture. This paper examines how and under what conditions public sector entrepreneurship develops, drawing on the example of international patients in the UK NHS. It reports on a subset of data from a wider study of UK medical tourism, and explores inward flows and NHS responses through the lens of public entrepreneurship. Interviews in the English NHS were conducted with managers of Foundation Trusts with interest in international patient work. Data is from seven Foundation Trusts, based on indepth, semi-structured interviews with a range of NHS managers, and three other key stakeholders (n = 16). Interviews were analysed using a framework on entrepreneurship developed from academic literature. Empirical findings showed that Trust managers were actively pursuing a strategy of expanding international patient activity. Respondents emphasised that this was in the context of the current financial climate for the NHS. International patients were seen as a possible route to ameliorating pressure on stretched NHS resources. The analysis of interviews revealed that public entrepreneurial behaviour requires an organisational managerial or political context in order to develop, such as currently in the UK. Public sector workers engaged in this process develop entrepreneurship - melding political, commercial and stakeholder insights - as a coping mechanism to health system constraints

An evaluation of a toolkit for the early detection, management, and control of carbapenemase-producing Enterobacteriaceae: a survey of acute hospital trusts in England.

Science.gov (United States)

Coope, C M; Verlander, N Q; Schneider, A; Hopkins, S; Welfare, W; Johnson, A P; Patel, B; Oliver, I

2018-03-09

Following hospital outbreaks of carbapenemase-producing Enterobacteriaceae (CPE), Public Health England published a toolkit in December 2013 to promote the early detection, management, and control of CPE colonization and infection in acute hospital settings. To examine awareness, uptake, implementation and usefulness of the CPE toolkit and identify potential barriers and facilitators to its adoption in order to inform future guidance. A cross-sectional survey of National Health Service (NHS) acute trusts was conducted in May 2016. Descriptive analysis and multivariable regression models were conducted, and narrative responses were analysed thematically and informed using behaviour change theory. Most (92%) acute trusts had a written CPE plan. Fewer (75%) reported consistent compliance with screening and isolation of CPE risk patients. Lower prioritization and weaker senior management support for CPE prevention were associated with poorer compliance. Awareness of the CPE toolkit was high and all trusts with patients infected or colonized with CPE had used the toolkit either as provided (32%), or to inform (65%) their own local CPE plan. Despite this, many respondents (80%) did not believe that the CPE toolkit guidance offered an effective means to prevent CPE or was practical to follow. CPE prevention and control requires robust IPC measures. Successful implementation can be hindered by a complex set of factors related to their practical execution, insufficient resources and a lack of confidence in the effectiveness of the guidance. Future CPE guidance would benefit from substantive user involvement, processes for ongoing feedback, and regular guidance updates. Copyright © 2018 The Healthcare Infection Society. All rights reserved.

Savings in its sights for Somerset Trust.

Science.gov (United States)

Russell, Colin

2011-10-01

Colin Russell, healthcare specialist at Schneider Electric (pictured), explains how the company has recently worked with Taunton and Somerset NHS Foundation Trust to implement a major energy-saving project at the Trust's Musgrove Park Hospital in Taunton. He argues that, at a time when all areas of the service are being asked to reduce costs, such partnerships can potentially save the institution millions of pounds and significantly reduce carbon emissions, while "revitalising" parts of the NHS estate, and ensuring continuity of vital hospital services for facilities managers.

A cross-sectional study of all clinicians' conflict of interest disclosures to NHS hospital employers in England 2015-2016.

Science.gov (United States)

Feldman, Harriet Ruth; DeVito, Nicholas J; Mendel, Jonathan; Carroll, David E; Goldacre, Ben

2018-03-05

We set out to document how NHS trusts in the UK record and share disclosures of conflict of interest by their employees. Cross-sectional study of responses to a Freedom of Information Act request for Gifts and Hospitality Registers. NHS Trusts (secondary/tertiary care organisations) in England. 236 Trusts were contacted, of which 217 responded. We assessed all disclosures for completeness and openness, scoring them for achieving each of five measures of transparency. 185 Trusts (78%) provided a register. 71 Trusts did not respond within the 28 day time limit required by the FoIA. Most COI registers were incomplete by design, and did not contain the information necessary to assess conflicts of interest. 126/185 (68%) did not record the names of recipients. 47/185 (25%) did not record the cash value of the gift or hospitality. Only 31/185 registers (16%) contained the names of recipients, the names of donors, and the cash amounts received. 18/185 (10%) contained none of: recipient name, donor name, and cash amount. Only 15 Trusts had their disclosure register publicly available online (6%). We generated a transparency index assessing whether each Trust met the following criteria: responded on time; provided a register; had a register with fields identifying donor, recipient, and cash amount; provided a register in a format that allowed further analysis; and had their register publicly available online. Mean attainment was 1.9/5; no NHS trust met all five criteria. Overall, recording of employees' conflicts of interest by NHS trusts is poor. None of the NHS Trusts in England met all transparency criteria. 19 did not respond to our FoIA requests, 51 did not provide a Gifts and Hospitality Register and only 31 of the registers provided contained enough information to assess employees' conflicts of interest. Despite obligations on healthcare professionals to disclose conflicts of interest, and on organisations to record these, the current system for logging and

Centralised 3D printing in the NHS: a radiological review.

Science.gov (United States)

Eley, K A

2017-04-01

In recent years, three-dimensional (3D) printing has seen an explosion of interest fuelled by improvements in technology and associated reduction in costs. The literature is replete with novel medical applications of custom anatomical models, prostheses, and surgical guides. Although the fundamental core of 3D printing lies in image manipulation, the driving force in many National Health Service (NHS) trusts has come from individual surgical specialties with 3D printers independently run and confined to respective departments. In this review of 3D printing, experience of establishing a new centralised 3D-printing service within an NHS hospital trust is reported, focusing on the requirements and challenges of such an endeavour. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Barking, Havering and Redbridge University Hospitals NHS Trust Fellowships in Clinical Leadership Programme: An Evaluation.

Science.gov (United States)

Miani, Celine; Marjanovic, Sonja; Jones, Molly Morgan; Marshall, Martin; Meikle, Samantha; Nolte, Ellen

2013-01-01

Leadership is seen to be central to improving the quality of healthcare and existing research suggests that absence of leadership is related to poor quality and safety performance. Leadership training might therefore provide an important means through which to promote quality improvement and, more widely, performance within the healthcare environment. This article presents an evaluation of the Fellowships in Clinical Leadership Programme, which combines leadership training and quality improvement initiatives with the placement of temporary external clinical champions in Barking, Havering and Redbridge University Hospitals NHS Trust. We assessed impacts of the Programme on individual and organisational change, alongside core enablers and barriers for Programme success. Analyses drew on the principles of a theory-of-change-led realist evaluation, using logic modelling to specify the underlying causal mechanisms of the Programme. Data collection involved a stakeholder workshop, online questionnaires of programme participants, senior managers and support staff (n=114), and follow-up in-depth semi-structured interviews with a subsample of survey participants (n=15). We observed that the Programme had notable impacts at individual and organisational levels. Examples of individual impact included enhanced communication and negotiation skills or increased confidence as a result of multi-modal leadership training. At the organisational level, participants reported indications of behaviour change among staff, with evidence of spill-over effects to non-participants towards a greater focus on patient-centred care. Our findings suggest that there is potential for combined leadership training and quality improvement programmes to contribute to strengthening a culture of care quality in healthcare organisations. Our study provides useful insights into strategies seeking to achieve sustainable improvement in NHS organisations.

Do expanded seven-day NHS services improve clinical outcomes? Analysis of comparative institutional performance from the ?NHS Services, Seven Days a Week? project 2013?2016

OpenAIRE

Gan, Hoong-Wei; Wong, Danny Jon Nian; Dean, Benjamin John Floyd; Hall, Alistair Scott

2017-01-01

Background The cause of adverse weekend clinical outcomes remains unknown. In 2013, the ?NHS Services, Seven Days a Week? project was initiated to improve access to services across the seven-day week. Three years on, we sought to analyse the impact of such changes across the English NHS. Methods Aggregated trust-level data on crude mortality rates, Summary Hospital-Level Mortality Indicator (SHMI), mean length of stay (LOS), A&E admission and four-hour breach rates were obtained from national...

Do expanded seven-day NHS services improve clinical outcomes? Analysis of comparative institutional performance from the "NHS Services, Seven Days a Week" project 2013-2016

OpenAIRE

Gan, H-W; Wong, D. J. N.; Dean, B. J. F.; Hall, A. S.

2017-01-01

Background: The cause of adverse weekend clinical outcomes remains unknown. In 2013, the “NHS Services, Seven Days a Week” project was initiated to improve access to services across the seven-day week. Three years on, we sought to analyse the impact of such changes across the English NHS. Methods: Aggregated trust-level data on crude mortality rates, Summary Hospital-Level Mortality Indicator (SHMI), mean length of stay (LOS), A&E admission and four-hour breach rates were obtained f...

An evaluation of Knowledge and Understanding Framework personality disorder awareness training: can a co-production model be effective in a local NHS mental health Trust?

Science.gov (United States)

Davies, Julie; Sampson, Mark; Beesley, Frank; Smith, Debra; Baldwin, Victoria

2014-05-01

5 Boroughs Partnership NHS Foundation Trust, in the Northwest of England, has trained over 500 staff in the Knowledge and Understanding Framework, level 1 personality disorder awareness training. This is a 3-day nationally devised training programme delivered via an innovative co-production model (i.e. co-delivery and partnership working with service users who have lived experience). This paper provides quantitative and qualitative information on the effectiveness of training delivery and also serves to provide some insight into the impact of service-user involvement via such a co-production model. Information on 162 participants using the Knowledge and Understanding Framework bespoke questionnaire (Personality Disorder Knowledge, Attitudes and Skills Questionnaire) suggests that the training can be effectively delivered by and within a local NHS Mental Health Trust. Results immediately post-training suggest an improvement in levels of understanding and capability efficacy and a reduction in negative emotional reactions. Indications from a 3-month follow-up suggest that while understanding and emotional reaction remain improved, capability efficacy regresses back to pre-training levels, suggesting the need for ongoing supervision and/or support to consolidate skills. Discussion includes guidelines for the implementation of a truly integrated co-production model of training provision, as well as advice relating to the maximization of long-term benefits. Copyright © 2014 John Wiley & Sons, Ltd.

The challenges in monitoring and preventing patient safety incidents for people with intellectual disabilities in NHS acute hospitals: evidence from a mixed-methods study.

Science.gov (United States)

Tuffrey-Wijne, Irene; Goulding, Lucy; Gordon, Vanessa; Abraham, Elisabeth; Giatras, Nikoletta; Edwards, Christine; Gillard, Steve; Hollins, Sheila

2014-09-24

There has been evidence in recent years that people with intellectual disabilities in acute hospitals are at risk of preventable deterioration due to failures of the healthcare services to implement the reasonable adjustments they need. The aim of this paper is to explore the challenges in monitoring and preventing patient safety incidents involving people with intellectual disabilities, to describe patient safety issues faced by patients with intellectual disabilities in NHS acute hospitals, and investigate underlying contributory factors. This was a 21-month mixed-method study involving interviews, questionnaires, observation and monitoring of incident reports to assess the implementation of recommendations designed to improve care provided for patients with intellectual disabilities and explore the factors that compromise or promote patient safety. Six acute NHS Trusts in England took part. Data collection included: questionnaires to clinical hospital staff (n = 990); questionnaires to carers (n = 88); interviews with: hospital staff including senior managers, nurses and doctors (n = 68) and carers (n = 37); observation of in-patients with intellectual disabilities (n = 8); monitoring of incident reports (n = 272) and complaints involving people with intellectual disabilities. Staff did not always readily identify patient safety issues or report them. Incident reports focused mostly around events causing immediate or potential physical harm, such as falls. Hospitals lacked effective systems for identifying patients with intellectual disabilities within their service, making monitoring safety incidents for this group difficult.The safety issues described by the participants were mostly related to delays and omissions of care, in particular: inadequate provision of basic nursing care, misdiagnosis, delayed investigations and treatment, and non-treatment decisions and Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders. The events leading to avoidable harm

Short message service (SMS) texting as a method of communication during on call: prevalence and experience of medical staff in a large acute NHS Trust in the UK.

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Matharu, J; Hale, B; Ammar, M; Brennan, P A

2016-10-01

With the widespread use of smartphones, text messaging has become an accepted form of communication for both social and professional use in medicine. To our knowledge no published studies have assessed the prevalence and use of short message service (SMS) texting by doctors on call. We have used an online questionnaire to seek information from doctors in a large NHS Trust in the UK about their use of texting while on call, what they use it for, and whether they send images relevant to patients' care. We received 302 responses (43% response rate), of whom 166 (55%) used SMS while on call. There was a significant association between SMS and age group (p=0.005), with the 20-30-year-old group using it much more than the other age groups. Doctors in the surgical specialties used it significantly less than those in other speciality groups (pcall was deemed to be safe and reliable (pcommunication to use when on call. Copyright © 2016 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Options for change in the NHS consultant contract.

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Clarke, R W; Gray, C

The lead negotiators for the management and consultant sides in an NHS trust in northern England responded to debate in their trust about consultant contracts by offering to research the attitudes of their peers towards a variety of contract options. The options tested included the current contract; models already examined in the trust and elsewhere, such as time sensitive and mild performance related contracts; and some more radical and speculative possibilities, including consultants franchising their services to the trust. Beyond the predictable conclusion that consultants would prefer no change while managers desired it, a time sensitive contract emerged as having potential for successful negotiation. On the other hand, neither consultants nor managers favoured a strict performance related contract or a fee for service contract. There was a strong similarity of opinion between the two groups on the relative salary values of the options, though the consultants consistently priced these higher than the managers.

Management of Older Inpatients Who Refuse Nonpsychiatric Medication Within Birmingham and Solihull Mental Health NHS Foundation Trust: Audit.

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Umotong, Eno

2016-12-01

The effects of poor medication compliance are well documented and include increased morbidity, early mortality, and financial costs to the society. According to national guidelines, when a competent patient refuses medication, the doctor on duty has a responsibility to ensure the patient understands their proposed course of action. The aims of this audit were to evaluate whether this consultation was taking place within older in-patient units across Birmingham and Solihull Mental Health NHS Foundation Trust when patients refuse nonpsychiatric medicines. Poor compliance was defined as more than five refusals of a nonpsychiatric medication over a 4-week period. A discussion with the duty doctor occurred in 75% of cases (27/36), which resulted in a change in prescription or compliance in 59% (16/27 patients). After patient refusal of medication, a consultation with the duty doctor is likely to improve compliance and uncover salient issues particularly in regards to capacity and drug suitability.

Measuring and modelling occupancy time in NHS continuing healthcare

Directory of Open Access Journals (Sweden)

Millard Peter H

2011-06-01

Full Text Available Abstract Background Due to increasing demand and financial constraints, NHS continuing healthcare systems seek to find better ways of forecasting demand and budgeting for care. This paper investigates two areas of concern, namely, how long existing patients stay in service and the number of patients that are likely to be still in care after a period of time. Methods An anonymised dataset containing information for all funded admissions to placement and home care in the NHS continuing healthcare system was provided by 26 (out of 31 London primary care trusts. The data related to 11289 patients staying in placement and home care between 1 April 2005 and 31 May 2008 were first analysed. Using a methodology based on length of stay (LoS modelling, we captured the distribution of LoS of patients to estimate the probability of a patient staying in care over a period of time. Using the estimated probabilities we forecasted the number of patients that are likely to be still in care after a period of time (e.g. monthly. Results We noticed that within the NHS continuing healthcare system there are three main categories of patients. Some patients are discharged after a short stay (few days, some others staying for few months and the third category of patients staying for a long period of time (years. Some variations in proportions of discharge and transition between types of care as well as between care groups (e.g. palliative, functional mental health were observed. A close agreement of the observed and the expected numbers of patients suggests a good prediction model. Conclusions The model was tested for care groups within the NHS continuing healthcare system in London to support Primary Care Trusts in budget planning and improve their responsiveness to meet the increasing demand under limited availability of resources. Its applicability can be extended to other types of care, such as hospital care and re-ablement. Further work will be geared towards

Medical Tourism: A Cost or Benefit to the NHS?

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Hanefeld, Johanna; Horsfall, Daniel; Lunt, Neil; Smith, Richard

2013-01-01

‘Medical Tourism’ – the phenomenon of people travelling abroad to access medical treatment - has received increasing attention in academic and popular media. This paper reports findings from a study examining effect of inbound and outbound medical tourism on the UK NHS, by estimating volume of medical tourism and associated costs and benefits. A mixed methods study it includes analysis of the UK International Passenger Survey (IPS); interviews with 77 returning UK medical tourists, 63 policymakers, NHS managers and medical tourism industry actors policymakers, and a review of published literature. These informed costing of three types of treatments for which patients commonly travel abroad: fertility treatment, cosmetic and bariatric surgery. Costing of inbound tourism relied on data obtained through 28 Freedom-of-Information requests to NHS Foundation Trusts. Findings demonstrate that contrary to some popular media reports, far from being a net importer of patients, the UK is now a clear net exporter of medical travellers. In 2010, an estimated 63,000 UK residents travelled for treatment, while around 52,000 patients sought treatment in the UK. Inbound medical tourists treated as private patients within NHS facilities may be especially profitable when compared to UK private patients, yielding close to a quarter of revenue from only 7% of volume in the data examined. Costs arise where patients travel abroad and return with complications. Analysis also indicates possible savings especially in future health care and social costs averted. These are likely to be specific to procedures and conditions treated. UK medical tourism is a growing phenomenon that presents risks and opportunities to the NHS. To fully understand its implications and guide policy on issues such as NHS global activities and patient safety will require investment in further research and monitoring. Results point to likely impact of medical tourism in other universal public health systems

Medical tourism: a cost or benefit to the NHS?

Directory of Open Access Journals (Sweden)

Johanna Hanefeld

Full Text Available 'Medical Tourism' - the phenomenon of people travelling abroad to access medical treatment - has received increasing attention in academic and popular media. This paper reports findings from a study examining effect of inbound and outbound medical tourism on the UK NHS, by estimating volume of medical tourism and associated costs and benefits. A mixed methods study it includes analysis of the UK International Passenger Survey (IPS; interviews with 77 returning UK medical tourists, 63 policymakers, NHS managers and medical tourism industry actors policymakers, and a review of published literature. These informed costing of three types of treatments for which patients commonly travel abroad: fertility treatment, cosmetic and bariatric surgery. Costing of inbound tourism relied on data obtained through 28 Freedom-of-Information requests to NHS Foundation Trusts. Findings demonstrate that contrary to some popular media reports, far from being a net importer of patients, the UK is now a clear net exporter of medical travellers. In 2010, an estimated 63,000 UK residents travelled for treatment, while around 52,000 patients sought treatment in the UK. Inbound medical tourists treated as private patients within NHS facilities may be especially profitable when compared to UK private patients, yielding close to a quarter of revenue from only 7% of volume in the data examined. Costs arise where patients travel abroad and return with complications. Analysis also indicates possible savings especially in future health care and social costs averted. These are likely to be specific to procedures and conditions treated. UK medical tourism is a growing phenomenon that presents risks and opportunities to the NHS. To fully understand its implications and guide policy on issues such as NHS global activities and patient safety will require investment in further research and monitoring. Results point to likely impact of medical tourism in other universal public health

Medical tourism: a cost or benefit to the NHS?

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Hanefeld, Johanna; Horsfall, Daniel; Lunt, Neil; Smith, Richard

2013-01-01

'Medical Tourism' - the phenomenon of people travelling abroad to access medical treatment - has received increasing attention in academic and popular media. This paper reports findings from a study examining effect of inbound and outbound medical tourism on the UK NHS, by estimating volume of medical tourism and associated costs and benefits. A mixed methods study it includes analysis of the UK International Passenger Survey (IPS); interviews with 77 returning UK medical tourists, 63 policymakers, NHS managers and medical tourism industry actors policymakers, and a review of published literature. These informed costing of three types of treatments for which patients commonly travel abroad: fertility treatment, cosmetic and bariatric surgery. Costing of inbound tourism relied on data obtained through 28 Freedom-of-Information requests to NHS Foundation Trusts. Findings demonstrate that contrary to some popular media reports, far from being a net importer of patients, the UK is now a clear net exporter of medical travellers. In 2010, an estimated 63,000 UK residents travelled for treatment, while around 52,000 patients sought treatment in the UK. Inbound medical tourists treated as private patients within NHS facilities may be especially profitable when compared to UK private patients, yielding close to a quarter of revenue from only 7% of volume in the data examined. Costs arise where patients travel abroad and return with complications. Analysis also indicates possible savings especially in future health care and social costs averted. These are likely to be specific to procedures and conditions treated. UK medical tourism is a growing phenomenon that presents risks and opportunities to the NHS. To fully understand its implications and guide policy on issues such as NHS global activities and patient safety will require investment in further research and monitoring. Results point to likely impact of medical tourism in other universal public health systems.

Healthcare scandals in the NHS: crime and punishment.

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Alghrani, Amel; Brazier, Margaret; Farrell, Anne-Maree; Griffiths, Danielle; Allen, Neil

2011-04-01

The Francis Report into failures of care at Mid Staffordshire NHS Foundation Trust Hospital documented a series of 'shocking' systematic failings in healthcare that left patients routinely neglected, humiliated and in pain as the Trust focused on cutting costs and hitting government targets. At present, the criminal law in England plays a limited role in calling healthcare professionals to account for failures in care. Normally, only if a gross error leads to death will a doctor or nurse face the prospect of prosecution. Doctors and nurses caring for patients under the Mental Health Act 1983 and the Mental Capacity Act 2005 may however be prosecuted for wilful neglect of a patient. In the light of the Francis Report, this article considers whether the criminal offence of wilful neglect should be extended to a broader healthcare setting and not confined to mental healthcare.

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

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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.

Hypnobirth within the NHS: time to ditch the parent craft?

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Gavin-Jones, Teri

2016-05-01

Antenatal education within the National Health Service (NHS) is a service in decline within some hospital trusts. Classes on offer are being moved into online formats or discontinued completely. Whilst research into antenatal education remains limited, what is known is that good birth preparation is of value. "Participative preparation for childbirth can enhance women's overall satisfaction with the childbirth experience" (Schrader McMillan et al 2009: 49). There are pockets of excellent antenatal education within the NHS, but no system for regulating the quality and content. Traditional 'parent craft' classes can be oversubscribed, turning what should be a participative group into an audience. Offering good quality antenatal education has the potential to increase normality, improve the birth outcome and the experience of both woman and her birth partner. Is it time to ditch the parent craft and implement dynamic woman-focused education?

Determination of risk identification process employed by NHS for a PFI hospital project in the UK

Directory of Open Access Journals (Sweden)

F. E. Mohamed Ghazali

2009-12-01

Full Text Available Long-term concession contracts associated with Private Finance Initiative (PFI projects, such as National Health Service (NHS hospitals, are subject to substantial risks, which may not only emerge from project activities such as design and construction, but also from global issues beyond the control of project parties, such as commercial, legal and political risks. Therefore, the principal parties involved must manage risks effectively and efficiently, as early as the project initiation stage, in order to ensure a successful delivery. The aim of this paper is to examine the risk identification process of the NHS PFI hospital in the UK, as a case study, in order to determine the techniques used in risk identification, and their significance, based on estimated probabilities of occurrence. These objectives were achieved through interviews with key personnel within the NHS Trust involved. Results found the sole technique used in risk identification to be brainstorming, through which more than thirty risks were identified and classified under six risk categories: planning, pre-commissioning, design, land purchasing, construction and operation. Thirteen risks were identified as significant based on their estimated probability of occurrence had the project been developed via public procurement. The results of this research will enable public sector clients like the NHS Trust to not only identify the significant risks, which will allow them to focus more attention on developing appropriate mitigation strategies and contingency plans, but also to improve its risk identification process through the use of other techniques in order to support findings from the brainstorming process.

Trust, choice and power in mental health care: experiences of patients with psychosis.

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Laugharne, Richard; Priebe, Stefan; McCabe, Rose; Garland, Natasha; Clifford, Damian

2012-09-01

Trust, choice and power are critical issues in clinical practice, public policies and a post-modern understanding of mental health care. We aimed to investigate the experiences and attitudes of patients with psychosis in relation to trust, choice and power. We conducted 20 in-depth interviews with patients with psychotic disorders in care of NHS services. The interviews were subjected to thematic analysis. Patients discussed aspects of their care in terms of dimensions that enhance or undermine trust, choice and power. Two interpretive themes emerged from this data. First, patients perceive the need for a shifting balance of power, according to the severity of their illness and their own experience of care, but feel that threats of coercion and neglect disable them. Second, they appreciate the expertise of clinicians, but particularly value 'the personal touch' that goes beyond this expertise, including personal disclosure about their own lives, common acts of kindness and conversation outside clinical matters. Patients view trust as a two-way process with responsibility shared between patient and clinician. The active involvement of patients with psychosis in their individual care may be strengthened, particularly when they are not acutely ill and have more experience of their illness. While patients value expertise and respect in interactions with clinicians, they also appreciate a 'personal touch', which may go beyond current notions of professionalism.

The UK National Health Service's 'innovation agenda': lessons on commercialisation and trust.

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Sterckx, Sigrid; Cockbain, Julian

2014-01-01

The UK National Health Service (the 'NHS'), encouraged by the 2011 report Innovation Health and Wealth, Accelerating Adoption and Diffusion in the NHS, and empowered by the Health and Social Care Act 2012, is in the process of adopting a new agenda for stimulating innovation in healthcare. For this, the bodies, body materials, and confidential health information of NHS patients may be co-opted. We explain why this brings the NHS into a moral conflict with its basic goal of providing a universal healthcare service. Putting NHS databases at the disposal of industry, without addressing ethical concerns regarding the privacy, autonomy, and moral integrity of patients and without requiring a 'kick-back' to enhance the service that the NHS provides, is inappropriate. As this article shows, with reference to the commercial arena of direct-to-consumer genetic testing, it is crucial that patient and public trust in the NHS is not eroded. © The Author 2014. Published by Oxford University Press; all rights reserved. For Permissions, please email: journals.permissions@oup.com.

An investigation into the move towards electronic journals: a case study of NHS libraries in Kent, Surrey and Sussex.

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England, Rebecca

2013-09-01

Electronic journals are so embedded into practice in academic libraries that it is easy to forget that this is not the case everywhere. In NHS libraries, for example, the staff face a particular set of issues. This article is based on Rebecca England's dissertation on this topic, completed as part of the MSc Econ course in Information and Library studies at Aberystwyth University. Rebecca is E-resources Librarian at the Maidstone and Tunbridge Wells NHS Trust. She investigated the momentum towards electronic journals in NHS libraries in the Kent, Surrey and Sussex region and the potential for a regional purchasing consortium. © 2013 The author. Health Information and Libraries Journal © 2013 Health Libraries Group.

Supplying commercial biomedical companies from a human tissue bank in an NHS hospital--a view from personal experience.

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Gray, N; Womack, C; Jack, S J

1999-04-01

NHS histopathology laboratories are well placed to develop banks of surgically removed surplus human tissues to meet the increasing demands of commercial biomedical companies. The ultimate aim could be national network of non-profit making NHS tissue banks conforming to national minimum ethical, legal, and quality standards which could be monitored by local research ethics committees. The Nuffield report on bioethics provides ethical and legal guidance but we believe that the patient should be fully informed and the consent given explicit. Setting up a tissue bank requires enthusiasm, hard work, and determination as well as coordination between professionals in the NHS trust and in the commercial sector. The rewards are exiting new collaborations with commercial biomedical companies which could help secure our future.

NHS-A isoform of the NHS gene is a novel interactor of ZO-1.

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Sharma, Shiwani; Koh, Katrina S Y; Collin, Caitlin; Dave, Alpana; McMellon, Amy; Sugiyama, Yuki; McAvoy, John W; Voss, Anne K; Gécz, Jozef; Craig, Jamie E

2009-08-15

Mutations in the NHS (Nance-Horan Syndrome) gene lead to severe congenital cataracts, dental defects and sometimes mental retardation. NHS encodes two protein isoforms, NHS-A and -1A that display cell-type dependent differential expression and localization. Here we demonstrate that of these two isoforms, the NHS-A isoform associates with the cell membrane in the presence of intercellular contacts and it immunoprecipitates with the tight junction protein ZO-1 in MDCK (Madin Darby Canine Kidney) epithelial cells and in neonatal rat lens. The NHS-1A isoform however is a cytoplasmic protein. Both Nhs isoforms are expressed during mouse development. Immunolabelling of developing mouse with the anti-NHS antibody that detects both isoforms revealed the protein in the developing head including the eye and brain. It was primarily expressed in epithelium including neural epithelium and certain vascular endothelium but only weakly expressed in mesenchymal cells. In the epithelium and vascular endothelium the protein associated with the cell membrane and co-localized with ZO-1, which indirectly indicates expression of the Nhs-A isoform in these structures. Membrane localization of the protein in the lens vesicle similarly supports Nhs-A expression. In conclusion, the NHS-A isoform of NHS is a novel interactor of ZO-1 and may have a role at tight junctions. This isoform is important in mammalian development especially of the organs in the head.

How do NHS general hospitals in England deal with patients with alcohol-related problems? A questionnaire survey.

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Owens, Lynn; Gilmore, Ian T; Pirmohamed, Munir

2005-01-01

Alcohol-related disease represents a major burden on hospitals. However, it is unclear whether hospitals have developed the necessary expertise and guidelines to deal with this burden. The aim of this survey was to determine what measures general hospital NHS Trusts in England had in place to deal with alcohol-related problems, including the employment of dedicated alcohol specialist nurses. Two postal surveys of all NHS general hospital Trusts in England, the first in 2000 (n = 138; 54% response rate) and the second in 2003 after the publication of the Royal College of Physicians (RCP) report on alcohol in secondary care (n = 164; 75% response rate). Between the two surveys, there was a significant increase (P = 0.005) in the number of dedicated alcohol nurses employed by general hospital trusts; however, the numbers remain low (n = 21). Additionally, the availability of prescribing guidelines for the management of alcohol withdrawal increased significantly (P = 0.0001). The survey indicates that most general hospitals do not have appropriate services in place to deal with such patients. Although there is a need and willingness to develop alcohol services in general hospitals, which is one of the key recommendations of the RCP report, the lack of funding is going to act as a major barrier.

Part-time work and job sharing in health care: is the NHS a family-friendly employer?

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Branine, Mohamed

2003-01-01

This paper examines the nature and level of flexible employment in the National Health Service (NHS) by investigating the extent to which part-time work and job sharing arrangements are used in the provision and delivery of health care. It attempts to analyse the reasons for an increasing number of part-timers and a very limited number of job sharers in the NHS and to explain the advantages and disadvantages of each pattern of employment. Data collected through the use of questionnaires and interviews from 55 NHS trusts reveal that the use of part-time work is a tradition that seems to fit well with the cost-saving measures imposed on the management of the service but at the same time it has led to increasing employee dissatisfaction, and that job sharing arrangements are suitable for many NHS employees since the majority of them are women with a desire to combine family commitments with career prospects but a very limited number of employees have had the opportunity to job share. Therefore it is concluded that to attract and retain the quality of staff needed to ensure high performance standards in the provision and delivery of health care the NHS should accept the diversity that exists within its workforce and take a more proactive approach to promoting a variety of flexible working practices and family-friendly policies.

Tackling Work Related Stress in a National Health Service Trust

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Vick, Donna; Whyatt, Hilary

2004-01-01

The challenge of tackling the problem of coping with work related stress in a National Health Service (NHS) Trust was undertaken. Ideas were developed within the context of two different action learning sets and led to actions resulting in a large therapy Taster Session event and the establishment of a centre offering alternative therapies and…

RCR audit of compliance with UK guidelines for the prevention and detection of acute kidney injury in adult patients undergoing iodinated contrast media injections for CT.

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Cope, L H; Drinkwater, K J; Howlett, D C

2017-12-01

To determine radiology departmental compliance with current UK guidance on contrast-induced acute kidney injury (CI-AKI) and to provide data on the incidence of clinically significant post-contrast AKI (PC-AKI) in computed tomography (CT) practice. A questionnaire was sent to all UK acute National Health Service (NHS) providers (NHS boards in Scotland, local health boards in Wales, NHS trusts in England and health and social care trusts in Northern Ireland) to assess compliance of provider protocols with current UK guidelines for the prevention, recognition, and management of CI-AKI. Audit data were collected for 40 consecutive fit outpatients and 40 consecutive acutely unwell patients/inpatients from hospitals within each participating provider to assess clinical compliance. Eighty-nine of 172 (52%) health service providers responded, and data on 7,159 contrast-enhanced CT examinations were provided. Compliance with guidelines was poor with wide variation in clinical practice. The observed incidence of clinically significant (requiring treatment or resulting in death) PC-AKI was zero in 3,590 outpatients, although two patients developed AKI due to other causes (sepsis and progressive malignancy). Fourteen out of 3,569 (0.4%) patients in the inpatient group developed clinically significant PC-AKI, and a further 17 patients were identified who met the Kidney Disease Improving Global Outcomes (KDIGO) definition of AKI (Electronic Supplementary Material Appendix S1), but did not require active treatment, giving an overall incidence of AKI of 0.9%. In patients at high risk due to impaired renal function prior to the scan, there was no difference in the median serum creatinine (SCr) before and after contrast medium administration in either group. Health service provider protocols and clinical practice demonstrate poor compliance with current UK guidance on CI-AKI. A very low incidence of PC- AKI was demonstrated. Copyright © 2017 The Royal College of Radiologists

Developing an explicit strategy towards social responsibility in the NHS: a case for including NHS managers in this strategy.

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Merali, Faruk

2006-01-01

To explore the concept of corporate social responsibility (CSR) within the UK National Health Service (NHS) and to examine how it may be developed to positively influence the psyche, behaviour and performance of NHS managers. Primary research based upon semi-structured individual face to face interviews with 20 NHS managers. Theoretical frameworks and concepts relating to organisational culture and CSR are drawn upon to discuss the findings. The NHS managers see themselves as being driven by altruistic core values. However, they feel that the public does not believe that they share the altruistic NHS value system. The study is based on a relatively small sample of NHS managers working exclusively in London and may not necessarily represent the views of managers either London-wide or nation-wide. It is suggested that an explicit recognition by the NHS of the socially responsible commitment of its managers within its CSR strategy would help challenge the existing negative public image of NHS managers and in turn improve the managers' self esteem and morale. This paper addresses the relative lacunae in research relating to public sector organisations (such as the NHS) explicitly including the role and commitment of its staff within the way it publicises its CSR strategy. This paper would be of interest to a wide readership including public sector and NHS policy formulators, NHS practitioners, academics and students.

Rolling out Productive Ward foundation modules across a hospital trust.

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Foster, Sam; Gordon, Pete; McSherry, Wilfred

The Shrewsbury and Telford Hospitals NHS Trust has spent the last 12 months rolling out the Productive Ward foundation modules across the whole organisation. This has resulted in measurable increases in time spent on direct care, and reduced infection rates and ward non-pay (non-staffing) expenditure. This article discusses the initiative and looks at how problems with the hospital supply chain are being addressed.

Mediating Trust in Terrorism Coverage

DEFF Research Database (Denmark)

Mogensen, Kirsten

crisis. While the framework is presented in the context of television coverage of a terror-related crisis situation, it can equally be used in connection with all other forms of mediated trust. Key words: National crisis, risk communication, crisis management, television coverage, mediated trust.......Mass mediated risk communication can contribute to perceptions of threats and fear of “others” and/or to perceptions of trust in fellow citizens and society to overcome problems. This paper outlines a cross-disciplinary holistic framework for research in mediated trust building during an acute...

East Lancashire Hospital Trust creates an open culture paving the way for service improvement 'Below ten thousand'.

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Tomlinson, Robert

2018-05-01

Reacting to a never event is difficult and often embarrassing for staff involved. East Lancashire Hospitals NHS Trust has demonstrated that treating staff with respect after a never event, creates an open culture that encourages problem solving and service improvement. The approach has allowed learning to be shared and paved the way for the trust to be the first in the UK to launch the patient centric behavioural noise reduction strategy 'Below ten thousand'.

The South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLAM BRC case register: development and descriptive data

Directory of Open Access Journals (Sweden)

Denis Mike

2009-08-01

Full Text Available Abstract Background Case registers have been used extensively in mental health research. Recent developments in electronic medical records, and in computer software to search and analyse these in anonymised format, have the potential to revolutionise this research tool. Methods We describe the development of the South London and Maudsley NHS Foundation Trust (SLAM Biomedical Research Centre (BRC Case Register Interactive Search tool (CRIS which allows research-accessible datasets to be derived from SLAM, the largest provider of secondary mental healthcare in Europe. All clinical data, including free text, are available for analysis in the form of anonymised datasets. Development involved both the building of the system and setting in place the necessary security (with both functional and procedural elements. Results Descriptive data are presented for the Register database as of October 2008. The database at that point included 122,440 cases, 35,396 of whom were receiving active case management under the Care Programme Approach. In terms of gender and ethnicity, the database was reasonably representative of the source population. The most common assigned primary diagnoses were within the ICD mood disorders (n = 12,756 category followed by schizophrenia and related disorders (8158, substance misuse (7749, neuroses (7105 and organic disorders (6414. Conclusion The SLAM BRC Case Register represents a 'new generation' of this research design, built on a long-running system of fully electronic clinical records and allowing in-depth secondary analysis of both numerical, string and free text data, whilst preserving anonymity through technical and procedural safeguards.

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

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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.

Capacity of English NHS hospitals to monitor quality in infection prevention and control using a new European framework: a multilevel qualitative analysis

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Iwami, Michiyo; Ahmad, Raheelah; Castro-Sánchez, Enrique; Birgand, Gabriel; Johnson, Alan P; Holmes, Alison

2017-01-01

Objective (1) To assess the extent to which current English national regulations/policies/guidelines and local hospital practices align with indicators suggested by a European review of effective strategies for infection prevention and control (IPC); (2) to examine the capacity of local hospitals to report on the indicators and current use of data to inform IPC management and practice. Design A national and local-level analysis of the 27 indicators was conducted. At the national level, documentary review of regulations/policies/guidelines was conducted. At the local level data collection comprised: (a) review of documentary sources from 14 hospitals, to determine the capacity to report performance against these indicators; (b) qualitative interviews with 3 senior managers from 5 hospitals and direct observation of hospital wards to find out if these indicators are used to improve IPC management and practice. Setting 2 acute English National Health Service (NHS) trusts and 1 NHS foundation trust (14 hospitals). Participants 3 senior managers from 5 hospitals for qualitative interviews. Primary and secondary outcome measures As primary outcome measures, a ‘Red-Amber-Green’ (RAG) rating was developed reflecting how well the indicators were included in national documents or their availability at the local organisational level. The current use of the indicators to inform IPC management and practice was also assessed. The main secondary outcome measure is any inconsistency between national and local RAG rating results. Results National regulations/policies/guidelines largely cover the suggested European indicators. The ability of individual hospitals to report some of the indicators at ward level varies across staff groups, which may mask required improvements. A reactive use of staffing-related indicators was observed rather than the suggested prospective strategic approach for IPC management. Conclusions For effective patient safety and infection prevention in

Capacity of English NHS hospitals to monitor quality in infection prevention and control using a new European framework: a multilevel qualitative analysis.

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Iwami, Michiyo; Ahmad, Raheelah; Castro-Sánchez, Enrique; Birgand, Gabriel; Johnson, Alan P; Holmes, Alison

2017-01-23

(1) To assess the extent to which current English national regulations/policies/guidelines and local hospital practices align with indicators suggested by a European review of effective strategies for infection prevention and control (IPC); (2) to examine the capacity of local hospitals to report on the indicators and current use of data to inform IPC management and practice. A national and local-level analysis of the 27 indicators was conducted. At the national level, documentary review of regulations/policies/guidelines was conducted. At the local level data collection comprised: (a) review of documentary sources from 14 hospitals, to determine the capacity to report performance against these indicators; (b) qualitative interviews with 3 senior managers from 5 hospitals and direct observation of hospital wards to find out if these indicators are used to improve IPC management and practice. 2 acute English National Health Service (NHS) trusts and 1 NHS foundation trust (14 hospitals). 3 senior managers from 5 hospitals for qualitative interviews. As primary outcome measures, a 'Red-Amber-Green' (RAG) rating was developed reflecting how well the indicators were included in national documents or their availability at the local organisational level. The current use of the indicators to inform IPC management and practice was also assessed. The main secondary outcome measure is any inconsistency between national and local RAG rating results. National regulations/policies/guidelines largely cover the suggested European indicators. The ability of individual hospitals to report some of the indicators at ward level varies across staff groups, which may mask required improvements. A reactive use of staffing-related indicators was observed rather than the suggested prospective strategic approach for IPC management. For effective patient safety and infection prevention in English hospitals, routine and proactive approaches need to be developed. Our approach to evaluation can

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.

Redefining NHS complaint handling--the real challenge.

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Seelos, L; Adamson, C

1994-01-01

More and more organizations find that a constructive and open dialogue with their customers can be an effective strategy for building long-term customer relations. In this context, it has been recognized that effective complaint-contact handling can make a significant contribution to organizations' attempts to maximize customer satisfaction and loyalty. Within the NHS, an intellectual awareness exists that effective complaint/contact handling can contribute to making services more efficient and cost-effective by developing customer-oriented improvement initiatives. Recent efforts have focused on redefining NHS complaint-handling procedures to make them more user-friendly and effective for both NHS employees and customers. Discusses the challenges associated with opening up the NHS to customer feedback. Highlights potential weaknesses in the current approach and argues that the real challenge is for NHS managers to facilitate a culture change that moves the NHS away from a long-established defensive complaint handling practice.

Transdiagnostic Risk Calculator for the Automatic Detection of Individuals at Risk and the Prediction of Psychosis: Second Replication in an Independent National Health Service Trust.

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Fusar-Poli, Paolo; Werbeloff, Nomi; Rutigliano, Grazia; Oliver, Dominic; Davies, Cathy; Stahl, Daniel; McGuire, Philip; Osborn, David

2018-06-12

The benefits of indicated primary prevention among individuals at Clinical High Risk for Psychosis (CHR-P) are limited by the difficulty in detecting these individuals. To overcome this problem, a transdiagnostic, clinically based, individualized risk calculator has recently been developed and subjected to a first external validation in 2 different catchment areas of the South London and Maudsley (SLaM) NHS Trust. Second external validation of real world, real-time electronic clinical register-based cohort study. All individuals who received a first ICD-10 index diagnosis of nonorganic and nonpsychotic mental disorder within the Camden and Islington (C&I) NHS Trust between 2009 and 2016 were included. The model previously validated included age, gender, ethnicity, age by gender, and ICD-10 index diagnosis to predict the development of any ICD-10 nonorganic psychosis. The model's performance was measured using Harrell's C-index. This study included a total of 13702 patients with an average age of 40 (range 16-99), 52% were female, and most were of white ethnicity (64%). There were no CHR-P or child/adolescent services in the C&I Trust. The C&I and SLaM Trust samples also differed significantly in terms of age, gender, ethnicity, and distribution of index diagnosis. Despite these significant differences, the original model retained an acceptable predictive performance (Harrell's C of 0.73), which is comparable to that of CHR-P tools currently recommended for clinical use. This risk calculator may pragmatically support an improved transdiagnostic detection of at-risk individuals and psychosis prediction even in NHS Trusts in the United Kingdom where CHR-P services are not provided.

Lung protective mechanical ventilation strategies in cardiothoracic critical care: a retrospective study

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Zochios V

2016-11-01

Full Text Available Vasileios Zochios,1–3 Matthew Hague,3,4 Kimberly Giraud,5 Nicola Jones3 1Department of Intensive Care Medicine, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, 2Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, 3Department of Anesthesia and Intensive Care Medicine, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, 4Department of Medicine, Colchester Hospital University NHS Foundation Trust, Colchester General Hospital, Colchester, 5Research and Development Department, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK Abstract: A body of evidence supports the use of low tidal volumes in ventilated patients without lung pathology to slow progress to acute respiratory distress syndrome (ARDS due to ventilator associated lung injury. We undertook a retrospective chart review and tested the hypothesis that tidal volume is a predictor of mortality in cardiothoracic (medical and surgical critical care patients receiving invasive mechanical ventilation. Independent predictors of mortality in our study included: type of surgery, albumin, H+, bilirubin, and fluid balance. In particular, it is important to note that cardiac, thoracic, and transplant surgical patients were associated with lower mortality. However, our study did not sample equally from The Berlin Definition of ARDS severity categories (mild, moderate, and severe hypoxemia. Although our study was not adequately powered to detect a difference in mortality between these groups, it will inform the development of a large prospective cohort study exploring the role of low tidal volume ventilation in cardiothoracic critically ill patients. Keywords: lung protective ventilation, cardiothoracic critical care, acute respiratory distress syndrome, invasive mechanical ventilation

Dynamic consent: a possible solution to improve patient confidence and trust in how electronic patient records are used in medical research.

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Williams, Hawys; Spencer, Karen; Sanders, Caroline; Lund, David; Whitley, Edgar A; Kaye, Jane; Dixon, William G

2015-01-13

With one million people treated every 36 hours, routinely collected UK National Health Service (NHS) health data has huge potential for medical research. Advances in data acquisition from electronic patient records (EPRs) means such data are increasingly digital and can be anonymised for research purposes. NHS England's care.data initiative recently sought to increase the amount and availability of such data. However, controversy and uncertainty following the care.data public awareness campaign led to a delay in rollout, indicating that the success of EPR data for medical research may be threatened by a loss of patient and public trust. The sharing of sensitive health care data can only be done through maintaining such trust in a constantly evolving ethicolegal and political landscape. We propose that a dynamic consent model, whereby patients can electronically control consent through time and receive information about the uses of their data, provides a transparent, flexible, and user-friendly means to maintain public trust. This could leverage the huge potential of the EPR for medical research and, ultimately, patient and societal benefit.

Partnership approach can pay dividends.

Science.gov (United States)

2013-08-01

While healthcare estates and facilities teams NHS-wide are acutely aware of the need to reduce their facilities' carbon footprint, obtaining the necessary funding to undertake the substantial improvements to buildings, plant, and equipment, that may, in many cases, be essential to achieving this goal, will remain a challenge for many Trusts for some time to come. Nevertheless, the Government has underlined its intention to support the NHS's carbon reduction efforts, having in late January announced a 50 million pounds capital fund for 2013-2014 'to fund new and innovative projects to improve energy efficiency and reduce the carbon footprint of the NHS'. HEJ reports on this, and a number of other potential funding streams available, to help NHS organisations contribute to the wider carbon-cutting agenda, and examines how bodies such as the Carbon and Energy Fund, and the Carbon Trust, can help both with funding, and via advice and technical support.

Burden, duration and costs of hospital bed closures due to acute gastroenteritis in England per winter, 2010/11-2015/16.

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Sandmann, F G; Jit, M; Robotham, J V; Deeny, S R

2017-09-01

Bed closures due to acute gastroenteritis put hospitals under pressure each winter. In England, the National Health Service (NHS) has monitored the winter situation for all acute trusts since 2010/11. To estimate the burden, duration and costs of hospital bed closures due to acute gastroenteritis in winter. A retrospective analysis of routinely collected time-series data of bed closures due to diarrhoea and vomiting was conducted for the winters 2010/11 to 2015/16. Two key issues were addressed by imputing non-randomly missing values at provider level, and filtering observations to a range of dates recorded in all six winters. The lowest and highest values imputed were taken to represent the best- and worst-case scenarios. Bed-days were costed using NHS reference costs, and potential staff absence costs were based on previous studies. In the best-to-worst case, a median of 88,000-113,000 beds were closed due to gastroenteritis each winter. Of these, 19.6-20.4% were unoccupied. On average, 80% of providers were affected, and had closed beds for a median of 15-21 days each winter. Hospital costs of closed beds were £5.7-£7.5 million, which increased to £6.9-£10.0 million when including staff absence costs due to illness. The median number of hospital beds closed due to acute gastroenteritis per winter was equivalent to all general and acute hospital beds in England being unavailable for a median of 0.88-1.12 days. Costs for hospitals are high but vary with closures each winter. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Assessing the impact of a new health sector pay system upon NHS staff in England

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Buchan James

2008-06-01

Full Text Available Abstract Background Pay and pay systems are a critical element in any health sector human resource strategy. Changing a pay system can be one strategy to achieve or sustain organizational change. This paper reports on the design and implementation of a completely new pay system in the National Health Service (NHS in England. 'Agenda for Change' constituted the largest-ever attempt to introduce a new pay system in the UK public services, covering more than one million staff. Its objectives were to improve the delivery of patient care as well as enhance staff recruitment, retention and motivation, and to facilitate new ways of working. Methods This study was the first independent assessment of the impact of Agenda for Change at a local and national level. The methods used in the research were a literature review; review of 'grey' unpublished documentation provided by key stakeholders in the process; analysis of available data; interviews with key national informants (representing government, employers and trade unions, and case studies conducted with senior human resource managers in ten NHS hospitals in England Results Most of the NHS trust managers interviewed were in favour of Agenda for Change, believing it would assist in delivering improvements in patient care and staff experience. The main benefits highlighted were: 'fairness', moving different staff groups on to harmonized conditions; equal pay claim 'protection'; and scope to introduce new roles and working practices. Conclusion Agenda for Change took several years to design, and has only recently been implemented. Its very scale and central importance to NHS costs and delivery of care argues for a full assessment at an early stage so that lessons can be learned and any necessary changes made. This paper highlights weaknesses in evaluation and limitations in progress. The absence of systematically derived and applied impact indicators makes it difficult to assess impact and impact

From vision to reality--managing change in the provision of library and information services to nurses, midwives, health visitors and PAMs: (professions allied to medicine) a case study of the North Thames experience with the Inner London Consortium.

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Godbolt, S; Williamson, J; Wilson, A

1997-06-01

One of the North Thames' pioneering consortia, the Inner London Consortium (ILC) is a complex body which includes NHS Trusts with teaching hospital university connections, community-based Trusts and general hospital acute Trusts. Within the consortium there are 12,000 trained nurses, midwives, health visitors and other professional staff working in the professions allied to medicine (PAMs), all of whom require access to and provision of appropriate library information services. In 1994, taking into account experiences elsewhere in the Region and nationally, it became clear that library issues were complex and would become acute with the move of nursing libraries from ILC Trust sites over a very short timescale. A report on the issues commissioned by the Consortium recommended that a library project, which built on existing NHS Trust PGMDE funded library resources and moved these to a multidisciplinary base to serve the consortium membership, be implemented. The objective of providing access to library information services for nurses and PAMs was achieved. Successes that emerged from the implementation included: The registration in Trust libraries of almost 12 000 new members within the initial 6-month monitoring period. The development of service level agreements and standards for the delivery of services to these new user groups. This paper describes the processes behind these significant and complex changes.

Identification of the gene for Nance-Horan syndrome (NHS).

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Brooks, S P; Ebenezer, N D; Poopalasundaram, S; Lehmann, O J; Moore, A T; Hardcastle, A J

2004-10-01

The disease intervals for Nance-Horan syndrome (NHS [MIM 302350]) and X linked congenital cataract (CXN) overlap on Xp22. To identify the gene or genes responsible for these diseases. Families with NHS were ascertained. The refined locus for CXN was used to focus the search for candidate genes, which were screened by polymerase chain reaction and direct sequencing of potential exons and intron-exon splice sites. Genomic structures and homologies were determined using bioinformatics. Expression studies were undertaken using specific exonic primers to amplify human fetal cDNA and mouse RNA. A novel gene NHS, with no known function, was identified as causative for NHS. Protein truncating mutations were detected in all three NHS pedigrees, but no mutation was identified in a CXN family, raising the possibility that NHS and CXN may not be allelic. The NHS gene forms a new gene family with a closely related novel gene NHS-Like1 (NHSL1). NHS and NHSL1 lie in paralogous duplicated chromosomal intervals on Xp22 and 6q24, and NHSL1 is more broadly expressed than NHS in human fetal tissues. This study reports the independent identification of the gene causative for Nance-Horan syndrome and extends the number of mutations identified.

The first missense mutation of NHS gene in a Tunisian family with clinical features of NHS syndrome including cardiac anomaly.

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Chograni, Manèl; Rejeb, Imen; Jemaa, Lamia Ben; Châabouni, Myriam; Bouhamed, Habiba Chaabouni

2011-08-01

Nance-Horan Syndrome (NHS) or X-linked cataract-dental syndrome is a disease of unknown gene action mechanism, characterized by congenital cataract, dental anomalies, dysmorphic features and, in some cases, mental retardation. We performed linkage analysis in a Tunisian family with NHS in which affected males and obligate carrier female share a common haplotype in the Xp22.32-p11.21 region that contains the NHS gene. Direct sequencing of NHS coding exons and flanking intronic sequences allowed us to identify the first missense mutation (P551S) and a reported SNP-polymorphism (L1319F) in exon 6, a reported UTR-SNP (c.7422 C>T) and a novel one (c.8239 T>A) in exon 8. Both variations P551S and c.8239 T>A segregate with NHS phenotype in this family. Although truncations, frame-shift and copy number variants have been reported in this gene, no missense mutations have been found to segregate previously. This is the first report of a missense NHS mutation causing NHS phenotype (including cardiac defects). We hypothesize also that the non-reported UTR-SNP of the exon 8 (3'-UTR) is specific to the Tunisian population.

NHS market liberalisation and the TTIP agreement.

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Regan, Paul; Ball, Elaine

2016-07-01

Governments over the past three decades have undermined the founding principles of the NHS through reforms and market liberalisation. With greater involvement of commercial interests in health care, the NHS will become less democratic and transparent. Recent reforms, which were intended to improve productivity, quality and cost efficiency, have left the NHS exposed to the unwieldy model of market liberalisation and the attrition of public health care. The role of community nurses has been particularly destabilised by commissioning, as their work is difficult to measure. The advent of the Transatlantic Trade and Investment Partnership could further undermine the NHS to the benefit of international commercial interests.

Corporate identity. Brand designs.

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Mathieson, Steve

2004-02-19

The past two years have seen a steadily more consistent brand identity for the NHS. Branding will become more important as foundation status and PCT commissioning makes acute hospitals more competitive. This has put pressure on some trusts that have their own strong identities.

Mixed messages: An evaluation of NHS Trust Social Media policies in the North West of England.

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Scragg, B; Shaikh, S; Robinson, L; Mercer, C

2017-08-01

Despite National Health Service (NHS) information strategy promoting the use of Social Media (SoMe) to encourage greater engagement between service users and providers, a team investigating online SoMe interaction between breast screening practitioners and clients found that practitioners alleged discouragement from employers' policies. This study aimed to investigate whether this barrier was genuine, and illuminate whether local policy differed from national strategy. The study used a qualitative grounded theory approach to generate a theory. Nine policies from the North West of England were analysed. A framework was derived from the data, and an analysis of policy tone followed by a detailed coding of policy content was undertaken. Comparative analysis continued by reviewing the literature, and a condensed framework revealed five broad categories that policies addressed. The analysis revealed the policies varied in content, but not in tone, which was mostly discouraging. Coding the content revealed that the most frequently addressed point was that of protecting the employers' reputation, and after further analysis, the resultant condensed framework showed that policies were imbalanced and heavily skewed towards Security, Conduct & Behaviour and Reputation. Practitioners within breast screening services are discouraged by overly prohibitive and prescriptive SoMe policies; with these varying tremendously in comprehensiveness, but with a narrow focus on security and employers reputation; in contrast with national strategy. Recommendations are that policy revision is undertaken with consultation by more than one stakeholder, and SoMe training is offered for all members of NHS staff. Copyright © 2017 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

Documentation of resuscitation decision-making: a survey of practice in the United Kingdom.

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Clements, Meredith; Fuld, Jonathan; Fritz, Zoë

2014-05-01

Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders have been in use since the 1990s. The Resuscitation Council UK (RCUK) provides guidance on the content and use of such forms in the UK but there is no national policy. To determine the content of DNACPR forms in the UK, and the geographical distribution of the use of different forms. All acute trusts within the United Kingdom were contacted via a combination of email and telephone, with a request for the current DNACPR form along with information about its development and use. Characteristics of the model RCUK DNACPR form were compared with the non-RCUK DNACPR forms which we received. Free text responses were searched for commonly occurring phrases. 118/161 English NHS Acute Trusts (accounting for 377 hospitals), 3/6 Northern Irish NHS Acute Trusts (accounting for 25 hospitals) and 3/7 Welsh Health Boards (accounting for 73 hospitals) responded. All Scottish hospitals have the same form. All responding trusts had active policies and have a DNACPR form in use. 38.9% of respondent hospitals have adopted the RCUK form with minor amendments. The remainder of the responding hospitals reported independent forms. 66.8% of non-RCUK forms include a transfer plan to ambulance staff and 48.4% of non-RCUK forms are valid in the community. Several independent trusts submitted DNACPR forms with escalation plans. There is wide variation in the forms used for indicating DNACPR decisions. Documentation is rapidly evolving to meet the needs of patients and to respond to new evidence. Copyright © 2014. Published by Elsevier Ireland Ltd.

Autonomy and performance in the public sector: the experience of English NHS hospitals.

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Verzulli, Rossella; Jacobs, Rowena; Goddard, Maria

2018-05-01

Since 2004, English NHS hospitals have been given the opportunity to acquire a more autonomous status known as a Foundation Trust (FT), whereby regulations and restrictions over financial, management, and organizational matters were reduced in order to create incentives to deliver higher-quality services in the most efficient way. Using difference-in-difference models, we test whether achieving greater autonomy (FT status) improved hospital performance, as proxied by measures of financial management, quality of care, and staff satisfaction. Results provide little evidence that the FT policy per se has made any difference to the performance of hospitals in most of these domains. Our findings have implications for health policy and inform the trend towards granting greater autonomy to public-sector organizations.

Nance-Horan syndrome protein, NHS, associates with epithelial cell junctions.

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Sharma, Shiwani; Ang, Sharyn L; Shaw, Marie; Mackey, David A; Gécz, Jozef; McAvoy, John W; Craig, Jamie E

2006-06-15

Nance-Horan syndrome, characterized by congenital cataracts, craniofacial, dental abnormalities and mental disturbances, is an X-linked disorder with significant phenotypic heterogeneity. Affected individuals have mutations in the NHS (Nance-Horan syndrome) gene typically resulting in premature truncation of the protein. This report underlines the complexity of the regulation of the NHS gene that transcribes several isoforms. We demonstrate the differential expression of the two NHS isoforms, NHS-A and NHS-1A, and differences in the subcellular localization of the proteins encoded by these isoforms. This may in part explain the pleiotropic features of the syndrome. We show that the endogenous and exogenous NHS-A isoform localizes to the cell membrane of mammalian cells in a cell-type-dependent manner and that it co-localizes with the tight junction (TJ) protein ZO-1 in the apical aspect of cell membrane in epithelial cells. We also show that the NHS-1A isoform is a cytoplasmic protein. In the developing mammalian lens, we found continuous expression of NHS that became restricted to the lens epithelium in pre- and postnatal lens. Consistent with the in vitro findings, the NHS-A isoform associates with the apical cell membrane in the lens epithelium. This study suggests that disturbances in intercellular contacts underlie cataractogenesis in the Nance-Horan syndrome. NHS is the first gene localized at TJs that has been implicated in congenital cataracts.

Healthcare reforms: implications for the education and training of acute and critical care nurses.

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Glen, S

2004-12-01

This paper offers a wide ranging analysis of the drivers that resulted in scrutiny of medical, nursing, and healthcare professional roles. It suggests that what is needed is a coherent vision of the future shape of the health workforce. This requires moving beyond the presumption that reforming working practices primarily involves "delegating doctors" responsibilities to nurses. The paper argues that it is self evident that the implications of changes in healthcare roles and the ability of existing professionals to function effectively in the future will require education, training, and human resource investment supportive of the changes. It suggests a clear definition of competence and a national standard to practice is essential for nurses working in acute and acute critical settings. There should therefore be a correlation between levels of practice, levels of education, and remuneration. Furthermore, education programmes for senior nurses should sit coherently alongside the education programmes required by Modernising Medical Careers. Finally, the realisation of the government's service and modernisation agenda will require a culture change within higher education institutions, postgraduate deaneries, professional organisations, workforce development confederations, and NHS trusts.

The impact of NHS based primary care complementary therapy services on health outcomes and NHS costs: a review of service audits and evaluations

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Wye Lesley

2009-03-01

Full Text Available Abstract Background The aim of this study was to review evaluations and audits of primary care complementary therapy services to determine the impact of these services on improving health outcomes and reducing NHS costs. Our intention is to help service users, service providers, clinicians and NHS commissioners make informed decisions about the potential of NHS based complementary therapy services. Methods We searched for published and unpublished studies of NHS based primary care complementary therapy services located in England and Wales from November 2003 to April 2008. We identified the type of information included in each document and extracted comparable data on health outcomes and NHS costs (e.g. prescriptions and GP consultations. Results Twenty-one documents for 14 services met our inclusion criteria. Overall, the quality of the studies was poor, so few conclusions can be made. One controlled and eleven uncontrolled studies using SF36 or MYMOP indicated that primary care complementary therapy services had moderate to strong impact on health status scores. Data on the impact of primary care complementary therapy services on NHS costs were scarcer and inconclusive. One controlled study of a medical osteopathy service found that service users did not decrease their use of NHS resources. Conclusion To improve the quality of evaluations, we urge those evaluating complementary therapy services to use standardised health outcome tools, calculate confidence intervals and collect NHS cost data from GP medical records. Further discussion is needed on ways to standardise the collection and reporting of NHS cost data in primary care complementary therapy services evaluations.

Private patients in NHS hospitals: comparison of two sources of information.

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Williams, B T; Pearson, J

1999-03-01

The use of National Health Service (NHS) hospitals to treat private patients is debatable on the grounds of equity of access. Hospital Episodes Statistics (HES) annual reports are the only routine source of information on the scale of this activity. The accuracy of the information is doubted. This enquiry tested the completeness of HES data against information obtained directly from private patient unit managers. Managers of the 71 pay bed units in NHS hospitals in England were asked to supply from local registers and accounts the numbers of in-patients and day cases admitted in 1995-1996. Their reports were matched with the numbers of first consultant episodes for private in-patients and day cases shown for those hospitals in the HES data file for that year. Of the 71 units 62 responded; 53 of these gave usable data. The 53 included, and 18 excluded from the comparison, matched on median and range of bed numbers. Managers identified 16 per cent more total admissions than did HES, 62,572 against 54,131; 13 per cent more in-patient admissions, 39,776 against 35,319; and 21 per cent more day cases, 22,796 against 18,812. More total admissions were reported by managers of 38 pay bed units than were recorded in HES, fewer by 12, and equal numbers by three. Similar sized discrepancies were noted for in-patient admissions and day cases. Reasons for the under-reporting of private patients in HES included the use of separate patient administration systems for private patients with a failure to feed data to HES, and the omission of some provider units altogether by a minority of trusts from the returns made to the Department of Health. Overall, HES underestimates the amount of private patient activity reported directly by NHS hospitals. No method of validating private patient data is currently available. An amendment to an existing statistical return would provide a check on numbers. Central guidance on the inclusion of private patient activity in data transmitted by

The relationship between organizational culture and performance in acute hospitals.

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Jacobs, Rowena; Mannion, Russell; Davies, Huw T O; Harrison, Stephen; Konteh, Fred; Walshe, Kieran

2013-01-01

This paper examines the relationship between senior management team culture and organizational performance in English acute hospitals (NHS Trusts) over three time periods between 2001/2002 and 2007/2008. We use a validated culture rating instrument, the Competing Values Framework, to measure senior management team culture. Organizational performance is assessed using a wide range of routinely collected indicators. We examine the associations between organizational culture and performance using ordered probit and multinomial logit models. We find that organizational culture varies across hospitals and over time, and this variation is at least in part associated in consistent and predictable ways with a variety of organizational characteristics and routine measures of performance. Moreover, hospitals are moving towards more competitive culture archetypes which mirror the current policy context, though with a stronger blend of cultures. The study provides evidence for a relationship between culture and performance in hospital settings. Copyright © 2012 Elsevier Ltd. All rights reserved.

Morality and Markets in the NHS

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Barnabas J Gilbert

2014-12-01

Full Text Available Since its establishment in 1948, the history of the National Health Service (NHS has been characterized by organisational turbulence and system reform. At the same time, progress in science, medicine and technology throughout the western world have revolutionized the delivery of healthcare. The NHS has become a much loved, if much critiqued, national treasure. It is against this backdrop that the role of this state-funded health service has been brought into moral question. Certainly, the challenges facing healthcare policy-makers are numerous and complex, but in the wake of the Health and Social Care Act (2012, no issue is more divisive than that of market-based reform. Here we explore the turbulent history of the NHS, from its foundation to the birth of the healthcare marketplace. We explore arguments for and against the healthcare market and resolve that, amid an evolving economic and moral framework, the NHS must ensure that its original tenets of equity and autonomy remain at its core. We propose a values-explicit, systems-based approach to renew focus on both the processes and the outcomes of care.

Identification of three novel NHS mutations in families with Nance-Horan syndrome.

Science.gov (United States)

Huang, Kristen M; Wu, Junhua; Brooks, Simon P; Hardcastle, Alison J; Lewis, Richard Alan; Stambolian, Dwight

2007-03-27

Nance-Horan Syndrome (NHS) is an infrequent and often overlooked X-linked disorder characterized by dense congenital cataracts, microphthalmia, and dental abnormalities. The syndrome is caused by mutations in the NHS gene, whose function is not known. The purpose of this study was to identify the frequency and distribution of NHS gene mutations and compare genotype with Nance-Horan phenotype in five North American NHS families. Genomic DNA was isolated from white blood cells from NHS patients and family members. The NHS gene coding region and its splice site donor and acceptor regions were amplified from genomic DNA by PCR, and the amplicons were sequenced directly. We identified three unique NHS coding region mutations in these NHS families. This report extends the number of unique identified NHS mutations to 14.

14 April 2014 - UK University College London Hospitals and National Health Service Foundation Trust Chairman R. Murley in the ATLAS cavern with CERN Head of Medical Applications S. Myers and Collaboration Spokesperson D. Charlton.

CERN Multimedia

Gadmer, Jean-Claude

2014-01-01

Mr Richard Murley Chairman Sir Robert Naylor Chief Executive University College London Hospitals (UCLH) – National Health Service (NHS) Foundation Trust United Kingdom of Great Britain and Northern Ireland

Commissioning healthcare for people with long term conditions: the persistence of relational contracting in England's NHS quasi-market.

Science.gov (United States)

Porter, Alison; Mays, Nicholas; Shaw, Sara E; Rosen, Rebecca; Smith, Judith

2013-01-01

Since 1991, there has been a series of reforms of the English National Health Service (NHS) entailing an increasing separation between the commissioners of services and a widening range of public and independent sector providers able to compete for contracts to provide services to NHS patients. We examine the extent to which local commissioners had adopted a market-oriented (transactional) model of commissioning of care for people with long term conditions several years into the latest period of market-oriented reform. The paper also considers the factors that may have inhibited or supported market-oriented behaviour, including the presence of conditions conducive to a health care quasi-market. We studied the commissioning of services for people with three long term conditions - diabetes, stroke and dementia - in three English primary care trust (PCT) areas over two years (2010-12). We took a broadly ethnographic approach to understanding the day-to-day practice of commissioning. Data were collected through interviews, observation of meetings and from documents. In contrast to a transactional, market-related approach organised around commissioner choice of provider and associated contracting, commissioning was largely relational, based on trust and collaboration with incumbent providers. There was limited sign of commissioners significantly challenging providers, changing providers, or decommissioning services.In none of the service areas were all the conditions for a well functioning quasi-market in health care in place. Choice of provider was generally absent or limited; information on demand and resource requirements was highly imperfect; motivations were complex; and transaction costs uncertain, but likely to be high. It was difficult to divide care into neat units for contracting purposes. As a result, it is scarcely surprising that commissioning practice in relation to all six commissioning developments was dominated by a relational approach. Our findings

Mixed messages: An evaluation of NHS Trust Social Media policies in the North West of England

International Nuclear Information System (INIS)

Scragg, B.; Shaikh, S.; Robinson, L.; Mercer, C.

2017-01-01

Introduction: Despite National Health Service (NHS) information strategy promoting the use of Social Media (SoMe) to encourage greater engagement between service users and providers, a team investigating online SoMe interaction between breast screening practitioners and clients found that practitioners alleged discouragement from employers' policies. This study aimed to investigate whether this barrier was genuine, and illuminate whether local policy differed from national strategy. Method: The study used a qualitative grounded theory approach to generate a theory. Nine policies from the North West of England were analysed. A framework was derived from the data, and an analysis of policy tone followed by a detailed coding of policy content was undertaken. Comparative analysis continued by reviewing the literature, and a condensed framework revealed five broad categories that policies addressed. Results: The analysis revealed the policies varied in content, but not in tone, which was mostly discouraging. Coding the content revealed that the most frequently addressed point was that of protecting the employers' reputation, and after further analysis, the resultant condensed framework showed that policies were imbalanced and heavily skewed towards Security, Conduct & Behaviour and Reputation. Conclusion: Practitioners within breast screening services are discouraged by overly prohibitive and prescriptive SoMe policies; with these varying tremendously in comprehensiveness, but with a narrow focus on security and employers reputation; in contrast with national strategy. Recommendations are that policy revision is undertaken with consultation by more than one stakeholder, and SoMe training is offered for all members of NHS staff. - Highlights: • Practitioners are discouraged from using SoMe by employers' policies. • This is at odds with national strategy of engagement with all stakeholders. • Policies are skewed towards protecting reputation and

Use staff wisely to save NHS money.

Science.gov (United States)

Moore, Alison

2015-12-09

The NHS could save up to £ 2 billion a year by improving workflow and containing workforce costs, according to Labour peer Lord Carter's review of NHS efficiency. Changes in areas such as rostering and management of annual leave must avoid increasing the pressure on staff.

Leading Change in Tissue Viability Best Practice: An Action Learning Programme for Link Nurse Practitioners

Science.gov (United States)

Kellie, Jean; Henderson, Eileen; Milsom, Brian; Crawley, Hayley

2010-01-01

This account of practice reports on an action learning initiative designed and implemented in partnership between a regional NHS Acute Trust and a UK Business School. The central initiative was the implementation of an action learning programme entitled "Leading change in tissue viability best practice: a development programme for Link Nurse…

Barriers to healthy eating by National Health Service (NHS hospital doctors in the hospital setting: results of a cross-sectional survey

Directory of Open Access Journals (Sweden)

Wilson Sue

2008-08-01

Full Text Available Abstract Background With high levels of obesity and related illness, improving the health of the nation is a major public health concern. This study aimed to identify factors that prevent healthy eating among doctors, and that are associated with satisfaction with catering services. Findings Methods: Cross-sectional survey of 328 NHS doctors working in two NHS Trusts with on-site hospital canteen. Questionnaire to establish perceived barriers to healthy eating, weekly use and satisfaction with the hospital canteen, lifestyle and dietary habits, gender, age, height, weight, job details, and affect. Results: 70% of doctors reported using their hospital canteen each week, with 2 visits per week on average. Canteen opening times, lack of selection and lack of breaks were the most commonly perceived barriers to healthy eating. Availability of healthy options caused the most dissatisfaction. Only 12% felt the NHS was supportive of healthy eating. 74% did not feel their canteen advocated healthy eating. Canteen use is associated with younger age (r = -0.254, p Conclusion Interventions to encourage regular meal breaks, eating breakfast and drinking more water each day need developing. Improved canteen accessibility and availability of healthy options at evenings and weekends may be beneficial.

Mortality of people with chronic fatigue syndrome: a retrospective cohort study in England and Wales from the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLaM BRC) Clinical Record Interactive Search (CRIS) Register.

Science.gov (United States)

Roberts, Emmert; Wessely, Simon; Chalder, Trudie; Chang, Chin-Kuo; Hotopf, Matthew

2016-04-16

Mortality associated with chronic fatigue syndrome is uncertain. We investigated mortality in individuals diagnosed with chronic fatigue syndrome in secondary and tertiary care using data from the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLaM BRC) Clinical Record Interactive Search (CRIS) register. We calculated standardised mortality ratios (SMRs) for all-cause, suicide-specific, and cancer-specific mortality for a 7-year observation period using the number of deaths observed in SLaM records compared with age-specific and sex-specific mortality statistics for England and Wales. Study participants were included if they had had contact with the chronic fatigue service (referral, discharge, or case note entry) and received a diagnosis of chronic fatigue syndrome. We identified 2147 cases of chronic fatigue syndrome from CRIS and 17 deaths from Jan 1, 2007, to Dec 31, 2013. 1533 patients were women of whom 11 died, and 614 were men of whom six died. There was no significant difference in age-standardised and sex-standardised mortality ratios (SMRs) for all-cause mortality (SMR 1·14, 95% CI 0·65-1·85; p=0·67) or cancer-specific mortality (1·39, 0·60-2·73; p=0·45) in patients with chronic fatigue syndrome when compared with the general population in England and Wales. This remained the case when deaths from suicide were removed from the analysis. There was a significant increase in suicide-specific mortality (SMR 6·85, 95% CI 2·22-15·98; p=0·002). We did not note increased all-cause mortality in people with chronic fatigue syndrome, but our findings show a substantial increase in mortality from suicide. This highlights the need for clinicians to be aware of the increased risk of completed suicide and to assess suicidality adequately in patients with chronic fatigue syndrome. National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London

Delivering scalable Telehealth: ‘What is Scale?’ with case studies from NHS providers, a perspective on the challenges, constraints and issues associated with ‘scalability’

OpenAIRE

Sonia Jane Milburn; Adrian Flowerday

2012-01-01

Introduction With local and national evidence highlighting and confirming numerous benefits gained from implementing telehealth, why is it so hard to roll out the technology at scale? Solent NHS Trust has worked alongside Docobo Limited, since 2005, to successfully introduce telehealth to its patients and clinical staff. Our Chronic Obstructive Pulmonary Disease, Chronic Heart Failure and Community Matron teams have utilised Telehealth tools into their normal practice and have delivered signi...

Challenges of commissioning and contracting for integrated care in the National Health Service (NHS) in England.

Science.gov (United States)

Addicott, Rachael

2016-01-01

For many years there has been a separation between purchasing and provision of services in the English National Health Service (NHS). Many studies report that this commissioning function has been weak: purchasers have had little impact or power in negotiations with large acute providers, and have had limited strategic control over the delivery of care. Nevertheless, commissioning has become increasingly embedded in the NHS structure since the arrival of Clinical Commissioning Groups (CCGs) in 2012. Recently, some of these CCGs have focused on how they can contract and commission in different ways to stimulate greater collaboration across providers. This paper examines experiences of commissioning and contracting for integrated care in the English NHS, based on a series of national-level interviews and case studies of five health economies that are implementing novel contracting models. The cases illustrated here demonstrate early experiments to drive innovation through contracting in the NHS that have largely relied on the vision of individual teams or leaders, in combination with external legal, procurement and actuarial support. It is unlikely that this approach will be sustainable or replicable across the country or internationally, despite the best intentions of commissioners. Designing and operating novel contractual approaches will require considerable determination, alongside advanced skills in procurement, contract management and commissioning. The cost of developing new contractual approaches is high, and as the process is difficult and resource-intensive, it is likely that dedicated teams or programs will be required to drive significant improvement.

The NHS as a learning organization: aspirations beyond the rainbow?

Science.gov (United States)

Timpson, J

1998-09-01

It is the intention of this paper to review the issues and challenges organizations face when aspiring to embrace and enact the tenets of a learning organization; and in particular the perceived impact on management strategy, structure and leadership styles. The paper is predicated on the premise that learning and knowledge act as vital strategic resources, crucial not only to organizations in terms of competitive advantage but to ethical enterprise per se. Modern life is characterized by change, against the backdrop of this continual turmoil, organizational learning has emerged as a dominant theme within contemporary management theory, with many commentators increasingly locating the capacity of an aspiring organization to accommodate the ethos of organizational learning, as the vital component in ensuring enduring efficiency, innovation and competitiveness. However, the utility of such learning needs to be scrutinized and evaluated in terms of service need and expectation. The paper will expand upon wider theoretical debates extant within the literature, by considering the concept and utility of the learning organization with specific reference to management reform extant within the British National Health Service (NHS). During the course of the review the various the theoretical positions contributing to the notion of the learning organization will be analysed, the practical ramifications of which will be examined in the context of reflective practice, clinical supervision and the wider cultural background of nursing and the NHS. The paper concludes that the NHS needs to reorientate management perspectives to focus attention more acutely on systems which are deliberately designed to facilitate shared learning, to unravel the ambiguities of organizational life, to affirm management belief in the nursing contribution and to achieve an as yet unrealized potential in terms of patient care and advanced nursing practice.

Can risk assessment predict suicide in secondary mental healthcare? Findings from the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLaM BRC) Case Register.

Science.gov (United States)

Lopez-Morinigo, Javier-David; Fernandes, Andrea C; Shetty, Hitesh; Ayesa-Arriola, Rosa; Bari, Ashraful; Stewart, Robert; Dutta, Rina

2018-06-02

The predictive value of suicide risk assessment in secondary mental healthcare remains unclear. This study aimed to investigate the extent to which clinical risk assessment ratings can predict suicide among people receiving secondary mental healthcare. Retrospective inception cohort study (n = 13,758) from the South London and Maudsley NHS Foundation Trust (SLaM) (London, UK) linked with national mortality data (n = 81 suicides). Cox regression models assessed survival from the last suicide risk assessment and ROC curves evaluated the performance of risk assessment total scores. Hopelessness (RR = 2.24, 95% CI 1.05-4.80, p = 0.037) and having a significant loss (RR = 1.91, 95% CI 1.03-3.55, p = 0.041) were significantly associated with suicide in the multivariable Cox regression models. However, screening statistics for the best cut-off point (4-5) of the risk assessment total score were: sensitivity 0.65 (95% CI 0.54-0.76), specificity 0.62 (95% CI 0.62-0.63), positive predictive value 0.01 (95% CI 0.01-0.01) and negative predictive value 0.99 (95% CI 0.99-1.00). Although suicide was linked with hopelessness and having a significant loss, risk assessment performed poorly to predict such an uncommon outcome in a large case register of patients receiving secondary mental healthcare.

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

From Hippocrates to Commodities: three models of NHS governance: NHS governance, regulation, Mid Staffordshire inquiry, health care as a commodity.

Science.gov (United States)

Newdick, Christopher

2014-01-01

A series of inquiries and reports suggest considerable failings in the care provided to some patients in the NHS. Although the Bristol Inquiry report of 2001 led to the creation of many new regulatory bodies to supervise the NHS, they have never enjoyed consistent support from government and the Mid Staffordshire Inquiry in 2013 suggests they made little difference. Why do some parts of the NHS disregard patients' interests and how we should we respond to the challenge? The following discusses the evolution of approaches to NHS governance through the Hippocratic, Managerial and Commercial models, and assesses their risks and benefits. Apart from the ethical imperative, the need for effective governance is driven both by the growth in information available to the public and the resources wasted by ineffective systems of care. Appropriate solutions depend on an understanding of the perverse incentives inherent in each model and the need for greater sensitivity to the voices of patients and the public. © The Author 2014. Published by Oxford University Press; all rights reserved. For Permissions, please email: journals. permissions@oup.com.

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.

IMatter: validation of the NHS Scotland Employee Engagement Index.

Science.gov (United States)

Snowden, Austyn; MacArthur, Ewan

2014-11-08

Employee engagement is a fundamental component of quality healthcare. In order to provide empirical data of engagement in NHS Scotland an Employee Engagement Index was co-constructed with staff. 'iMatter' consists of 25 Likert questions developed iteratively from the literature and a series of validation events with NHS Scotland staff. The aim of this study was to test the face, content and construct validity of iMatter. Cross sectional survey of NHS Scotland staff. In January 2013 iMatter was sent to 2300 staff across all disciplines in NHS Scotland. 1280 staff completed it. Demographic data were collected. Internal consistency of the scale was calculated. Construct validity consisted of concurrent application of factor analysis and Rasch analysis. Face and content validity were checked using 3 focus groups. The sample was representative of the NHSScotland population. iMatter showed very strong reliability (α = 0.958). Factor analysis revealed a four-factor structure consistent with the following interpretation: iMatter showed evidence of high reliability and validity. It is a popular measure of staff engagement in NHS Scotland. Implications for practice focus on the importance of coproduction in psychometric development.

英国国民卫生服务制度(NHS)的结构性改革与治理模式%Study on structural reform and governance models of National Health Service in UK

Institute of Scientific and Technical Information of China (English)

王小万; 陈丽萍; 刘丽杭

2017-01-01

基于英国NHS在管理体制与机制上所实施的结构性改革措施,从完善法律、建立问责机制、完善财务管理和经营模式4个维度,系统阐述了NHS的结构性改革与治理模式的特点;作为一种"公共利益公司",NHS所属公立医院基于公私伙伴关系的原则,在坚持公益性的前提下,引入企业经营行为组建了信托基金医疗联合体,并根据NHS的核心原则,免费医疗、需求导向、可负担性等,基于购买合同向辖区患者或居民提供医疗保健服务.随着相关改革措施的逐步实施,NHS信托基金医疗联合体的法人地位和自主决策权得到明显提升,能真正做到对自身的发展负责;同时,随着对提供者行为的规范,以及医疗服务市场竞争与规制机制的完善,也极大的促进了医疗机构之间的有序竞争和医疗服务供给的多元化发展.%Based on the structural reform approaches of management system and mechanism implemented by the British NHS, this paper systematically introduced governance models and characteristics of NHS Foundation Trusts(FTs)from the four dimensions:perfecting the laws,establishing accountability framework,improving finan-cial management,and operational governance business model.As a public benefit corporation, on the basis of the principle of public-private partnerships(Public-Private-Partnership, PPP), NHS foundation trusts currently intro-duces a number of entrepreneurial practices under the premise of public welfare attribute, and provide goods and services according to entrustment contract and core NHS principles-free medical care,demand-oriented,affordability and so on.With these reform measures being implemented,the legal status and independent decision-making power of NHS Trust Fund Medical Consortium will be remarkably improved,so as the Foundation Trusts will be much more"on their own"and take complete responsibility for ensuring that they are successful.At the same time, with the norms of

Change management of mergers: the impact on NHS staff and their psychological contracts.

Science.gov (United States)

Cortvriend, Penny

2004-08-01

The NHS has experienced a significant amount of organisational change and restructuring, which has included numerous mergers and de-mergers, since the Labour party came to power in the UK in 1997. However, to date there has been little in the way of evaluation of such changes, particularly the impact of organisational restructuring on the staff involved. This paper examines the human aspect of a merger, and subsequent de-merger, within a primary care trust (PCT) in the North of England, using a focus group methodology. The findings demonstrate that leadership and management styles have a significant impact on staff experiencing such changes. In addition, the psychological contract can be damaged due to the impact of several factors, inducing exit or intention to leave. Employees experienced a constant cycle of change with little time for stabilisation or adjustment, leading to negativity and lowered motivation at times.

A management approach that drives actions strategically: balanced scorecard in a mental health trust case study.

Science.gov (United States)

Schmidt, Stefan; Bateman, Ian; Breinlinger-O'Reilly, Jochen; Smith, Peter

2006-01-01

Achieving excellence is a current preoccupation in U.K. public health organisations. This article aims to use a case study to explain how a mental health trust delivers excellent performance using a balanced scorecard (BSC) management approach. Reports a project to implement a BSC approach in the South West Yorkshire Mental Health NHS Trust to achieve its "excellence" objectives. The authors were participants in the project. The design of the pilot project was informed theoretically by the work of Kaplan and Norton and practically by in-house discussions on a strategy to achieve excellence. Explains the process of building a BSC strategy step-by-step. Discusses how the vision and strategies of a mental health trust can be translated into tangible measures, which are the basis for actions that are driven strategically. There are many possibilities for a BSC management approach and this case study is specific to mental health trusts in the UK, although it is believed that the case has a universally applicable modus operandi. This article will help healthcare managers to evaluate the benefits of a BSC management approach. This article explains how actions can be structured in connection with a BSC management approach.

Longitudinal changes in extended roles in radiography: A new perspective

Energy Technology Data Exchange (ETDEWEB)

Price, R.C. [School of Paramedic Sciences, Physiotherapy and Radiography, Faculty of Health and Human Sciences, University of Hertfordshire, College Lane, Hatfield, Hertfordshire AL10 9AB (United Kingdom)]. E-mail: r.c.price@herts.ac.uk; Le Masurier, S.B. [University of Hertfordshire, College Lane, Hatfield, Hertfordshire AL10 9AB (United Kingdom)

2007-02-15

Purpose: The purpose of this research was to update data on the scope of changes to radiographic practice since the principal author's last survey in 2000. The study also sought to identify any regional patterns in the adoption and diffusion of extended roles and to map the implementation of the 4-tier structure. Method: Structured questionnaires were sent to radiology managers at acute National Health Service (NHS) trusts across the United Kingdom. Information sought included region, teaching/non-teaching status, the nature of extended role tasks undertaken and the year in which these tasks were adopted, numbers of radiographers and radiologists in post. Information was also sought on the implementation of the '4-tier structure'. Results: Some 177 questionnaires were returned from a total of 258 dispatched giving a 68.6% response rate. In 166 trusts, radiographers administered intravenous injections; they performed barium enemas in 147 trusts and barium meals in 19 trusts, while a red dot system was in operation in 143 trusts. Each category showed an increase from that reported in 2000. Likewise reporting by radiographers had increased since 2000. Responses indicated that at 146 trusts, radiographers were reporting in ultrasound; reporting of the appendicular skeleton was undertaken at 81 trusts and axial skeletal reporting at 70 trusts. Barium enemas were reported by radiographers in 78 trusts. Reporting was also undertaken by radiographers on barium meals, mammography, nuclear medicine, paediatric and chest radiography; and all showed an increase in frequency since 2000. Regional differences were again apparent in reporting, with a greater prevalence in the English regions, with the exception of London. In respect of the 4-tier structure, 59% of the sample employed assistant practitioners, 47% advanced practitioners and 3% employed consultants. The numbers reported in each category (excluding practitioners) were 158 assistants, 623 advanced

Longitudinal changes in extended roles in radiography: A new perspective

International Nuclear Information System (INIS)

Price, R.C.; Le Masurier, S.B.

2007-01-01

Purpose: The purpose of this research was to update data on the scope of changes to radiographic practice since the principal author's last survey in 2000. The study also sought to identify any regional patterns in the adoption and diffusion of extended roles and to map the implementation of the 4-tier structure. Method: Structured questionnaires were sent to radiology managers at acute National Health Service (NHS) trusts across the United Kingdom. Information sought included region, teaching/non-teaching status, the nature of extended role tasks undertaken and the year in which these tasks were adopted, numbers of radiographers and radiologists in post. Information was also sought on the implementation of the '4-tier structure'. Results: Some 177 questionnaires were returned from a total of 258 dispatched giving a 68.6% response rate. In 166 trusts, radiographers administered intravenous injections; they performed barium enemas in 147 trusts and barium meals in 19 trusts, while a red dot system was in operation in 143 trusts. Each category showed an increase from that reported in 2000. Likewise reporting by radiographers had increased since 2000. Responses indicated that at 146 trusts, radiographers were reporting in ultrasound; reporting of the appendicular skeleton was undertaken at 81 trusts and axial skeletal reporting at 70 trusts. Barium enemas were reported by radiographers in 78 trusts. Reporting was also undertaken by radiographers on barium meals, mammography, nuclear medicine, paediatric and chest radiography; and all showed an increase in frequency since 2000. Regional differences were again apparent in reporting, with a greater prevalence in the English regions, with the exception of London. In respect of the 4-tier structure, 59% of the sample employed assistant practitioners, 47% advanced practitioners and 3% employed consultants. The numbers reported in each category (excluding practitioners) were 158 assistants, 623 advanced practitioners and six

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...

An evaluation of mindfulness-based childbirth and parenting courses for pregnant women and prospective fathers/partners within the UK NHS (MBCP-4-NHS).

Science.gov (United States)

Warriner, Sian; Crane, Catherine; Dymond, Maret; Krusche, Adele

2018-05-26

An evaluation of mindfulness-based childbirth and parenting courses for pregnant women and prospective fathers/partners within the UK NHS (MBCP-4-NHS). To explore the usefulness within the National Health Service (NHS) of a brief (four week, ten hour) course based upon the Mindfulness Based Childbirth and Parenting (MBCP) programme (Duncan and Bardacke, 2010) described here as MBCP-4-NHS. The National Maternity Review (2016) and report of The Independent Mental Health Taskforce to the NHS (2016a, 2016b) in England highlight the need for significant investment into perinatal mental health services, with the Government pledging funding to improve such services through a range of measures. Whilst the field of mindfulness during the perinatal period is in need of well controlled trials and studies exploring the mechanisms of action (Hall et al., 2016) the limited research to date supports the potential for mindfulness based interventions in pregnancy and the need for further scientific study in this area (Dhillon et al., 2017; Shi and Macbeth, 2017). Particularly because it may broaden women's repertoire of coping strategies with the potential to improve the developmental trajectory of both parents and infants (Dunn et al., 2012; Duncan and Bardacke, 2010; Vieten and Astin, 2008). However, most of the studies to date have involved lengthy courses of around 8-9 weeks (24 h) duration, which may not be feasible or economical within a UK NHS setting and therefore, would be unlikely to be adopted as routine practice. An initial pilot study to discover if MBCP-4-NHS is acceptable and feasible within NHS maternity services, comparing maternal and paternal pre and post intervention self-report measures of mental health to begin to explore the effectiveness of this intervention. NHS antenatal education classes held in children's centres for expectant parents across Oxfordshire. All expectant parents receiving Oxfordshire maternity services between October 2014 and January 2015

Supporting staff in employment: the emotional wellbeing of staff in an NHS psychiatric hospital.

Science.gov (United States)

Patterson, I D; Bell, J S

2000-09-01

The objective of this study was to assess the emotional wellbeing of a broad sample of NHS employees in a psychiatric setting; to seek their views on sources of distress; and to identify preferred ways of dealing with it. A cross-sectional postal survey, employing two questionnaires: GHQ-28, and a semi-structured questionnaire. These were sent to a nominal 50% sample (n = 599). The population was the staff of a large Scottish psychiatric service. A 47.9% response rate was achieved; 32.9% of respondents exceeded a cut-off score of four on the GHQ-28. Neither occupational, group nor gender effects were significant on this measure. The reporting of emotionally-distressing problems affecting their performance was found to be more common amongst doctors; males, overall, showed a non-significant trend towards having been affected more than females by such problems; and older staff (above 45) were affected significantly more often than younger staff. Almost a third of staff were unaware of the availability of an internal organisational resource (the Occupational Health service). NHS Trusts should ensure the culture at work is appropriate from a preventative point of view and be aware that factors outwith the workplace can affect employees emotional wellbeing and performance. Preventative and supportive measures to minimise psychological distress in the workforce should be considered; the Scottish Needs Assessment Programme: Mental Health in the Workplace offers useful guidance.

Identification of three novel NHS mutations in families with Nance-Horan syndrome

OpenAIRE

Huang, Kristen M.; Wu, Junhua; Brooks, Simon P.; Hardcastle, Alison J.; Lewis, Richard Alan; Stambolian, Dwight

2007-01-01

Purpose Nance-Horan Syndrome (NHS) is an infrequent and often overlooked X-linked disorder characterized by dense congenital cataracts, microphthalmia, and dental abnormalities. The syndrome is caused by mutations in the NHS gene, whose function is not known. The purpose of this study was to identify the frequency and distribution of NHS gene mutations and compare genotype with Nance-Horan phenotype in five North American NHS families. Methods Genomic DNA was isolated from white blood cells f...

The NHS: the story so far (1948-2010).

Science.gov (United States)

Shapiro, Jonathan

2010-08-01

The NHS has long held a paradoxical position in the national psyche: a constant, reassuring presence that seems to be in a state of continual flux. This is partly because while the service is based in the public sector (with its reputation for risk aversion and change at a glacial pace), it is also exposed to the ever present currents of political pressure. Equally important is the changing nature of both medical technology and public expectation, each of which exert constant and inexorable pressures on the service. This article will briefly describe the story of the NHS from its inception in 1948 to the present day, with an emphasis on developments over the last 20 years. During this time the notion of organising healthcare has developed and formed the focus of much of the change in systems across the developed world. The narrative will highlight some of the major challenges that the NHS will face over the next few years, and introduce the series about the future of the NHS that will appear in this journal signposting some of the topics that will be followed up in these articles.

Impact of NHS Direct on other services: the characteristics and origins of its nurses \\ud

OpenAIRE

Morrell, C.J.; Munro, J.F.; O'Cathain, A.; Warren, K.; Nicholl, J.

2002-01-01

OBJECTIVE:: To characterise the NHS Direct nurse workforce and estimate the impact of NHS Direct on the staffing of other NHS nursing specialties. \\ud \\ud METHOD: A postal survey of NHS Direct nurses in all 17 NHS Direct call centres operating in June 2000. \\ud \\ud RESULTS: The response rate was 74% (682 of 920). In the three months immediately before joining NHS Direct, 20% (134 of 682, 95% confidence intervals 17% to 23%) of respondents had not been working in the NHS. Of the 540 who came f...

A trust-wide review of clinical nurse specialists' productivity.

Science.gov (United States)

Balsdon, Helen; Wilkinson, Susan

2014-04-01

The contribution made by clinical nurse specialists (CNSs) to patient care needs to be understood fully to provide assurance of effective use of resources. However, CNS roles are often poorly understood and not easily articulated. Due to the diversity of these roles, robust reviews of performance and economic benefits can be regarded as time consuming and resource intense, and many organisations enlist external agencies to clarify the contribution to care made by their CNSs. This article gives an overview of a Cambridge University Hospitals NHS Foundation Trust internal review of CNS roles without the support of an external agency. The review provided assurance that this group of nurses is being used effectively and identified opportunities to use the role in different ways to increase effectiveness.

The role of insulin detemir in overweight type 2 diabetes management

OpenAIRE

Soran, Handrean

2009-01-01

Yared N Demssie1, Naveed Younis2, Handrean Soran31Department of Diabetes and Endocrinology, Salford Royal Foundation NHS Trust, Salford, UK; 2Department of Medicine, University Hospital South Manchester Foundation NHS Trust, Wythenshawe, Manchester, UK; 3University Department of Medicine, Central Manchester and Manchester Children’s NHS Foundation Trust, Manchester, UKAbstract: The recent evidence-based shift towards an algorithm of early initiation and aggressive titration of insul...

Measuring progress towards a primary care-led NHS.

Science.gov (United States)

Miller, P; Craig, N; Scott, A; Walker, A; Hanlon, P

1999-07-01

The push towards a 'primary care-led' National Health Service (NHS) has far-reaching implications for the future structure of the NHS. The policy involves both a growing emphasis on the role of primary care practitioners in the commissioning of health services, and a change from hospital to primary and community settings for a range of services and procedures. Although the terminology has changed, this emphasis remains in the recent Scottish Health Service White Paper and its English counterpart. To consider three questions in relation to this policy goal. First, does the evidence base support the changes? Secondly, what is the scale of the changes that have occurred? Thirdly, what are the barriers to the development of a primary care-led NHS? Programme budgets were compiled to assess changes over time in the balance of NHS resource allocation with respect to primary and secondary care. Total NHS revenue expenditure for the 15 Scottish health boards was grouped into four blocks or 'programmes': primary care, secondary care, community services, and a residual. The study period was 1991/2 to 1995/6. Expenditure data were supplied by the Scottish Office. Ambiguity of definitions and the absence of good data cause methodological difficulties in evaluating the scale and the appropriateness of the shift. The data that are available suggest that, at the aggregate level, there have been changes over time in the balance of resource allocation between care settings: relative investment into primary care has increased. It would appear that this investment is relatively small and from growth money rather than a 'shift' from secondary care. In addition, the impact of GP-led commissioning is variable but limited. General practitioners' (GPs') attitudes to the policy suggest that progress towards a primary care-led NHS will continue to be patchy. The limited shift to date, alongside evidence of ambivalent attitudes to the shift on the part of GPs, suggest that this is a policy

New mutations in the NHS gene in Nance-Horan Syndrome families from the Netherlands

NARCIS (Netherlands)

Florijn, Ralph J.; Loves, Willem; Maillette de Buy Wenniger-Prick, Liesbeth J. J. M.; Mannens, Marcel M. A. M.; Tijmes, Nel; Brooks, Simon P.; Hardcastle, Alison J.; Bergen, Arthur A. B.

2006-01-01

Mutations in the NHS gene cause Nance-Horan Syndrome (NHS), a rare X-chromosomal recessive disorder with variable features, including congenital cataract, microphthalmia, a peculiar form of the ear and dental anomalies. We investigated the NHS gene in four additional families with NHS from the

An evaluation on the effectiveness of Web 2.0 Startpages (Netvibes & Pageflakes) within NHS libraries.

Science.gov (United States)

McCormick, Carol; Pickard, Alison Jane

2013-06-01

Carol McCormick was Learning Resources Advisor in the library at James Cook University Hospital, South Teesside when she completed her BSc (Hons) Librarianship (Work Based Learning) degree at Northumbria University. She gained a 1st Class Honours and is now Learning Resources Librarian. Carol's dissertation formed part of a wider action research project into the provision of current awareness services at James Cook University Hospital. This article reports on the evaluation which was conducted after a Web 2.0 Startpage, or portal, had been introduced to improve access to current awareness information for all staff within the Trust. It is the second article in the Dissertations into practice series to examine the use of web-based tools to improve access to information for NHS staff. AM. © 2013 The authors. Health Information and Libraries Journal © 2013 Health Libraries Group.

Physician involvement enhances coding accuracy to ensure national standards: an initiative to improve awareness among new junior trainees.

Science.gov (United States)

Nallasivan, S; Gillott, T; Kamath, S; Blow, L; Goddard, V

2011-06-01

Record Keeping Standards is a development led by the Royal College of Physicians of London (RCP) Health Informatics Unit and funded by the National Health Service (NHS) Connecting for Health. A supplementary report produced by the RCP makes a number of recommendations based on a study held at an acute hospital trust. We audited the medical notes and coding to assess the accuracy, documentation by the junior doctors and also to correlate our findings with the RCP audit. Northern Lincolnshire & Goole Hospitals NHS Foundation Trust has 114,000 'finished consultant episodes' per year. A total of 100 consecutive medical (50) and rheumatology (50) discharges from Diana Princess of Wales Hospital from August-October 2009 were reviewed. The results showed an improvement in coding accuracy (10% errors), comparable to the RCP audit but with 5% documentation errors. Physician involvement needs enhancing to improve the effectiveness and to ensure clinical safety.

Lessons from 2012: What the NHS Can Learn from Britain's Olympic Success.

Science.gov (United States)

Maile, Edward J; Blake, Alastair M

2013-01-01

The 2012 London Olympic and Paralympic Games were widely regarded as an organisational and sporting success for the United Kingdom. Therefore, it is prudent to consider what other large, public endeavours might learn from the Games' success. Team GB worked to develop a positive team culture based around shared values. This is something the National Health Service (NHS) could learn from, as an organisation which can appear to lack this culture. The NHS should also work harder to adopt evidence-based practices, and to adopt them quickly, as is often the case in sport. Sport is the ultimate example of transparent results reporting, and the NHS ought to consider systematic reporting of risk-adjusted performance data, which may drive improved performance. The NHS should pay attention to the experiences of successful Olympic sports with centralised centres of excellence, and to medical data which suggests that better outcomes result from centres of excellence. The NHS and wider government should look to Olympic athletes and place more emphasis on prevention of disease by encouraging positive lifestyle choices. Finally, the NHS should develop private sector partnerships carefully. We must look to gather knowledge and ideas from every area of life in pursuit of excellence in the NHS. Experience of the Olympics offers a number of instructive lessons.

A model of organisational dysfunction in the NHS.

Science.gov (United States)

Pope, Rachael

2013-01-01

This paper explores the reasons for the sometimes seemingly irrational and dysfunctional organisational behaviour within the NHS. It seeks to provide possible answers to the persistent historical problem of intimidating and negative behaviour between staff, and the sometimes inadequate organisational responses. The aim is to develop a model to explain and increase understanding of such behaviour in the NHS. This paper is conceptual in nature based upon a systematic literature review. The concepts of organisational silence, normalised organisational corruption, and protection of image, provide some possible answers for these dysfunctional responses, as does the theory of selective moral disengagement. The NHS exhibits too high a level of collective ego defences and protection of its image and self-esteem, which distorts its ability to address problems and to learn. Organisations and the individuals within them can hide and retreat from reality and exhibit denial; there is a resistance to voice and to "knowing". The persistence and tolerance of negative behaviour is a corruption and is not healthy or desirable. Organisations need to embrace the identity of a listening and learning organisation; a "wise" organisation. The "Elephant in the room" of persistent negative behaviour has to be acknowledged; the silence must be broken. There is a need for cultures of "respect", exhibiting "intelligent kindness". A model has been developed to increase understanding of dysfunctional organisational behaviour in the NHS primarily for leaders/managers of health services, health service regulators and health researchers/academics. Research, with ethical approval, is currently being undertaken to test and develop the conceptual model to further reflect the complexities of the NHS culture.

Customer care in the NHS.

Science.gov (United States)

Ruddick, Fred

2015-01-20

Viewing individuals in need of NHS care as customers has the potential to refocus the way their care is delivered. This article highlights some of the benefits of reframing the nurse-patient relationship in terms of customer care, and draws parallels between good customer care and the provision of high quality patient care in the NHS. It explores lessons to be learned from those who have studied the customer experience, which can be adapted to enhance the customer care experience within the health service. Developing professional expertise in the knowledge and skills that underpin good-quality interpersonal encounters is essential to improve the customer experience in health care and should be prioritised alongside the development of more technical skills. Creating a culture where emotional intelligence, caring and compassion are essential requirements for all nursing staff will improve patient satisfaction.

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...

Case-mix & patients' reports of outcome in Independent Sector Treatment Centres: Comparison with NHS providers.

Science.gov (United States)

Browne, John; Jamieson, Liz; Lewsey, Jim; van der Meulen, Jan; Copley, Lynn; Black, Nick

2008-04-09

There has been considerable concern expressed about the outcomes achieved in Independent Sector Treatment Centres (ISTCs) introduced in England since 2003. Our aim was to compare the case-mix and patients' reported outcomes of surgery in ISTCs and in NHS providers. Prospective cohort study of 769 patients treated in six ISTCs and 1895 treated in 20 NHS providers (acute hospitals and treatment centres) in England during 2006-07. Participants underwent one of three day surgery procedures (inguinal hernia repair, varicose vein surgery, cataract extraction) or hip or knee replacement. Change in patient-reported health status and health related quality of life (measured using a disease-specific and a generic (EQ-5D) instrument) was assessed either 3-months (day surgery) or 6-months (hip/knee) after surgery. In addition patient-reported post-operative complications and an overall assessment of success of surgery were collected. Outcome measures were adjusted (using multivariable regression) for patient characteristics (disease severity, duration of symptoms, age, sex, socioeconomic status, general health, previous similar surgery, comorbidity). Post-operative response rates varied by procedure (73%-88%) and were similar for those treated in ISTCs and NHS facilities. Patients treated in ISTCs were healthier, were less likely to have any comorbidity and, for those undergoing cataract surgery or joint replacement, their primary condition was less severe. Those undergoing hernia repair or joint replacement were less likely to have had similar surgery before. When adjustment was made for pre-operative characteristics, patients undergoing cataract surgery or hip replacement in ISTCs achieved a slightly greater improvement in functional status and quality of life than those treated in NHS facilities, while the opposite was true of patients undergoing hernia repair. No significant differences were found for the two other procedures. Patients treated in ISTCs were less likely to

Patients with computed tomography-proven acute diverticulitis require follow-up to exclude colorectal cancer

Directory of Open Access Journals (Sweden)

Shafquat Zaman

2017-04-01

Full Text Available Background/Aims: Traditionally, patients with acute diverticulitis undergo follow-up endoscopy to exclude colorectal cancer (CRC. However, its usefulness has been debated in this era of high-resolution computed tomography (CT diagnosis. We assessed the frequency and outcome of endoscopic follow-up for patients with CT-proven acute diverticulitis, according to the confidence in the CT diagnosis.Methods: Records of patients with CT-proven acute diverticulitis between October 2007 and March 2014 at Sandwell & West Birmingham Hospitals NHS Trust were retrieved. The National Cancer Registry confirmed the cases of CRC. Endoscopy quality indicators were compared between these patients and other patients undergoing the same endoscopic examination over the same period.Results: We identified 235 patients with CT-proven acute diverticulitis, of which, 187 were managed conservatively. The CT report was confident of the diagnosis of acute diverticulitis in 75% cases. Five of the 235 patients were subsequently diagnosed with CRC (2.1%. Three cases of CRC were detected in the 187 patients managed conservatively (1.6%. Forty-eight percent of the conservatively managed patients underwent follow-up endoscopy; one case of CRC was identified. Endoscopies were often incomplete and caused more discomfort for patients with diverticulitis compared with controls.Conclusions: CRC was diagnosed in patients with CT-proven diverticulitis at a higher rate than in screened asymptomatic populations, necessitating follow-up. CT reports contained statements regarding diagnostic uncertainty in 25% cases, associated with an increased risk of CRC. Follow-up endoscopy in patients with CT-proven diverticulitis is associated with increased discomfort and high rates of incompletion. The use of other follow-up modalities should be considered.

A novel NHS mutation causes Nance-Horan Syndrome in a Chinese family.

Science.gov (United States)

Tian, Qi; Li, Yunping; Kousar, Rizwana; Guo, Hui; Peng, Fenglan; Zheng, Yu; Yang, Xiaohua; Long, Zhigao; Tian, Runyi; Xia, Kun; Lin, Haiying; Pan, Qian

2017-01-07

Nance-Horan Syndrome (NHS) (OMIM: 302350) is a rare X-linked developmental disorder characterized by bilateral congenital cataracts, with occasional dental anomalies, characteristic dysmorphic features, brachymetacarpia and mental retardation. Carrier females exhibit similar manifestations that are less severe than in affected males. Here, we report a four-generation Chinese family with multiple affected individuals presenting Nance-Horan Syndrome. Whole-exome sequencing combined with RT-PCR and Sanger sequencing was used to search for a genetic cause underlying the disease phenotype. Whole-exome sequencing identified in all affected individuals of the family a novel donor splicing site mutation (NM_198270: c.1045 + 2T > A) in intron 4 of the gene NHS, which maps to chromosome Xp22.13. The identified mutation results in an RNA processing defect causing a 416-nucleotide addition to exon 4 of the mRNA transcript, likely producing a truncated NHS protein. The donor splicing site mutation NM_198270: c.1045 + 2T > A of the NHS gene is the causative mutation in this Nance-Horan Syndrome family. This research broadens the spectrum of NHS gene mutations, contributing to our understanding of the molecular genetics of NHS.

What does patient feedback reveal about the NHS? A mixed methods study of comments posted to the NHS Choices online service

Science.gov (United States)

Brookes, Gavin; Baker, Paul

2017-01-01

Objective To examine the key themes of positive and negative feedback in patients’ online feedback on NHS (National Health Service) services in England and to understand the specific issues within these themes and how they drive positive and negative evaluation. Design Computer-assisted quantitative and qualitative studies of 228 113 comments (28 971 142 words) of online feedback posted to the NHS Choices website. Comments containing the most frequent positive and negative evaluative words are qualitatively examined to determine the key drivers of positive and negative feedback. Participants Contributors posting comments about the NHS between March 2013 and September 2015. Results Overall, NHS services were evaluated positively approximately three times more often than negatively. The four key areas of focus were: treatment, communication, interpersonal skills and system/organisation. Treatment exhibited the highest proportion of positive evaluative comments (87%), followed by communication (77%), interpersonal skills (44%) and, finally, system/organisation (41%). Qualitative analysis revealed that reference to staff interpersonal skills featured prominently, even in comments relating to treatment and system/organisational issues. Positive feedback was elicited in cases of staff being caring, compassionate and knowing patients’’ names, while rudeness, apathy and not listening were frequent drivers of negative feedback. Conclusions Although technical competence constitutes an undoubtedly fundamental aspect of healthcare provision, staff members were much more likely to be evaluated both positively and negatively according to their interpersonal skills. Therefore, the findings reported in this study highlight the salience of such ‘soft’ skills to patients and emphasise the need for these to be focused upon and developed in staff training programmes, as well as ensuring that decisions around NHS funding do not result in demotivated and rushed staff. The

New mutations in the NHS gene in Nance-Horan Syndrome families from the Netherlands.

Science.gov (United States)

Florijn, Ralph J; Loves, Willem; Maillette de Buy Wenniger-Prick, Liesbeth J J M; Mannens, Marcel M A M; Tijmes, Nel; Brooks, Simon P; Hardcastle, Alison J; Bergen, Arthur A B

2006-09-01

Mutations in the NHS gene cause Nance-Horan Syndrome (NHS), a rare X-chromosomal recessive disorder with variable features, including congenital cataract, microphthalmia, a peculiar form of the ear and dental anomalies. We investigated the NHS gene in four additional families with NHS from the Netherlands, by dHPLC and direct sequencing. We identified an unique mutation in each family. Three out of these four mutations were not reported before. We report here the first splice site sequence alteration mutation and three protein truncating mutations. Our results suggest that X-linked cataract and NHS are allelic disorders.

The Long-Term Cost to the UK NHS and Social Services of Different Durations of IV Thiamine (Vitamin B1) for Chronic Alcohol Misusers with Symptoms of Wernicke's Encephalopathy Presenting at the Emergency Department.

Science.gov (United States)

Wilson, Edward C F; Stanley, George; Mirza, Zulfiquar

2016-04-01

Wernicke's encephalopathy (WE) is an acute neuropsychiatric condition caused by depleted intracellular thiamine, most commonly arising in chronic alcohol misusers, who may present to emergency departments (EDs) for a variety of reasons. Guidelines recommend a minimum 5-day course of intravenous (IV) thiamine in at-risk patients unless WE can be excluded. To estimate the cost impact on the UK public sector (NHS and social services) of a 5-day course of IV thiamine, vs a 2- and 10-day course, in harmful or dependent drinkers presenting to EDs. A Markov chain model compared expected prognosis of patients under alternative admission strategies over 35 years. Model inputs were derived from a prospective cohort study, expert opinion via structured elicitation and NHS costing databases. Costs (2012/2013 price year) were discounted at 3.5 %. Increasing treatment from 2 to 5 days increased acute care costs but reduced the probability of disease progression and thus reduced the expected net costs by GBP87,000 per patient (95 % confidence interval GBP19,300 to GBP172,300) over 35 years. Increasing length of stay to optimize IV thiamine replacement will place additional strain on acute care but has potential UK public sector cost savings. Social services and the NHS should explore collaborations to realise both the health benefits to patients and savings to the public purse.

Five-year workplace wellness intervention in the NHS

OpenAIRE

Blake, Holly; Zhou, Dingyuan; Batt, Mark E.

2013-01-01

aims:\\ud Poor health and well-being has been observed among NHS staff and has become a key focus in current public health policy. The objective of this study was to deliver and evaluate a five-year employee wellness programme aimed at improving the health and well-being of employees in a large NHS workplace.\\ud method:\\ud A theory-driven multi-level ecological workplace wellness intervention was delivered including health campaigns, provision of facilities and health-promotion activities to e...

The use of mobile technology in health libraries: a summary of a UK-based survey.

Science.gov (United States)

Chamberlain, David; Elcock, Martin; Puligari, Preeti

2015-12-01

Health libraries have changed over the past fifteen years in the format of the information they provide. This is driven by developments in technology. To conduct a survey of NHS health libraries in the United Kingdom in order to summarise how mobile technologies are being used, how they are promoted and how they are delivered, highlighting good practice and solutions to issues. An online survey was carried out in 2013 and sent to academic and NHS web-based discussion lists. There were 199 responses. Main replies were from large Acute Hospital Trusts. Only 18% of respondents had conducted research into use of mobile technology (MT) within their Trust. Forty per cent of Trusts offered clinical point of care tools, 29% mobile catalogues, and 30% had mobile enabled web sites. Libraries utilised third-party partnerships rather than develop their own applications or tools. Seventy per cent of Trusts promoted new MT services via e-mail. Network restrictions were the main barrier to development as well as finance and expertise. Uptake and development of MT is sporadic and driven by individuals. There is an opportunity for collaboration and sharing resources and expertise. There are benefits to adopting user-friendly resources. © 2015 Health Libraries Group.

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

Tackling racism in the NHS.

Science.gov (United States)

Dean, Erin

2016-11-30

Essential facts Trade union Unite has developed a policy briefing on a new toolkit to combat racism in the NHS. It can help nurses and other staff tackle racial discrimination in health, with black and minority ethnic (BME) nurses often treated unequally compared with their white colleagues.

Hopewell Furnace NHS : alternative transportation study

Science.gov (United States)

2009-12-31

This study assesses the potential for an alternative transportation system (ATS) at Hopewell Furnace National Historic Site (NHS). The Volpe Center investigated internal circulation and potential partnerships with local historic, cultural, and recrea...

Implications of the UK NHS consent policy for nuclear medicine practice.

Science.gov (United States)

Greaves, Claire D; Tindale, Wendy B

2005-02-01

To comply with government policy on consent, the Sheffield Teaching Hospitals (STH) National Health Service (NHS) Trust introduced a new consent policy in February 2002. Verbal or written consent (depending on the level of risk) must be obtained prior to each study. The patient must be fully informed and given time to reach a decision. Consideration needs to be given to the following: to whom, when and how to provide such information and obtain consent. Each study type and patient circumstance needs to be classified according to risk. Consideration of the risks resulted in a local policy in which written consent is required for the following: therapeutic procedures, studies on pregnant women, studies in which pregnancy needs to be avoided, research procedures, cardiac stress for myocardial perfusion scintigraphy and intrathecal administration. Patient information leaflets have been updated with new information about the study and any risks. Information is now available for both patients and hospital staff. Compliance with the consent policy in a service department provides logistic challenges, but it is possible to fully inform patients in advance about their treatment, allowing them to give informed consent.

Policy and organizational implications of gender imbalance in the NHS.

Science.gov (United States)

Miller, Karen

2007-01-01

The purpose of the paper is to examine the policy and organizational implications of gender imbalance in management, which research suggests exists in the NHS. The research in this paper involved a qualitative approach with an analysis of elite interviews conducted with a non-random sample of officials involved in health policy and interviews with a random sample of senior managers in NHS Scotland. The research formed part of a larger study, which explored the enablers and inhibitors to female career progression in various Scottish sectors. The paper finds that gender imbalance in management exists in the NHS. This is manifested in a masculine organizational context, leadership and policy decision-making process, which have implications for female career advancement opportunities and subsequently access to macro policy decisions. The paper involved a sample (30 percent) of senior managers and examined policy processes in NHS Scotland. To improve the external validity of the findings further research should be conducted in NHS organizations in England and Wales. The findings in the paper suggest that gender imbalance in management and a masculine organizational context and leadership style within the NHS create a less than conducive environment for female employees. This has practical implications in terms of levels of part-time employment, career progression and attrition rates. The paper adds to the debate of gender and organizational studies by examining the health sector, which has high levels of female employment but low levels of female representation at senior management levels. The paper therefore adds to an often-neglected area of study, women in leadership and senior managerial positions. The paper is original in its approach by examining the micro and meso organizational dimensions which impact on women's ability to influence macro health policy.

Effects of a live educational music therapy intervention on acute psychiatric inpatients' perceived social support and trust in the therapist: a four-group randomized effectiveness study.

Science.gov (United States)

Silverman, Michael J

2014-01-01

Social support is associated with enhanced illness management and recovery in persons with mental illness, making it an important topic addressed through acute inpatient psychoeducational programs. In addition, trust in the therapist may mediate clinical outcomes in this patient population. To date, few studies have examined the effect of music-based psychoeducational programs on these variables. The purpose of this study was to isolate and examine the component parts of a live educational music therapy intervention, and its effect on acute psychiatric inpatients' perceived social support from significant others, family, and friends and trust in the therapist. This study also explored whether trust in therapist varied across conditions, but did not examine it as a mediator for social support. Participants (N = 96) were cluster-randomized in a single-session posttest-only design to one of four conditions: live educational music therapy, recorded educational music therapy, education without music, or recreational music therapy without education. Conditions were designed to isolate the following intervention components: live vs. recorded music, educational vs. non-educational content, and music vs. nonmusic modality. Dependent measures were assessed post intervention via established self-report instruments evaluating perceived social support and trust in the therapist. There were no significant between-group differences for social support or trust in therapist total scores. However, subscale score analyses revealed two significant between-group differences: (a) participants in the Live Educational Music Therapy condition reported significantly higher perceived therapist competence compared with the Recorded Educational Music Therapy condition; (b) participants in the Live Educational Music Therapy condition reported significantly higher perceived support from friends compared with the Recreational Music Therapy condition. Live educational music therapy may be a way to

Who uses NHS health checks? Investigating the impact of ethnicity and gender and method of invitation on uptake of NHS health checks.

Science.gov (United States)

Cook, Erica J; Sharp, Chloe; Randhawa, Gurch; Guppy, Andy; Gangotra, Raj; Cox, Jonathon

2016-01-20

NHS Health Checks is a national risk assessment prevention programme for all individuals aged 40-74 that reside in England. Through the systematic assessment of an individual's ten year disease risk, this programme aims to provide early identification and subsequent management of this risk. However, there is limited evidence on how socio-demographic factors impact on uptake and what influence the invitation method has on uptake to this programme. NHS Health Check data from April 2013 to March 2014 was analysed (N = 50,485) for all 30 GP Practices in Luton, a culturally diverse town in England, UK. Data was collected for age, ethnicity, uptake (attendance and non attendance) and invitation method (letter written, verbal face-to-face, telephone). Actual usage of NHS Health Checks was determined for each ethnic group of the population and compared using Chi-square analysis. The overall uptake rate for Luton was 44 %, markedly lower that the set target of 50-75 %. The findings revealed a variation of uptake in relation to age, gender, level of deprivation. Ethnicity and gender variations were also found, with 'White British' 'Black Caribbean' and 'Indian' patients most likely to take up a NHS Health Check. However, patients from 'Any Other White Background' and 'Black African' were significantly less likely to uptake an NHS Health Check compared to all other ethnic groups. Ethnicity and gender differences were also noted in relation to invitation method. The findings revealed that different invitation methods were effective for different ethnic and gender groups. Therefore, it is suggested that established protocols of invitation are specifically designed for maximizing the response rate for each population group. Future research should now focus on uncovering the barriers to uptake in particular culturally diverse population groups to determine how public health teams can better engage with these communities.

Case-mix & patients' reports of outcome in Independent Sector Treatment Centres: Comparison with NHS providers

Directory of Open Access Journals (Sweden)

van der Meulen Jan

2008-04-01

Full Text Available Abstract Background There has been considerable concern expressed about the outcomes achieved in Independent Sector Treatment Centres (ISTCs introduced in England since 2003. Our aim was to compare the case-mix and patients' reported outcomes of surgery in ISTCs and in NHS providers. Methods Prospective cohort study of 769 patients treated in six ISTCs and 1895 treated in 20 NHS providers (acute hospitals and treatment centres in England during 2006–07. Participants underwent one of three day surgery procedures (inguinal hernia repair, varicose vein surgery, cataract extraction or hip or knee replacement. Change in patient-reported health status and health related quality of life (measured using a disease-specific and a generic (EQ-5D instrument was assessed either 3-months (day surgery or 6-months (hip/knee after surgery. In addition patient-reported post-operative complications and an overall assessment of success of surgery were collected. Outcome measures were adjusted (using multivariable regression for patient characteristics (disease severity, duration of symptoms, age, sex, socioeconomic status, general health, previous similar surgery, comorbidity. Results Post-operative response rates varied by procedure (73%–88% and were similar for those treated in ISTCs and NHS facilities. Patients treated in ISTCs were healthier, were less likely to have any comorbidity and, for those undergoing cataract surgery or joint replacement, their primary condition was less severe. Those undergoing hernia repair or joint replacement were less likely to have had similar surgery before. When adjustment was made for pre-operative characteristics, patients undergoing cataract surgery or hip replacement in ISTCs achieved a slightly greater improvement in functional status and quality of life than those treated in NHS facilities, while the opposite was true of patients undergoing hernia repair. No significant differences were found for the two other

Management of acute attacks of hereditary angioedema: potential role of icatibant

Directory of Open Access Journals (Sweden)

Hilary J Longhurst

2010-09-01

Full Text Available Hilary J LonghurstDepartment of Immunology, Barts and The London NHS Trust, London, UKAbstract: Icatibant (Firazyr® is a novel subcutaneous treatment recently licensed in the European Union for acute hereditary angioedema. Hereditary angioedema, resulting from inherited partial C1 inhibitor deficiency, is a disabling condition characterized by intermittent episodes of bradykinin-mediated angioedema. Icatibant blocks bradykinin B2 receptors, attenutating the episode. Randomized double-blind, placebo-controlled trials of icatibant, showed significant superiority over oral tranexamic acid in 74 European patients and a trend to improvement in a similar US trial comparing icatibant with placebo in 55 patients. Outcomes for several endpoints did not reach significance in the US trial, perhaps because of low participant numbers and confounding factors: a further trial is planned. Open label studies have shown benefit in multiple treatments for attacks at all sites. Approximately 10% of patients require a second dose for re-emergent symptoms, usually 10 to 27 hours after the initial treatment. Its subcutaneous route of administration, good tolerability and novel mode of action make icatibant a promising addition to the limited repertoire of treatments for hereditary angioedema.Keywords: hereditary angioedema, bradykinin, icatibant, C1 inhibitor deficiency

Training to raise staff awareness about safeguarding children.

Science.gov (United States)

Fleming, Jane

2015-04-01

To improve outcomes for children and young people health organisations are required to train all staff in children's safeguarding. This creates difficulties for large complex organisations where most staff provide services to the adult population. Heart of England NHS Foundation Trust is a large acute and community trust that had difficulties in engaging staff in children's safeguarding training. Compliance rates for clinical staff who were trained in children's safeguarding were low and needed to be addressed. This article sets out why safeguarding training is important for all staff and how the trust achieved staff engagement and improved compliance rates. To evaluate, maintain and develop safeguarding knowledge, understanding, skills, attitude and behaviour further resources are planned to allow access to learning resources in a variety of formats.

Evidence-based commissioning in the English NHS: who uses which sources of evidence? A survey 2010/2011.

Science.gov (United States)

Clarke, Aileen; Taylor-Phillips, Sian; Swan, Jacky; Gkeredakis, Emmanouil; Mills, Penny; Powell, John; Nicolini, Davide; Roginski, Claudia; Scarbrough, Harry; Grove, Amy

2013-05-28

To investigate types of evidence used by healthcare commissioners when making decisions and whether decisions were influenced by commissioners' experience, personal characteristics or role at work. Cross-sectional survey of 345 National Health Service (NHS) staff members. The study was conducted across 11 English Primary Care Trusts between 2010 and 2011. A total of 440 staff involved in commissioning decisions and employed at NHS band 7 or above were invited to participate in the study. Of those, 345 (78%) completed all or a part of the survey. Participants were asked to rate how important different sources of evidence (empirical or practical) were in a recent decision that had been made. Backwards stepwise logistic regression analyses were undertaken to assess the contributions of age, gender and professional background, as well as the years of experience in NHS commissioning, pay grade and work role. The extent to which empirical evidence was used for commissioning decisions in the NHS varied according to the professional background. Only 50% of respondents stated that clinical guidelines and cost-effectiveness evidence were important for healthcare decisions. Respondents were more likely to report use of empirical evidence if they worked in Public Health in comparison to other departments (pfinance OR  0.19, 95%CI 0.05 to 0.78, other departments OR 0.35, 95%CI 0.17 to 0.71) or if they were female (OR 1.8 95% CI 1.01 to 3.1) rather than male. Respondents were more likely to report use of practical evidence if they were more senior within the organisation (pay grade 8b or higher OR 2.7, 95%CI 1.4 to 5.3, p=0.004 in comparison to lower pay grades). Those trained in Public Health appeared more likely to use external empirical evidence while those at higher pay scales were more likely to use practical evidence when making commissioning decisions. Clearly, National Institute for Clinical Excellence (NICE) guidance and government publications (eg, National Service

Evidence-based commissioning in the English NHS: who uses which sources of evidence? A survey 2010/2011

Science.gov (United States)

Clarke, Aileen; Taylor-Phillips, Sian; Swan, Jacky; Gkeredakis, Emmanouil; Mills, Penny; Powell, John; Nicolini, Davide; Roginski, Claudia; Scarbrough, Harry; Grove, Amy

2013-01-01

Objectives To investigate types of evidence used by healthcare commissioners when making decisions and whether decisions were influenced by commissioners’ experience, personal characteristics or role at work. Design Cross-sectional survey of 345 National Health Service (NHS) staff members. Setting The study was conducted across 11 English Primary Care Trusts between 2010 and 2011. Participants A total of 440 staff involved in commissioning decisions and employed at NHS band 7 or above were invited to participate in the study. Of those, 345 (78%) completed all or a part of the survey. Main outcome measures Participants were asked to rate how important different sources of evidence (empirical or practical) were in a recent decision that had been made. Backwards stepwise logistic regression analyses were undertaken to assess the contributions of age, gender and professional background, as well as the years of experience in NHS commissioning, pay grade and work role. Results The extent to which empirical evidence was used for commissioning decisions in the NHS varied according to the professional background. Only 50% of respondents stated that clinical guidelines and cost-effectiveness evidence were important for healthcare decisions. Respondents were more likely to report use of empirical evidence if they worked in Public Health in comparison to other departments (pfinance OR  0.19, 95%CI 0.05 to 0.78, other departments OR 0.35, 95%CI 0.17 to 0.71) or if they were female (OR 1.8 95% CI 1.01 to 3.1) rather than male. Respondents were more likely to report use of practical evidence if they were more senior within the organisation (pay grade 8b or higher OR 2.7, 95%CI 1.4 to 5.3, p=0.004 in comparison to lower pay grades). Conclusions Those trained in Public Health appeared more likely to use external empirical evidence while those at higher pay scales were more likely to use practical evidence when making commissioning decisions. Clearly, National Institute for

Five-year workplace wellness intervention in the NHS.

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Blake, Holly; Zhou, Dingyuan; Batt, Mark E

2013-09-01

Poor health and well-being has been observed among NHS staff and has become a key focus in current public health policy. The objective of this study was to deliver and evaluate a five-year employee wellness programme aimed at improving the health and well-being of employees in a large NHS workplace. A theory-driven multi-level ecological workplace wellness intervention was delivered including health campaigns, provision of facilities and health-promotion activities to encourage employees to make healthy lifestyle choices and sustained behaviour changes. An employee questionnaire survey was distributed at baseline (n = 1,452) and at five years (n = 1,134), including measures of physical activity, BMI, diet, self-efficacy, social support, perceived general health and mood, smoking behaviours, self-reported sickness absence, perceived work performance and job satisfaction. Samples were comparable at baseline and follow-up. At five years, significantly more respondents actively travelled (by walking or cycling both to work and for non-work trips) and more were active while at work. Significantly more respondents met current recommendations for physical activity at five years than at baseline. Fewer employers reported 'lack of time' as a barrier to being physically active following the intervention. Significantly lower sickness absence, greater job satisfaction and greater organisational commitment was reported at five years than at baseline. Improvements in health behaviours, reductions in sickness absence and improvements in job satisfaction and organisational commitment were observed following five years of a workplace wellness intervention for NHS employees. These findings suggest that health-promoting programmes should be embedded within NHS infrastructure.

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

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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/

Downsizing of acute inpatient beds associated with private finance initiative: Scotland's case study

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Dunnigan, Matthew G; Pollock, Allyson M

2003-01-01

Objectives To evaluate whether the projected 24% reduction in acute bed numbers in Lothian hospitals, which formed part of the private finance initiative (PFI) plans for the replacement Royal Infirmary of Edinburgh, is being compensated for by improvements in efficiency and greater use of community facilities, and to ascertain whether there is an independent PFI effect by comparing clinical activity and performance in acute specialties in Lothian hospitals with other NHS hospitals in Scotland. Design Comparison of projected and actual trends in acute bed capacity and inpatient and day case admissions in the first five years (1995-6 to 2000-1) of Lothian Health Board's integrated healthcare plan. Population study of trends in bed rate, hospital activity, length of stay, and throughput in Lothian hospitals compared with the rest of Scotland from 1990-1 to 2000-1. Main outcome measures Staffed bed rates, admission rates, mean lengths of stay, occupancy, and throughput in four adult acute specialty groups in 1990-1, 1995-6, and 2000-1. Results By 2000-1, rates for inpatient admission in all acute, medical, surgical, and intensive therapy specialties in Lothian hospitals were respectively 20%, 6%, 28%, and 38% below those in the rest of Scotland. Day case rates in all acute and acute surgical specialties were 13% and 33% lower. The proportion of delayed discharges in staffed acute and post-acute NHS beds in Lothian hospitals exceeded the Scottish average (15% and 12% respectively; Pfinance initiative (PFI) hospitals in England and Scotland projected reductions in acute beds of about 30% in the five years before the opening of the new replacement hospitalsThe new PFI Royal Infirmary of Edinburgh, which will fully open in 2003, is the cornerstone of Lothian Health Board's healthcare plan for its acute hospitalsWhat this study addsCompared with other Scottish NHS hospitals, service delivery has been reduced across Lothian associated with PFI developmentThe planning targets

Out-of-hours MRI provision in the UK and models of service delivery

International Nuclear Information System (INIS)

Hauptfleisch, J.; Meagher, T.M.; King, D.; López de Heredia, L.; Hughes, R.J.

2013-01-01

Aim: To examine current out-of-hours magnetic resonance imaging (MRI) provision through a snapshot survey of National Health Service (NHS) trusts and to assay how radiographer staffing cover was provided for out-of-hours services. Materials and methods: A snapshot postal survey was mailed to heads of service of all 234 trusts in England and Wales. A literature search on the models of service delivery and correlation with the authors' internal MRI rota, which has provided a full on-call service for 20 years was undertaken. Results: The response rate was 45.7% (107 of 234); 14% of responders provided full access to MRI 24 h a day; 63% provided extended weekday service, typically to 20.00 h; and 81% provided a weekend daytime service. The radiographers running the service were typically from the core MRI team. Approximately one-third (29.9%) of trusts provided training in basic brain and spine MRI to non-core MRI team members, but they typically did not participate in out-of-hours provision. Conclusion: There is currently a paucity of information on the provision of out-of-hours MRI in the NHS. However, there is increasing pressure to provide complex imaging out of hours, and in the future, trauma centres may be required to provide MRI to assess spinal injury. The authors describe a system to provide access to MRI at no additional cost to the organization based on 20 years of experience. A minority of surveyed acute NHS trusts have full out-of-hours access to MRI. Demand for MRI provision out of core hours is likely to increase

Approaches to leadership and managing change in the NHS.

Science.gov (United States)

Lumbers, Melanie

2018-05-24

The NHS is continually changing as research evidence leads to new practices and technology transforms the workplace. Resistance to some changes may occur because of staff fears about adapting to and coping with new methods. This is where change models and leadership are important. This article discusses changes taking place in the NHS, and some theoretical models of change. Leadership styles are also discussed, including those most useful for the nurse to use when leading a team and implementing change.

Organisational culture and post-merger integration in an academic health centre: a mixed-methods study.

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Ovseiko, Pavel V; Melham, Karen; Fowler, Jan; Buchan, Alastair M

2015-01-22

Around the world, the last two decades have been characterised by an increase in the numbers of mergers between healthcare providers, including some of the most prestigious university hospitals and academic health centres. However, many mergers fail to bring the anticipated benefits, and successful post-merger integration in university hospitals and academic health centres is even harder to achieve. An increasing body of literature suggests that organisational culture affects the success of post-merger integration and academic-clinical collaboration. This paper reports findings from a mixed-methods single-site study to examine 1) the perceptions of organisational culture in academic and clinical enterprises at one National Health Service (NHS) trust, and 2) the major cultural issues for its post-merger integration with another NHS trust and strategic partnership with a university. From the entire population of 72 clinician-scientists at one of the legacy NHS trusts, 38 (53%) completed a quantitative Competing Values Framework survey and 24 (33%) also provided qualitative responses. The survey was followed up by semi-structured interviews with six clinician-scientists and a group discussion including five senior managers. The cultures of two legacy NHS trusts differed and were primarily distinct from the culture of the academic enterprise. Major cultural issues were related to the relative size, influence, and history of the legacy NHS trusts, and the implications of these for respective identities, clinical services, and finances. Strategic partnership with a university served as an important ameliorating consideration in reaching trust merger. However, some aspects of university entrepreneurial culture are difficult to reconcile with the NHS service delivery model and may create tension. There are challenges in preserving a more desirable culture at one of the legacy NHS trusts, enhancing cultures in both legacy NHS trusts during their post-merger integration, and

Job evaluation for clinical nursing jobs by implementing the NHS JE system.

Science.gov (United States)

Kahya, Emin; Oral, Nurten

2007-10-01

The purpose of this paper was to evaluate locally all the clinical nursing jobs implementing the NHS JE system in four hospitals. The NHS JE was developed by the Department of Health in the UK in 2003-2004. A job analysis questionnaire was designed to gather current job descriptions. It was distributed to each of 158 clinical nurses and supervisor nurses in 31 variety clinics at four hospitals in one city. The questionnaires were analysed to evaluate locally all the identified 94 nursing jobs. Fourteen of 19 nursing jobs in the medical and surgical clinics can be matched to the nurse national job in the NHS JE system. The results indicated that two new nursing jobs titled nurse B and nurse advanced B should be added to the list of national nursing jobs in the NHS JE system.

Unmeasured improvement work: the lack of routinely collected, service-related data in NHS endoscopy units in England involved in "modernisation"

Directory of Open Access Journals (Sweden)

Hutchings Hayley A

2008-01-01

Full Text Available Abstract Background The availability of routinely collected service-related endoscopy data from NHS endoscopy units has never been quantified. Methods This retrospective observational study asked 19 endoscopy units to submit copies of all in-house, service-related endoscopy data that had been routinely collected by the unit – Referral numbers, Activity, Number of patients waiting and Number of lost slots. Nine of the endoscopy units had previously participated in the Modernising Endoscopy Services (MES project during 2003 to redesign their endoscopy services. These MES sites had access to additional funding and data collection software. The other ten (Control sites had modernised independently. All data was requested in two phases and corresponded to eight specific time points between January 2003 and April 2006. Results Only eight of 19 endoscopy units submitted routinely collected, service-related data. Another site's data was collected specifically for the study. A further two units claimed to routinely collect service-related data but did not submit any to the study. The remaining eight did not collect any service-related endoscopy data routinely and liaised with their Trust for data. Of the eight sites submitting service-related data, only three were MES project sites. Of these three, the data variables collected were limited and none collected the complete set of endoscopy data variables requested. Of the other five sites, two collected all four endoscopy data types. Data for the three MES project sites went back as far as January 2003, whilst the five Control sites were only able to submit data from December 2003 onwards. Conclusion There was a lack of service-related endoscopy data routinely collected by the study sites, especially those who had participated in the MES project. Without this data, NHS endoscopy services cannot have a true understanding of their services, cannot identify problems and cannot measure the impact of any

Xcat, a novel mouse model for Nance-Horan syndrome inhibits expression of the cytoplasmic-targeted Nhs1 isoform.

Science.gov (United States)

Huang, Kristen M; Wu, Junhua; Duncan, Melinda K; Moy, Chris; Dutra, Amalia; Favor, Jack; Da, Tong; Stambolian, Dwight

2006-01-15

Nance-Horan syndrome (NHS) is an X-linked disorder characterized by congenital cataracts, dental anomalies, dysmorphic features and mental retardation. A recent report suggests that the novel gene NHS1 is involved in this disorder due to the presence of point mutations in NHS patients. A possible mouse model for NHS, Xcat, was mapped to a 2.11 Mb interval on the X-chromosome. Sequence and FISH analysis of the X-chromosome region containing the Xcat mutation reveal a large insertion between exons 1 and 2 of the mouse Nhs1 gene. The insertion inhibits the expression of the Nhs1 isoform containing exon 1 and results in exclusive expression of the alternative isoform containing exon 1A. Quantitative RT-PCR of Xcat cDNA shows reduced levels of Nhs1 transcripts. The Nhs1 protein is strongly expressed within the cytoplasm of elongating lens fiber cells from wild-type neonate lens, but is significantly reduced within the Xcat lens. Transient transfection studies of CHO cells with Nhs1-GFP fusion proteins were done to determine whether the amino acids encoded by exon 1 were critical for protein localization. We found the presence of Nhs1 exon 1 critical for localization of the fusion protein to the cytoplasm, whereas fusion proteins lacking Nhs1 exon 1 are predominantly nuclear. These results indicate that the first exon of Nhs1 contains crucial information required for the proper expression and localization of Nhs1 protein. Inhibition of expression of the exon 1 containing isoform results in the abnormal phenotype of Xcat.

The fallacy of choice in the common law and NHS policy.

Science.gov (United States)

Whiteman, Ingrid

2013-06-01

Neither the English courts nor the National Health Service (NHS) have been immune to the modern mantra of patient choice. This article examines whether beneath the rhetoric any form of real choice is endorsed either in law or in NHS policy. I explore the case law on 'consent', look at choice within the NHS and highlight the dilemmas that a mismatch of language and practice poses for clinicians. Given the variance in interpretation and lack of consistency for the individual patient I argue for a semantic change that obviates the use of 'choice', focussing instead on the options for treatment that are available and accessible, with due acknowledgement of individual patient preferences, without raising unfettered and false expectations.

Never trust a croup…

Science.gov (United States)

Nickinson, Andrew; Minhas, Jatinder Singh; Bhalla, Minak; Anwuzia-Iwegbu, Charles; Chapman, John

2011-01-01

A 2-year-old girl presented to the James Paget University Hospitals Trust with croup-like symptoms and was later discharged with dexamethasone syrup. The patient re-presented 6 h later following maternal concern with signs of acute respiratory distress. After a period of clinical stability, she acutely decompensated without any prior signs of a life-threatening deterioration. She was managed using nebulised epinephrine and showed signs of clinical improvement. Although improvement persisted, the child showed signs of exhaustion following the preceding events and was later intubed with an endotracheal tube and transferred to the paediatric intensive care unit at Addenbrooke’s University Hospital, Cambridge. Endotracheal aspiration later grew parainfluenza virus, rhinovirus and Staphylococcus aureus and the patient was diagnosed with the exceptionally rare life threatening complications of croup, bacterial tracheitis. The patient was discharged from intensive care 7 days later and has since made a full recovery. PMID:22689599

Secondary analysis of hospital patient experience scores across England's National Health Service - How much has improved since 2005?

Directory of Open Access Journals (Sweden)

Kate Honeyford

Full Text Available To examine trends in patient experience and consistency between hospital trusts and settings.Observational study of publicly available patient experience surveys of three hospital settings (inpatients (IP, accident and emergency (A&E and outpatients (OP of 130 acute NHS hospital trusts in England between 2004/05 and 2014/15.Overall patient experience has been good, showing modest improvements over time across the three hospital settings. Individual questions with the biggest improvement across all three settings are cleanliness (IP: +7.1, A&E: +6.5, OP: +4.7 and information about danger signals (IP: +3.8, A&E: +3.9, OP: +4.0. Trust performance has been consistent over time: 71.5% of trusts ranked in the same cluster for more than five years. There is some consistency across settings, especially between outpatients and inpatients. The lowest-scoring questions, regarding information at discharge, are the same in all years and all settings.The greatest improvement across all three settings has been for cleanliness, which has seen national policies and targets. Information about danger signals and medication side-effects showed least consistency across settings and scores have remained low over time, despite information about danger signals showing a big increase in score. Patient experience of aspects of access and waiting have declined, as has experience of discharge delay, likely reflecting known increases in pressure on England's NHS.

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...

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...

Clinical psychologists' experiences of NHS organisational change

OpenAIRE

Colley, Rich; Eccles, Fiona; Hutton, Cheryl

2015-01-01

Organisational-change experiences of eight clinical psychologists working in the NHS were captured. Three themes revealed the challenges they experienced and how their knowledge and skills have helped them understand, cope with, and respond to change.

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...

A review of the evidence concerning hepatic glutathione depletion and susceptibility to hepatotoxicity after paracetamol overdose

Directory of Open Access Journals (Sweden)

Kalsi SS

2011-12-01

Full Text Available Sarbjeet S Kalsi1,2, Paul I Dargan2–4, W Stephen Waring5, David M Wood2–41Emergency Department, Guy’s and St Thomas’ NHS Foundation Trust, London, UK; 2Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK; 3King’s Health Partners, London, UK; 4King’s College London, London, UK; 5York Teaching Hospital NHS Foundation Trust, York, UKAbstract: Paracetamol (acetaminophen poisoning is common throughout the world. The management of nonstaggered (acute paracetamol overdose is based on the plasma paracetamol concentration plotted on a treatment nomogram. In the UK there are two treatment lines on this nomogram, with the lower treatment line used for individuals felt to be at ‘high risk’ of paracetamol-related hepatotoxicity either as a result of induction of cytochrome P450 isoenzymes or reduction of intrahepatic glutathione. In this article we review the risk factors that, in current guidelines, are felt to increase risk due to a reduction in intrahepatic glutathione concentrations. Based on our review of the published literature, we feel that cystic fibrosis, acute viral illness, malnutrition, and eating disorders such as anorexia nervosa are likely to be associated with reduction in intrahepatic glutathione concentrations, and that this risk is likely to be related to malnutrition secondary to the disease. Chronic hepatitis C infection is also associated with reduced glutathione concentrations, although this appears to be independent of any associated malnutrition. Ageing and acute fasting are not associated with an increased risk of paracetamol-related hepatotoxicity due to reductions in glutathione concentrations. Finally, the evidence for HIV infection is inconclusive, particularly as the majority of studies were conducted in the pre-anti-viral treatment (HAART era; however it is likely that patients with symptomatic HIV/AIDS have reduced glutathione concentrations due to associated malnutrition. Although

Novel causative mutations in patients with Nance-Horan syndrome and altered localization of the mutant NHS-A protein isoform

OpenAIRE

Sharma, Shiwani; Burdon, Kathryn P.; Dave, Alpana; Jamieson, Robyn V.; Yaron, Yuval; Billson, Frank; Van Maldergem, Lionel; Lorenz, Birgit; Gécz, Jozef; Craig, Jamie E.

2008-01-01

Purpose Nance-Horan syndrome is typically characterized by severe bilateral congenital cataracts and dental abnormalities. Truncating mutations in the Nance-Horan syndrome (NHS) gene cause this X-linked genetic disorder. NHS encodes two isoforms, NHS-A and NHS-1A. The ocular lens expresses NHS-A, the epithelial and neuronal cell specific isoform. The NHS-A protein localizes in the lens epithelium at the cellular periphery. The data to date suggest a role for this isoform at cell-cell junction...

An investigation into dental digital radiography in dental practices in West Kent following the introduction of the 2006 NHS General Dental Services contract.

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Mauthe, Peter W; Eaton, Kenneth A

2011-04-01

The primary aims of the study were to investigate the use of digital radiography within primary dental care practices in the West Kent Primary Care Trust (PCT) area and general dental practitioners' (GDPs) self-reported change in radiographic prescribing patterns following the introduction of the nGDS contract in 2006. Data were gathered via a piloted, self-completed questionnaire, and circulated to all GDPs listed on the National Health Service (NHS) Choices website as practising in the West Kent PCT area. There were three mailings and follow-up telephone calls. The resulting data were entered into a statistical software database and, where relevant, statistically tested, using the chi-square test and Pearson correlation coefficient. Of 223 GDPs, 168 (75%) responded. There were 163 usable questionnaires. The respondents represented 85% of the general dental practices in West Kent. Eighty (49%) respondents were using digital intra-oral radiography. Of those who used digital radiography, 44 (55%) reported that they used phosphor plate systems and 36 (45%) that they used direct digital sensors. Eighty-three (51%) had a panoramic machine in their practice, 46 of whom (55%) were using digital systems; of these, 32 (67%) were using a direct digital system. Seventy-one GDPs reported that they worked exclusively or mainly in private practice. Forty (56%) of these 'mainly private' GDPs reported that they used digital radiographic systems, whereas only 40 (44%) of the 89 'mainly NHS' GDPs reported using digital radio-graphic systems. On average, mainly private GDPs made the transition to a digital radiographic system six months before mainly NHS GDPs. Of those who provided NHS dentistry before and after April 2006, only 18 (14%) reported taking fewer radiographs and seven (6%) taking more. In February 2010, of the West Kent GDPs who responded to the questionnaire, just under 50% used digital radio graphy. Mainly private GDPs were more likely to use digital radiography than

Team performance in the Italian NHS: the role of reflexivity.

Science.gov (United States)

Urbini, Flavio; Callea, Antonino; Chirumbolo, Antonio; Talamo, Alessandra; Ingusci, Emanuela; Ciavolino, Enrico

2018-04-09

Purpose The purpose of this paper is twofold: first, to investigate the goodness of the input-process-output (IPO) model in order to evaluate work team performance within the Italian National Health Care System (NHS); and second, to test the mediating role of reflexivity as an overarching process factor between input and output. Design/methodology/approach The Italian version of the Aston Team Performance Inventory was administered to 351 employees working in teams in the Italian NHS. Mediation analyses with latent variables were performed via structural equation modeling (SEM); the significance of total, direct, and indirect effect was tested via bootstrapping. Findings Underpinned by the IPO framework, the results of SEM supported mediational hypotheses. First, the application of the IPO model in the Italian NHS showed adequate fit indices, showing that the process mediates the relationship between input and output factors. Second, reflexivity mediated the relationship between input and output, influencing some aspects of team performance. Practical implications The results provide useful information for HRM policies improving process dimensions of the IPO model via the mediating role of reflexivity as a key role in team performance. Originality/value This study is one of a limited number of studies that applied the IPO model in the Italian NHS. Moreover, no study has yet examined the role of reflexivity as a mediator between input and output factors in the IPO model.

The NHS and market forces in healthcare: the need for organisational ethics.

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Frith, Lucy

2013-01-01

The NHS in England is an organisation undergoing substantial change. The passage of the Health and Social Care Act 2012, consolidates and builds on previous health policies and introduces further 'market-style' reforms of the NHS. One of the main aspects of these reforms is to encourage private and third sector providers to deliver NHS services. The rationale for this is to foster a more competitive market in healthcare to encourage greater efficiency and innovation. This changing healthcare environment in the English NHS sharpens the need for attention to be paid to the ethical operation of healthcare organisations. All healthcare organisations need to consider the ethical aspects of their operation, whether state or privately run. However, the changes in the type of organisations used to provide healthcare (such as commercial companies) can create new relationships and ethical tensions. This paper will chart the development of organisational ethics as a concern in applied ethics and how it arose in the USA largely owing to changes in the organisation of healthcare financing and provision. It will be argued that an analogous transition is happening in the NHS in England. The paper will conclude with suggestions for the development of organisational ethics programmes to address some of the possible ethical issues raised by this new healthcare environment that incorporates both private and public sector providers.

The cost of ignoring acute cholecystectomy.

Science.gov (United States)

Garner, J P; Sood, S K; Robinson, J; Barber, W; Ravi, K

2009-01-01

Biliary symptoms whilst awaiting elective cholecystectomy are common, resulting in hospital admission, further investigation and increased hospital costs. Immediate cholecystectomy during the first admission is safe and effective, even when performed laparoscopically, but acute laparoscopic cholecystectomy has only recently become increasingly commonplace in the UK. This study was designed to quantify this problem in our hospital and its cost implications. The case notes of all patients undergoing laparoscopic cholecystectomy in our hospital between January 2004 and June 2005 were examined for details of hospital admissions with biliary symptoms or complications whilst waiting for elective cholecystectomy. Additional bed occupancy and radiological investigations were recorded and these costs to the trust calculated. We compared the potential tariff income to the hospital trust for the actual management of these patients and if a policy of acute laparoscopic cholecystectomy on first admission were in place. In the 18-month study period, 259 patients (202 females) underwent laparoscopic cholecystectomy. Of these, 147 presented as out-patients and only 11% required hospital admission because of biliary symptoms whilst waiting for elective surgery. There were 112 patients who initially presented acutely and were managed conservatively. Twenty-four patients were re-admitted 37 times, which utilised 231 hospital bed-days and repeat investigations costing over 40,000 pounds. There would have been a marginal increase in tariff income if a policy of acute laparoscopic cholecystectomy had been in place. Adoption of a policy of acute laparoscopic cholecystectomy on the index admission would result in substantial cost savings to the trust, reduce elective cholecystectomy waiting times and increase tariff income.

Green pioneers.

Science.gov (United States)

Trueland, Jennifer

The government has set tough targets for the NHS in England to reduce its carbon footprint. In this article, nurses and managers at Nottinghamshire Healthcare NHS Trust explain how a programme of 'greening' initiatives - including a trial of electric cars for community staff - have slashed the trust's CO2 output.

'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

Differential biotin labelling of the cell envelope proteins in lipopolysaccharidic diderm bacteria: Exploring the proteosurfaceome of Escherichia coli using sulfo-NHS-SS-biotin and sulfo-NHS-PEG4-bismannose-SS-biotin.

Science.gov (United States)

Monteiro, Ricardo; Chafsey, Ingrid; Leroy, Sabine; Chambon, Christophe; Hébraud, Michel; Livrelli, Valérie; Pizza, Mariagrazia; Pezzicoli, Alfredo; Desvaux, Mickaël

2018-06-15

Surface proteins are the major factor for the interaction between bacteria and its environment, playing an important role in infection, colonisation, virulence and adaptation. However, the study of surface proteins has proven difficult mainly due to their hydrophobicity and/or relatively low abundance compared with cytoplasmic proteins. To overcome these issues new proteomic strategies have been developed, such as cell-surface protein labelling using biotinylation reagents. Sulfo-NHS-SS-biotin is the most commonly used reagent to investigate the proteins expressed at the cell surface of various organisms but its use in lipopolysaccharidic diderm bacteria (archetypical Gram-negative bacteria) remains limited to a handful of species. While generally pass over in silence, some periplasmic proteins, but also some inner membrane lipoproteins, integral membrane proteins and cytoplasmic proteins (cytoproteins) are systematically identified following this approach. To limit cell lysis and diffusion of the sulfo-NHS-SS-biotin through the outer membrane, biotin labelling was tested over short incubation times and proved to be as efficient for 1 min at room temperature. To further limit labelling of protein located below the outer membrane, the use of high-molecular weight sulfo-NHS-PEG4-bismannose-SS-biotin appeared to recover differentially cell-envelope proteins compared to low-molecular weight sulfo-NHS-SS-biotin. Actually, the sulfo-NHS-SS-biotin recovers at a higher extent the proteins completely or partly exposed in the periplasm than sulfo-NHS-PEG4-bismannose-SS-biotin, namely periplasmic and integral membrane proteins as well as inner membrane and outer membrane lipoproteins. These results highlight that protein labelling using biotinylation reagents of different sizes provides a sophisticated and accurate way to differentially explore the cell envelope proteome of lipopolysaccharidic diderm bacteria. While generally pass over in silence, some periplasmic proteins

Market--what market? A review of Health Authority purchasing in the NHS internal market.

Science.gov (United States)

West, P A

1998-05-01

This paper argues that the British NHS Reforms (the 'Reforms') set out in Working for Patients [1] largely failed to create a market, to achieve the changes that market forces might have been expected to achieve or to meet the objectives set for the NHS in Working for Patients. It draws on the available literature and the author's experience of work with the NHS during the 6 years after Working for Patients. It is hampered, as are all such reviews of the UK Reforms, by the lack of a detailed and systematic research appraisal of the internal market. Many small changes, resulting from market mechanisms, may have occurred throughout the NHS without being publicized or well documented. But overall, there is little convincing evidence that the Reforms have achieved their goals or met the objectives of the politicians who initiated them. The argument here is necessarily limited by the space available (but see [2] for a detailed analysis of the NHS Reforms). The initial sections of the paper examine the characteristics of markets and market power and the extent to which the NHS Reforms created a market, with health authorities and fund-holders as its buyers. The paper concentrates in particular on health authorities. Later sections then examine the extent to which the Reforms met the objectives set out in Working for Patients.

The barriers to and enablers of providing reasonably adjusted health services to people with intellectual disabilities in acute hospitals: evidence from a mixed-methods study.

Science.gov (United States)

Tuffrey-Wijne, Irene; Goulding, Lucy; Giatras, Nikoletta; Abraham, Elisabeth; Gillard, Steve; White, Sarah; Edwards, Christine; Hollins, Sheila

2014-04-16

To identify the factors that promote and compromise the implementation of reasonably adjusted healthcare services for patients with intellectual disabilities in acute National Health Service (NHS) hospitals. A mixed-methods study involving interviews, questionnaires and participant observation (July 2011-March 2013). Six acute NHS hospital trusts in England. Reasonable adjustments for people with intellectual disabilities were identified through the literature. Data were collected on implementation and staff understanding of these adjustments. Data collected included staff questionnaires (n=990), staff interviews (n=68), interviews with adults with intellectual disabilities (n=33), questionnaires (n=88) and interviews (n=37) with carers of patients with intellectual disabilities, and expert panel discussions (n=42). Hospital strategies that supported implementation of reasonable adjustments did not reliably translate into consistent provision of such adjustments. Good practice often depended on the knowledge, understanding and flexibility of individual staff and teams, leading to the delivery of reasonable adjustments being haphazard throughout the organisation. Major barriers included: lack of effective systems for identifying and flagging patients with intellectual disabilities, lack of staff understanding of the reasonable adjustments that may be needed, lack of clear lines of responsibility and accountability for implementing reasonable adjustments, and lack of allocation of additional funding and resources. Key enablers were the Intellectual Disability Liaison Nurse and the ward manager. The evidence suggests that ward culture, staff attitudes and staff knowledge are crucial in ensuring that hospital services are accessible to vulnerable patients. The authors suggest that flagging the need for specific reasonable adjustments, rather than the vulnerable condition itself, may address some of the barriers. Further research is recommended that describes and

The most dangerous hospital or the most dangerous equation?

Science.gov (United States)

Tu, Yu-Kang; Gilthorpe, Mark S

2007-11-15

Hospital mortality rates are one of the most frequently selected indicators for measuring the performance of NHS Trusts. A recent article in a national newspaper named the hospital with the highest or lowest mortality in the 2005/6 financial year; a report by the organization Dr Foster Intelligence provided information with regard to the performance of all NHS Trusts in England. Basic statistical theory and computer simulations were used to explore the relationship between the variations in the performance of NHS Trusts and the sizes of the Trusts. Data of hospital standardised mortality ratio (HSMR) of 152 English NHS Trusts for 2005/6 were re-analysed. A close examination of the information reveals a pattern which is consistent with a statistical phenomenon, discovered by the French mathematician de Moivre nearly 300 years ago, described in every introductory statistics textbook: namely that variation in performance indicators is expected to be greater in small Trusts and smaller in large Trusts. From a statistical viewpoint, the number of deaths in a hospital is not in proportion to the size of the hospital, but is proportional to the square root of its size. Therefore, it is not surprising to note that small hospitals are more likely to occur at the top and the bottom of league tables, whilst mortality rates are independent of hospital sizes. This statistical phenomenon needs to be taken into account in the comparison of hospital Trusts performance, especially with regard to policy decisions.

Do NHS walk-in centres in England provide a model of integrated care?

Directory of Open Access Journals (Sweden)

C. Salisbury

2003-08-01

Full Text Available Purpose: To undertake a comprehensive evaluation of NHS walk-in centres against criteria of improved access, quality, user satisfaction and efficiency. Context: Forty NHS walk-in centres have been opened in England, as part of the UK governments agenda to modernise the NHS. They are intended to improve access to primary care, provide high quality treatment at convenient times, and reduce inappropriate demand on other NHS providers. Care is provided by nurses rather than doctors, using computerised algorithms, and nurses use protocols to supply treatments previously only available from doctors. Data sources: Several linked studies were conducted using different sources of data and methodologies. These included routinely collected data, site visits, patient interviews, a survey of users of walk-in centres, a study using simulated patients to assess quality of care, analysis of consultation rates in NHS services near to walk-in centres, and audit of compliance with protocols. Conclusion & discussion: The findings illustrate many of the issues described in a recent WHO reflective paper on Integrated Care, including tensions between professional judgement and use of protocols, problems with incompatible IT systems, balancing users' demands and needs, the importance of understanding health professionals' roles and issues of technical versus allocative efficiency.

NHS constitution values for values-based recruitment: a virtue ethics perspective.

Science.gov (United States)

Groothuizen, Johanna Elise; Callwood, Alison; Gallagher, Ann

2018-05-17

Values-based recruitment is used in England to select healthcare staff, trainees and students on the basis that their values align with those stated in the Constitution of the UK National Health Service (NHS). However, it is unclear whether the extensive body of existing literature within the field of moral philosophy was taken into account when developing these values. Although most values have a long historical tradition, a tendency to assume that they have just been invented, and to approach them uncritically, exists within the healthcare sector. Reflection is necessary. We are of the opinion that selected virtue ethics writings, which are underpinned by historical literature as well as practical analysis of the healthcare professions, provide a helpful framework for evaluation of the NHS Constitution values, to determine whether gaps exist and improvements can be made. Based on this evaluation, we argue that the definitions of certain NHS Constitution values are ambiguous. In addition to this, we argue that 'integrity' and 'practical wisdom', two important concepts in the virtue ethics literature, are not sufficiently represented within the NHS Constitution values. We believe that the NHS Constitution values could be strengthened by providing clearer definitions, and by integrating 'integrity' and 'practical wisdom'. This will benefit values-based recruitment strategies. Should healthcare policy-makers in other countries wish to develop a similar values-based recruitment framework, we advise that they proceed reflectively, and take previously published virtue ethics literature into consideration. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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.

Employee engagement within the NHS: a cross-sectional study.

Science.gov (United States)

Jeve, Yadava Bapurao; Oppenheimer, Christina; Konje, Justin

2015-02-01

Employee engagement is the emotional commitment of the employee towards the organisation. We aimed to analyse baseline work engagement using Utrecht Work Engagement Scale (UWES) at a teaching hospital. We have conducted a cross-sectional study within the National Health Service (NHS) Teaching Hospital in the UK. All participants were working age population from both genders directly employed by the hospital. UWES has three constituting dimensions of work engagement as vigor, dedication, and absorption. We conducted the study using UWES-9 tool. Outcome measures were mean score for each dimension of work engagement (vigor, dedication, absorption) and total score compared with control score from test manual. We found that the score for vigor and dedication is significantly lower than comparison group (Pengagement level is below average within the NHS employees. Vigor and dedication are significantly lower, these are characterised by energy, mental resilience, the willingness to invest one's effort, and persistence as well as a sense of significance, enthusiasm, inspiration, pride, and challenge. The NHS employees are immersed in work. Urgent need to explore strategies to improve work engagement as it is vital for improving productivity, safety and patient experience.

The early NHS and the crisis of public health nursing.

Science.gov (United States)

Webster, C

2000-01-01

Establishment of the NHS in 1948 is rightly seen as a major turning point in health care in the United Kingdom. Notwithstanding conditions of severe austerity, the NHS succeeded remarkably well in its basic remit to make all essential medical care available to the entire population, free at point of delivery. The benefits of the new system extended across the entire front of its services. However, it is important to recognise that the reforms of 1948 were uniformly advantageous. It has for instance long been recognised that the NHS failed to bring about the expected transformation in standards of general medical practice. In this short paper the author argues that public health represented a further major sphere of underdevelopment. The fact that, with minor exceptions, public health is the least studied aspect of the early NHS is itself suggestive of its status as the Cinderella of the modern health services. The author also underlines the adverse implications of this inferior position for domiciliary midwifery, district nursing and health visiting. These constituted small but strategically important sectors of nursing, all of which fell under public health administration in the new health service. The author concentrates on the first phase of the NHS, the period between 1948 and 1974, now often regarded as its golden age. For the purposes of this discussion, most of the evidence relates to the formative phase of the new service, when many major policy questions relating to public health were first confronted. It is suggested that the early neglect of public health and its constituent nursing functions has left a legacy of problems that have still not entirely been resolved. For the purposes of this paper the term will be used to embrace the totality of health functions administered by departments of local government in the period from 1948 to 1974. Most of these services fell within the public health departments of local government, headed by the Medical Office

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.

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 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…

Fluorescence studies on the aggregation behaviors of collagen modified with NHS-activated poly(γ-glutamic acid).

Science.gov (United States)

Zhang, Min; Yang, Junhui; Yang, Qili; Huang, Liulian; Wu, Hui; Chen, Lihui; Ding, Cuicui

2018-06-01

The poly(γ-glutamic acid)-NHS (γ-PGA-NHS) esters were used to endow collagen with both of excellent water-solubility and thermal stability via cross-linking reaction between γ-PGA-NHS and collagen. In the present work, the effect of γ-PGA-NHS on the aggregation of collagen molecules was studied by fluorescence techniques. The fluorescence emission spectra of pyrene in collagen solutions and the intrinsic fluorescence emission spectra of collagen suggested different effects of γ-PGA-NHS on collagen molecules: inhibiting aggregation below critical aggregation concentration (CAC) and promoting aggregation above CAC. The two-dimensional (2D) fluorescence correlation spectra indicated that the intermolecular hydrogen bonding and cross-linking between γ-PGA-NHS and collagen would influence the aggregation of collagen molecules. By the ultra-sensitive differential scanning calorimeter (VP-DSC), it was found that the main denaturational transition temperature (T m2 ) of modified collagen increased, while its calorimetric enthalpy changes (ΔH 2 ) decreased compared to those of native collagen, further indicating that the modification of γ-PGA-NHS influenced the aggregation of collagen molecules. The study provide useful information for the utilizing and or the processing of water-soluble collagen in aqueous solution in the fields such as cosmetics, health care products, tissue engineering and biomedical materials, etc. Copyright © 2018 Elsevier B.V. All rights reserved.

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.

The design of a corporate identity for a department of medical illustration: a case study.

Science.gov (United States)

Thompson, G

2001-06-01

This paper outlines the author's attempt to design and introduce a corporate identity into the Department of Medical Illustration at the South Buckinghamshire NHS Trust. It is intended to furnish the reader with an insight into the process of designing a corporate identity and to relate one department's experience. This may be useful for those who wish to develop a corporate identity of their own or contribute, as a department, towards an identity for their own Trust or other institution. A major change in government policy about the identity of NHS Trusts has meant that use of the department's new logo has had to be abandoned in favour of the new NHS corporate identity.

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...

Can Six Sigma be the "cure" for our "ailing" NHS?

Science.gov (United States)

Antony, Jiju; Downey-Ennis, Kay; Antony, Frenie; Seow, Chris

2007-01-01

The purpose of this research is to analyse whether Six Sigma business strategy can be used to improve the financial and operational performance of the NHS. The paper will also look at some of the major challenges and barriers in the implementation of this powerful process improvement strategy within the healthcare sector. This paper discusses whether Six Sigma DMAIC methodology can be a useful and disciplined approach to tackle process- and quality-related problems in the NHS. The paper presents some key findings from other researchers in the field, followed by some comments on whether Six Sigma is a useful approach to be considered by the NHS for cost reduction and defect reduction strategies. The paper illustrates the point that Six Sigma is not confined just to manufacturing industry, rather it is equally applicable to service industry, especially the healthcare and financial sectors. The application of Six Sigma in the UK health sector is relatively new and the purpose of the paper is to increase the awareness of this powerful business strategy in healthcare discipline.

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

Novel causative mutations in patients with Nance-Horan syndrome and altered localization of the mutant NHS-A protein isoform.

Science.gov (United States)

Sharma, Shiwani; Burdon, Kathryn P; Dave, Alpana; Jamieson, Robyn V; Yaron, Yuval; Billson, Frank; Van Maldergem, Lionel; Lorenz, Birgit; Gécz, Jozef; Craig, Jamie E

2008-01-01

Nance-Horan syndrome is typically characterized by severe bilateral congenital cataracts and dental abnormalities. Truncating mutations in the Nance-Horan syndrome (NHS) gene cause this X-linked genetic disorder. NHS encodes two isoforms, NHS-A and NHS-1A. The ocular lens expresses NHS-A, the epithelial and neuronal cell specific isoform. The NHS-A protein localizes in the lens epithelium at the cellular periphery. The data to date suggest a role for this isoform at cell-cell junctions in epithelial cells. This study aimed to identify the causative mutations in new patients diagnosed with Nance-Horan syndrome and to investigate the effect of mutations on subcellular localization of the NHS-A protein. All coding exons of NHS were screened for mutations by polymerase chain reaction (PCR) and sequencing. PCR-based mutagenesis was performed to introduce three independent mutations in the NHS-A cDNA. Expression and localization of the mutant proteins was determined in mammalian epithelial cells. Truncating mutations were found in 6 out of 10 unrelated patients from four countries. Each of four patients carried a novel mutation (R248X, P264fs, K1198fs, and I1302fs), and each of the two other patients carried two previously reported mutations (R373X and R879X). No mutation was found in the gene in four patients. Two disease-causing mutations (R134fs and R901X) and an artificial mutation (T1357fs) resulted in premature truncation of the NHS-A protein. All three mutant proteins failed to localize to the cellular periphery in epithelial cells and instead were found in the cytoplasm. This study brings the total number of mutations identified in NHS to 18. The mislocalization of the mutant NHS-A protein, revealed by mutation analysis, is expected to adversely affect cell-cell junctions in epithelial cells such as the lens epithelium, which may explain cataractogenesis in Nance-Horan syndrome patients. Mutation analysis also shed light on the significance of NHS-A regions for

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...

Provision of NHS generalist and specialist services to care homes in England: review of surveys.

Science.gov (United States)

Iliffe, Steve; Davies, Susan L; Gordon, Adam L; Schneider, Justine; Dening, Tom; Bowman, Clive; Gage, Heather; Martin, Finbarr C; Gladman, John R F; Victor, Christina; Meyer, Julienne; Goodman, Claire

2016-03-01

The number of beds in care homes (with and without nurses) in the United Kingdom is three times greater than the number of beds in National Health Service (NHS) hospitals. Care homes are predominantly owned by a range of commercial, not-for-profit or charitable providers and their residents have high levels of disability, frailty and co-morbidity. NHS support for care home residents is very variable, and it is unclear what models of clinical support work and are cost-effective. To critically evaluate how the NHS works with care homes. A review of surveys of NHS services provided to care homes that had been completed since 2008. It included published national surveys, local surveys commissioned by Primary Care organisations, studies from charities and academic centres, grey literature identified across the nine government regions, and information from care home, primary care and other research networks. Data extraction captured forms of NHS service provision for care homes in England in terms of frequency, location, focus and purpose. Five surveys focused primarily on general practitioner services, and 10 on specialist services to care home. Working relationships between the NHS and care homes lack structure and purpose and have generally evolved locally. There are wide variations in provision of both generalist and specialist healthcare services to care homes. Larger care home chains may take a systematic approach to both organising access to NHS generalist and specialist services, and to supplementing gaps with in-house provision. Access to dental care for care home residents appears to be particularly deficient. Historical differences in innovation and provision of NHS services, the complexities of collaborating across different sectors (private and public, health and social care, general and mental health), and variable levels of organisation of care homes, all lead to persistent and embedded inequity in the distribution of NHS resources to this population

Volunteering and overseas placements in the NHS: a survey of current activity.

Science.gov (United States)

Chatwin, John; Ackers, Louise

2016-10-19

The study aimed to establish current levels of overseas volunteering and placement activity across all staff grades within the National Health Service (NHS) in the North West of England. Cross-sectional survey. Descriptive statistics. 4 main regional hospitals in the North West of England, and additional NHS staff training events. Convenience sample of NHS staff (n=911). 911 NHS staff took part in the survey. The medical and dental staff group returned the highest number of responses (32.1%). 42% of staff reported some form of overseas volunteering or placement experience. Most staff took an international placement as students (33.6% men; 40.6% women). Medium-term placements were undertaken by 46.7% of men, and 52.5% of women. Settlement stays (ie, over 1 year) were reported by 7.6% men, and 8.3% women). The majority of respondents engaged in international placement were from the age groups incorporating 'below 25' to '41-50' (74%). Multiple placement experiences were uncommon: 2.5% of respondents reported three periods of overseas activity, and 1.5% reported four. All those with multiple placement experience came from the staff groups incorporating midwife/nurse/health visitor, and medical and dental. This survey captured a snapshot of current levels of volunteering and overseas placement activity across NHS staff grades in the North West. Owing to relatively homogenous organisational structures, findings are likely to broadly represent the position across the organisation as a whole. Although some degree of overseas placement activity is undertaken by a relatively high proportion of NHS staff, such activity is currently heavily skewed towards higher clinical staff grades. Significant numbers of allied health professionals and equivalent non-clinical cadres also report overseas experience, and we anticipate that the numbers will continue to rise if current policy initiatives gain momentum. Published by the BMJ Publishing Group Limited. For permission to use

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...

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

The National Health Service (NHS) at 70: some comparative reflections.

Science.gov (United States)

Tuohy, Carolyn H

2018-03-16

As the National Health Service (NHS) turns 70, it bears comparison with another universal system celebrating an anniversary this year: Canada's 50-year-old medicare model. Each system is iconically popular, and each revolves around a profession-state accommodation. Both the popularity and the central axis of each system have been tested by external shocks in the form of periodic fiscal cycles of investment and austerity, and internal stresses generating organizational cycles of centralization and decentralization. In addition, the English NHS has undergone periodic bursts of major policy change, which have arguably moved the system closer to the Canadian single-payer model.

The most dangerous hospital or the most dangerous equation?

Directory of Open Access Journals (Sweden)

Tu Yu-Kang

2007-11-01

Full Text Available Abstract Background Hospital mortality rates are one of the most frequently selected indicators for measuring the performance of NHS Trusts. A recent article in a national newspaper named the hospital with the highest or lowest mortality in the 2005/6 financial year; a report by the organization Dr Foster Intelligence provided information with regard to the performance of all NHS Trusts in England. Methods Basic statistical theory and computer simulations were used to explore the relationship between the variations in the performance of NHS Trusts and the sizes of the Trusts. Data of hospital standardised mortality ratio (HSMR of 152 English NHS Trusts for 2005/6 were re-analysed. Results A close examination of the information reveals a pattern which is consistent with a statistical phenomenon, discovered by the French mathematician de Moivre nearly 300 years ago, described in every introductory statistics textbook: namely that variation in performance indicators is expected to be greater in small Trusts and smaller in large Trusts. From a statistical viewpoint, the number of deaths in a hospital is not in proportion to the size of the hospital, but is proportional to the square root of its size. Therefore, it is not surprising to note that small hospitals are more likely to occur at the top and the bottom of league tables, whilst mortality rates are independent of hospital sizes. Conclusion This statistical phenomenon needs to be taken into account in the comparison of hospital Trusts performance, especially with regard to policy decisions.

Managing clinical negligence litigation and costs in the NHS.

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Tingle, John

2016-11-24

John Tingle, Reader in Health Law, Nottingham Trent University, discusses recent Government proposals to improve NHS maternity services and make changes to litigation and patient safety investigation procedures.

Surgical assessment clinic - One stop emergency out-patient clinic for rapid assessment, reduced admissions and improved acute surgical service: A quality improvement study

Directory of Open Access Journals (Sweden)

Christina A.W. Macano

2017-11-01

Conclusion: By providing suitable guidance for referring practitioners we have optimised our clinic use significantly and improved our acute ambulatory surgical care. We have reduced admissions, provided rapid treatment and have established a service that helps address the ever increasing demand on acute services within the NHS.

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

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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.

Setting standards and monitoring quality in the NHS 1999-2013: a classic case of goal conflict.

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Littlejohns, Peter; Knight, Alec; Littlejohns, Anna; Poole, Tara-Lynn; Kieslich, Katharina

2017-04-01

2013 saw the National Health Service (NHS) in England severely criticized for providing poor quality despite successive governments in the previous 15 years, establishing a range of new institutions to improve NHS quality. This study seeks to understand the contributions of political and organizational influences in enabling the NHS to deliver high-quality care through exploring the experiences of two of the major new organizations established to set standards and monitor NHS quality. We used a mixed method approach: first a cross-sectional, in-depth qualitative interview study and then the application of principal agent modeling (Waterman and Meier broader framework). Ten themes were identified as influencing the functioning of the NHS regulatory institutions: socio-political environment; governance and accountability; external relationships; clarity of purpose; organizational reputation; leadership and management; organizational stability; resources; organizational methods; and organizational performance. The organizations could be easily mapped onto the framework, and their transience between the different states could be monitored. We concluded that differing policy objectives for NHS quality monitoring resulted in central involvement and organizational change. This had a disruptive effect on the ability of the NHS to monitor quality. Constant professional leadership, both clinical and managerial, and basing decisions on best evidence, both technical and organizational, helped one institution to deliver on its remit, even within a changing political/policy environment. Application of the Waterman-Meier framework enabled an understanding and description of the dynamic relationship between central government and organizations in the NHS and may predict when tensions will arise in the future. © 2016 The Authors. The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd. © 2016 The Authors. The International Journal of Health

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

Doing transformational change in the English NHS in the context of "big bang" redisorganisation.

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Hunter, David J; Erskine, Jonathan; Small, Adrian; McGovern, Tom; Hicks, Chris; Whitty, Paula; Lugsden, Edward

2015-01-01

The purpose of this paper is to examine a bold and ambitious scheme known as the North East transformation system (NETS). The principal aim of the NETS is the achievement of a step-change in the quality of health services delivered to people living in the North East region of England. The paper charts the origins of the NETS and its early journey before describing what happened to it when the UK coalition government published its proposals for unexpected major structural change in the NHS. This had a profound impact on the leadership and direction of the NETS and resulted in it taking a different direction from that intended. The research design took the form of a mixed methods, longitudinal 3.5-year study aimed at exploring transformational change in terms of content, context, process and outcomes. The sample of study sites comprised 14 NHS trusts in the North East region chosen to provide geographical coverage of the area and to reflect the scale, scope and variety of the bodies that formed part of the NETS programme. The qualitative component of the research, which the paper draws upon, included 68 semi-structured interviews, observational studies and focus groups. Data analysis made use of both deductive and inductive frameworks. The deductive framework adopted was Pettigrew et al.'s "receptive contexts for change" and four of the eight factors stood out as especially important and form the basis of the paper. The fate of the NETS was shaped and influenced by the eight factors comprising the Pettigrew et al. receptive contexts for change framework but four factors in particular stood out as being especially significant: environmental pressure, quality and coherence of policy, key people leading change, supportive organisational culture. Perhaps the most significant lesson from the NETS is that achieving whole systems change is particularly vulnerable to the vicissitudes of politics especially where that system, like the UK NHS, is itself subject to those very

'Searching for the people in charge': appraising the 1983 Griffiths NHS management inquiry.

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Gorsky, Martin

2013-01-01

This is the first of two related articles in the present volume which examine the recent history of health services management using the case of the British National Health Service (NHS). In the historiography of the NHS the 1980s is widely seen as a watershed, when public policy first sought to introduce market disciplines into its operation. Administrative and managerial reforms were central to this process, and their origins and impact have been the subject of continuing debate. This article examines and evaluates one of the key events in this history, the Griffiths NHS Inquiry of 1983, which put in place the principles of 'general management' in the NHS. Drawing on both documentary records and oral evidence it offers fresh perspectives on the reasons why the Conservative government embarked on this reform, on the workings of the inquiry team under the leadership of the businessman Roy Griffiths, and on the uneven course of the implementation of his recommendations. While its initial impact arguably did not meet the expectations of its supporters, it is suggested that several of Griffiths' key concerns have grown, not diminished, in importance as aspects of subsequent health politics. These include: the need for clinician involvement in NHS management and financing; the conundrum of how to depoliticise the central direction of the service while retaining political accountability; the desirability of measuring and improving performance; and the question of how best to incorporate the wishes of patients and public in the decision-making arena.

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

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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.

Plus ça change, plus c'est la même chose: senior NHS managers' narratives of restructuring.

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Macfarlane, Fraser; Exworthy, Mark; Wilmott, Micky; Greenhalgh, Trish

2011-09-01

The UK National Health Service (NHS) is regularly restructured. Its smooth operation and organisational memory depends on the insights and capability of managers, especially those with experience of previous transitions. Narrative methods can illuminate complex change from the perspective of key actors. We used an adaptation of Wengraf's biographical narrative life interview method to explore how 20 senior NHS managers (chief executives, directors and assistant directors) had perceived and responded to major transitions since 1974. Data were analysed thematically using insights from phenomenology, neo-institutional theory and critical management studies. Findings were contextualised within a literature review of NHS policy and management 1974-2009. Managers described how experience in different NHS organisations helped build resilience and tacit knowledge, and how a strong commitment to the 'NHS brand' allowed them to weather a succession of policy changes and implement and embed such changes locally. By synthesising these personal and situated micro-narratives, we built a wider picture of macro-level institutional change in the NHS, in which the various visible restructurings in recent years appear to have masked a deeper continuity in terms of enduring values, norms and ways of working. We consider the implications of these findings for the future NHS. © 2011 The Authors. Sociology of Health & Illness © 2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

The costs to the NHS of multiple births after IVF treatment in the UK.

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Ledger, William L; Anumba, Dilly; Marlow, Neil; Thomas, Christine M; Wilson, Edward C F

2006-01-01

To determine the cost to the NHS resulting from multiple pregnancies arising from IVF treatment in the UK, and to compare those costs with the cost to the NHS due to singleton pregnancies resulting from IVF treatment. A modelling study using data from published literature and cost data from national sources in the public domain, calculating direct costs from the diagnosis of a clinical pregnancy until the end of the first year after birth. Academic Unit of Reproductive and Developmental Medicine. Theoretic core modelling study using data from published literature. The analysis was based on the total annual number of births resulting from an IVF treatment in the UK. Main outcome measures total direct costs to the NHS per IVF singleton, twin or triplet family. Cost of singleton, twin and triplet IVF pregnancies in the UK. Total direct costs to the NHS per IVF twin or triplet family (maternal + infant costs) are substantially higher than per IVF singleton family (singleton: pounds 3313; twin: pounds 9122; and triplet: pounds 32,354). Multiple pregnancies after IVF are associated with 56% of the direct cost of IVF pregnancies, although they represent less than 1/3 of the total annual number of maternities in the UK. Multiple pregnancies after IVF are associated with high direct costs to the NHS. Redirection of money saved by implementation of a mandatory 'two embryo transfer' policy into increased provision of IVF treatment could double the number of NHS-funded IVF treatment cycles at no extra cost. Further savings could be made if a selective 'single embryo transfer' policy were to be adopted.

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

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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....

Electronic records' 1.4 m pounds annual saving.

Science.gov (United States)

Baillie, Jonathan

2011-03-01

The St. Helens & Knowsley Teaching Hospitals NHS Trust says it has reached a significant milestone in a major project via which it aims to cease completely using paper-based patient records and other patient-related information such as discharge summaries and X-ray results by converting all such documentation to online electronic form. With the purchase of three Kodak high-speed document scanners, which digitise the files, and a tailored version of C Cube Solutions' electronic document management software (EDMS), all 27 hospital departments at the Trust's two main acute hospitals have now "gone live" with the radical new system for medical records, and, as HEJ editor Jonathan Baillie reports, preparations are in hand to convert other important patient documentation into electronic form.

Setting standards and monitoring quality in the NHS 1999–2013: a classic case of goal conflict

Science.gov (United States)

Knight, Alec; Littlejohns, Anna; Poole, Tara‐Lynn; Kieslich, Katharina

2016-01-01

Abstract 2013 saw the National Health Service (NHS) in England severely criticized for providing poor quality despite successive governments in the previous 15 years, establishing a range of new institutions to improve NHS quality. This study seeks to understand the contributions of political and organizational influences in enabling the NHS to deliver high‐quality care through exploring the experiences of two of the major new organizations established to set standards and monitor NHS quality. We used a mixed method approach: first a cross‐sectional, in‐depth qualitative interview study and then the application of principal agent modeling (Waterman and Meier broader framework). Ten themes were identified as influencing the functioning of the NHS regulatory institutions: socio‐political environment; governance and accountability; external relationships; clarity of purpose; organizational reputation; leadership and management; organizational stability; resources; organizational methods; and organizational performance. The organizations could be easily mapped onto the framework, and their transience between the different states could be monitored. We concluded that differing policy objectives for NHS quality monitoring resulted in central involvement and organizational change. This had a disruptive effect on the ability of the NHS to monitor quality. Constant professional leadership, both clinical and managerial, and basing decisions on best evidence, both technical and organizational, helped one institution to deliver on its remit, even within a changing political/policy environment. Application of the Waterman–Meier framework enabled an understanding and description of the dynamic relationship between central government and organizations in the NHS and may predict when tensions will arise in the future. © 2016 The Authors. The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd. PMID:27435020

Hospital autopsy: Endangered or extinct?

Science.gov (United States)

Turnbull, Angus; Osborn, Michael; Nicholas, Nick

2015-08-01

To determine the hospital autopsy rate for the UK in 2013. A study of data from a 'Freedom of Information' request to all (n=186) acute NHS Trusts within England (n=160), NHS Boards in Scotland (n=14) and Wales (n=7) and Social Care Trusts in Northern Ireland (n=5). Hospital autopsy rates were calculated from the number of hospital autopsies performed in 2013 as a percentage of total inpatient deaths in the Trust that year. The UK response rate was 99% (n=184), yielding a mean autopsy rate of 0.69%. The mean rates were 0.51% (England), 2.13% (Scotland), 0.65% (Wales) and 0.46% (Northern Ireland). 23% (n=38) of all included respondents had a rate of 0% and 86% (n=143) a rate less than 1%. The decline in hospital autopsy has continued relentlessly and, for better or for worse, the practice is on the verge of extinction in the UK. The study highlights to health professionals and policy makers the magnitude of this decline. Further research should investigate the impact of this on patient safety, clinical audit, public health and medical education. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Employee Engagement within the NHS: A Cross-Sectional Study

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Yadava Bapurao Jeve

2015-02-01

Full Text Available Background Employee engagement is the emotional commitment of the employee towards the organisation. We aimed to analyse baseline work engagement using Utrecht Work Engagement Scale (UWES at a teaching hospital. Methods We have conducted a cross-sectional study within the National Health Service (NHS Teaching Hospital in the UK. All participants were working age population from both genders directly employed by the hospital. UWES has three constituting dimensions of work engagement as vigor, dedication, and absorption. We conducted the study using UWES-9 tool. Outcome measures were mean score for each dimension of work engagement (vigor, dedication, absorption and total score compared with control score from test manual. Results We found that the score for vigor and dedication is significantly lower than comparison group (P< 0.0001 for both. The score for absorption was significantly higher than comparison group (P< 0.0001. However, total score is not significantly different. Conclusion The study shows that work engagement level is below average within the NHS employees. Vigor and dedication are significantly lower, these are characterised by energy, mental resilience, the willingness to invest one’s effort, and persistence as well as a sense of significance, enthusiasm, inspiration, pride, and challenge. The NHS employees are immersed in work. Urgent need to explore strategies to improve work engagement as it is vital for improving productivity, safety and patient experience.

Next Generation Hemostatic Materials Based on NHS-Ester Functionalized Poly(2-oxazoline)s.

Science.gov (United States)

Boerman, Marcel A; Roozen, Edwin; Sánchez-Fernández, María José; Keereweer, Abraham R; Félix Lanao, Rosa P; Bender, Johan C M E; Hoogenboom, Richard; Leeuwenburgh, Sander C; Jansen, John A; Van Goor, Harry; Van Hest, Jan C M

2017-08-14

In order to prevent hemorrhage during surgical procedures, a wide range of hemostatic agents have been developed. However, their efficacy is variable; hemostatic devices that use bioactive components to accelerate coagulation are dependent on natural sources, which limits reproducibility. Hybrid devices in which chain-end reactive poly(ethylene glycol) is employed as active component sometimes suffer from irregular cross-linking and dissolution of the polar PEG when blood flow is substantial. Herein, we describe a synthetic, nonbioactive hemostatic product by coating N-hydroxysuccinimide ester (NHS)-functional poly(2-oxazoline)s (POx-NHS) onto gelatin patches, which acts by formation of covalent cross-links between polymer, host blood proteins, gelatin and tissue to seal the wound site and prevent hemorrhage during surgery. We studied different process parameters (including polymer, carrier, and coating technique) in direct comparison with clinical products (Hemopatch and Tachosil) to obtain deeper understanding of this class of hemostatic products. In this work, we successfully prove the hemostatic efficacy of POx-NHS as polymer powders and coated patches both in vitro and in vivo against Hemopatch and Tachosil, demonstrating that POx-NHS are excellent candidate polymers for the development of next generation hemostatic patches.

The limits of market-based reforms in the NHS: the case of alternative providers in primary care.

Science.gov (United States)

Coleman, Anna; Checkland, Kath; McDermott, Imelda; Harrison, Stephen

2013-01-01

Historically, primary medical care in the UK has been delivered by general practitioners who are independent contractors, operating under a contract, which until 2004 was subject to little performance management. In keeping with the wider political impetus to introduce markets and competition into the NHS, reforms were introduced to allow new providers to bid for contracts to provide primary care services in England. These contracts known as 'Alternative Provider Medical Services', were encouraged by two centrally-driven rounds of procurement (2007/8 and 2008/9). This research investigated the commissioning and operation of such Alternative Providers of Primary Care (APPCs). Two qualitative case studies were undertaken in purposively sampled English Primary Care Trusts (PCTs) and their associated APPCs over 14 months (2009-10). We observed 65 hours of meetings, conducted 23 interviews with PCT and practice staff, and gathered relevant associated documentation. We found that the procurement and contracting process was costly and time-consuming. Extensive local consultation was undertaken, and there was considerable opposition in some areas. Many APPCs struggled to build up their patient list sizes, whilst over-performing on walk-in contracts. Contracting for APPCs was 'transactional', in marked contrast to the 'relational' contracting usually found in the NHS, with APPCs subject to tight performance management. These complicated and costly processes contrast to those experienced by traditionally owned GP partnerships. However, managers reported that the perception of competition had led existing practices to improve their services. The Coalition Government elected in 2010 is committed to 'Any Qualified Provider' of secondary care, and some commentators argue that this should also be applied to primary care. Our research suggests that, if this is to happen, a debate is needed about the operation of a market in primary care provision, including the trade-offs between

Does cytochrome P450 liver isoenzyme induction increase the risk of liver toxicity after paracetamol overdose?

Directory of Open Access Journals (Sweden)

Kalsi SS

2011-10-01

Full Text Available Sarbjeet S Kalsi1,2, David M Wood2–4, W Stephen Waring5, Paul I Dargan2–4 1Emergency Department, 2Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust, London; 3King's Health Partners, 4King's College London, London; 5York Teaching Hospital NHS Foundation Trust, York, UK Abstract: Paracetamol (acetaminophen, N-acetyl-p-aminophenol, 4-hydroxyacetanilide is the most common cause of acute liver failure in developed countries. There are a number of factors which potentially impact on the risk of an individual developing hepatotoxicity following an acute paracetamol overdose. These include the dose of paracetamol ingested, time to presentation, decreased liver glutathione, and induction of cytochrome P450 (CYP isoenzymes responsible for the metabolism of paracetamol to its toxic metabolite N-acetyl-p-benzoquinoneimine (NAPQI. In this paper, we review the currently published literature to determine whether induction of relevant CYP isoenzymes is a risk factor for hepatotoxicity in patients with acute paracetamol overdose. Animal and human in vitro studies have shown that the CYP isoenzyme responsible for the majority of human biotransformation of paracetamol to NAPQI is CYP2E1 at both therapeutic and toxic doses of paracetamol. Current UK treatment guidelines suggest that patients who use a number of drugs therapeutically should be treated as “high-risk” after paracetamol overdose. However, based on our review of the available literature, it appears that the only drugs for which there is evidence of the potential for an increased risk of hepatotoxicity associated with paracetamol overdose are phenobarbital, primidone, isoniazid, and perhaps St John's wort. There is no evidence that other drugs often quoted as increasing risk, such as carbamazepine, phenytoin, primidone, rifampicin, rifabutin, efavirenz, or nevirapine, should be considered risk factors for hepatotoxicity in patients presenting with acute paracetamol overdose. Keywords

NHS should provide nurses with decent catering facilities.

Science.gov (United States)

Whelan, Adrian

2016-11-16

How about the NHS gives us access to decent catering facilities or even tables and chairs that aren't a 10 to 15-minute walk away from the ward or unit - which must be taken out of the already paltry half-hour meal break?

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

Antithrombotics in trauma: management strategies in the older patients

Directory of Open Access Journals (Sweden)

Wong H

2017-10-01

Full Text Available Henna Wong,1,2 Nicola Lovett,3 Nicola Curry,1 Ku Shah,2 Simon J Stanworth1,2,4 1Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, 2Radcliffe Department of Medicine, University of Oxford, Oxford BRC Haematology Theme, 3Department of Geratology, Oxford University Hospitals NHS Foundation Trust, 4Department of Haematology, NHS Blood and Transplant, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK Abstract: The ageing population has resulted in a change in the demographics of trauma, and older adult trauma now accounts for a growing number of trauma admissions. The management of older adult trauma can be particularly challenging, and exhibits differences to that of the younger age groups affected by trauma. Frailty syndromes are closely related with falls, which are the leading cause of major trauma in older adults. Comorbid disease and antithrombotic use are more common in the older population. Physiological changes that occur with ageing can alter the expected clinical presentation of older persons after injury and their susceptibility to injury. Following major trauma, definitive control of hemorrhage remains essential for improving outcomes. In the initial assessment of an injured patient, it is important to consider whether the patient is taking anticoagulants or antiplatelets and if measures to promote hemostasis such as reversal are indicated. After hemostasis is achieved and bleeding has stopped, longer-term decisions to recommence antithrombotic agents can be challenging, especially in older people. In this review, we discuss one aspect of management for the older trauma patients in greater detail, that is, acute and longer-term management of antithrombotic therapy. As we consider the health needs of an ageing population, rise in elderly trauma and increasing use of antithrombotic therapy, the need for research in this area becomes more pressing to establish best

Investigating the effectiveness and cost-effectiveness of FITNET-NHS (Fatigue In Teenagers on the interNET in the NHS) compared to Activity Management to treat paediatric chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME): protocol for a randomised controlled trial.

Science.gov (United States)

Baos, Sarah; Brigden, Amberly; Anderson, Emma; Hollingworth, William; Price, Simon; Mills, Nicola; Beasant, Lucy; Gaunt, Daisy; Garfield, Kirsty; Metcalfe, Chris; Parslow, Roxanne; Downing, Harriet; Kessler, David; Macleod, John; Stallard, Paul; Knoop, Hans; Van de Putte, Elise; Nijhof, Sanne; Bleijenberg, Gijs; Crawley, Esther

2018-02-22

Paediatric chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) is a relatively common and disabling condition. The National Institute for Health and Clinical Excellence (NICE) recommends Cognitive Behavioural Therapy (CBT) as a treatment option for paediatric CFS/ME because there is good evidence that it is effective. Despite this, most young people in the UK are unable to access local specialist CBT for CFS/ME. A randomised controlled trial (RCT) showed FITNET was effective in the Netherlands but we do not know if it is effective in the National Health Service (NHS) or if it is cost-effective. This trial will investigate whether FITNET-NHS is clinically effective and cost-effective in the NHS. Seven hundred and thirty-four paediatric patients (aged 11-17 years) with CFS/ ME will be randomised (1:1) to receive either FITNET-NHS (online CBT) or Activity Management (delivered via video call). The internal pilot study will use integrated qualitative methods to examine the feasibility of recruitment and the acceptability of treatment. The full trial will assess whether FITNET-NHS is clinically effective and cost-effective. The primary outcome is disability at 6 months, measured using the SF-36-PFS (Physical Function Scale) questionnaire. Cost-effectiveness is measured via cost-utility analysis from an NHS perspective. Secondary subgroup analysis will investigate the effectiveness of FITNET-NHS in those with co-morbid mood disorders. If FITNET-NHS is found to be feasible and acceptable (internal pilot) and effective and cost-effective (full trial), its provision by the NHS has the potential to deliver substantial health gains for the large number of young people suffering from CFS/ME but unable to access treatment because there is no local specialist service. This trial will provide further evidence evaluating the delivery of online CBT to young people with chronic conditions. ISRCTN registry, registration number: ISRCTN18020851 . Registered on 4 August 2016.

Cost-utility and value-of-information analysis of early versus delayed laparoscopic cholecystectomy for acute cholecystitis

DEFF Research Database (Denmark)

Wilson, E; Gurusamy, K; Gluud, C

2010-01-01

BACKGROUND:: A recent systematic review found early laparoscopic cholecystectomy (ELC) to be safe and to shorten total hospital stay compared with delayed laparoscopic cholecystectomy (DLC) for acute cholecystitis. The cost-effectiveness of ELC versus DLC for acute cholecystitis is unknown. METHODS......, there is a 70.9 per cent probability that ELC is cost effective compared with DLC. Full implementation of ELC could save the NHS pound8.5 million per annum. CONCLUSION:: The results of this decision analytic modelling study suggest that on average ELC is less expensive and results in better quality of life than......:: A decision tree model estimating and comparing costs to the UK National Health Service (NHS) and quality-adjusted life years (QALYs) gained following a policy of either ELC or DLC was developed with a time horizon of 1 year. Uncertainty was investigated with probabilistic sensitivity analysis, and value...

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...

Experiences with developing and implementing a virtual clinic for glaucoma care in an NHS setting

Directory of Open Access Journals (Sweden)

Kotecha A

2015-10-01

Full Text Available Aachal Kotecha,1,2 Alex Baldwin,1 John Brookes,1 Paul J Foster1,2 1Glaucoma Service, Moorfields Eye Hospital National Health Service Foundation Trust, 2NIHR BRC, Moorfields Eye Hospital, NHS Foundation Trust and UCL Institute of Ophthalmology, University College London, London, UK Background: This article describes the development of a virtual glaucoma clinic, whereby technicians collect information for remote review by a consultant specialist.Design and Methods: This was a hospital-based service evaluation study. Patients suitable for the stable monitoring service (SMS were low-risk patients with “suspect”, “early”-to-“moderate” glaucoma who were deemed stable by their consultant care team. Three technicians and one health care assistant ran the service. Patients underwent tests in a streamlined manner in a dedicated clinical facility, with virtual review of data by a consultant specialist through an electronic patient record.Main outcome measure: Feasibility of developing a novel service within a UK National Health Service setting and improvement of patient journey time within the service were studied.Results: Challenges to implementation of virtual clinic include staffing issues and use of information technology. Patient journey time within the SMS averaged 51 minutes, compared with 92 minutes in the glaucoma outpatient department. Patient satisfaction with the new service was high.Conclusion: Implementing innovation into existing services of the National Health Service is challenging. However, the virtual clinic showed an improved patient journey time compared with that experienced within the general glaucoma outpatient department. There exists a discrepancy between patient management decisions of reviewers, suggesting that some may be more risk averse than others when managing patients seen within this model. Future work will assess the ability to detect progression of disease in this model compared with the general

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.

Leadership in the NHS: does the Emperor have any clothes?

Science.gov (United States)

Checkland, Kath

2014-10-01

In this essay, I explore the rise of the concept of 'leadership' in the English NHS, highlighting the similarity with a previous shift from (bad, old) 'administration' to (good, new) 'management'. I take a critical look at this discursive shift and highlight some of the overblown claims made for the value of 'clinical leadership'. I argue that, rather than turning all NHS staff into leaders, we should perhaps tone down the level of our rhetoric and instead emphasize the need for a service full of good followers who will maintain a relentless focus on care, quality and efficiency. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

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.

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.

[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...

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

Creating a positive workplace culture.

Science.gov (United States)

Sergeant, Jenny; Laws-Chapman, Colette

2012-02-01

This article considers the link between emotional resilience and the mental and physical wellbeing of healthcare staff, and how this affects leadership and patient care. The authors outline six steps to building and sustaining emotional resilience. In two NHS surveys (Boorman 2009, Healthcare Commission 2010) staff reported that their physical health and emotional wellbeing affected their ability to undertake daily activities and their ability to care for patients. Some NHS trusts are addressing staff wellbeing through emotional resilience training. Guy's and St Thomas' NHS Foundation Trust, London, for example, includes it in its preceptorship programme, which supports transition from student to staff nurse.

Competitive strategy for providers.

Science.gov (United States)

Hackett, M C

1996-01-01

National Health Service (NHS) Trusts are struggling to determine a long-term strategic direction for their organizations in response to the competitive pressures generated by the NHS reforms. The development of long-term strategic direction and the methods to implement this are presenting real challenges to the Trusts which have inherited service configurations based on bureaucratic planning frameworks rather than service configurations suited to a more competitive environment. Examines the strategic choices available to these organizations; explores the importance of identifying positive strategic choices; and discusses the advantages and disadvantages in the context of the NHS internal market.

Network analysis of patient flow in two UK acute care hospitals identifies key sub-networks for A&E performance.

Science.gov (United States)

Bean, Daniel M; Stringer, Clive; Beeknoo, Neeraj; Teo, James; Dobson, Richard J B

2017-01-01

The topology of the patient flow network in a hospital is complex, comprising hundreds of overlapping patient journeys, and is a determinant of operational efficiency. To understand the network architecture of patient flow, we performed a data-driven network analysis of patient flow through two acute hospital sites of King's College Hospital NHS Foundation Trust. Administration databases were queried for all intra-hospital patient transfers in an 18-month period and modelled as a dynamic weighted directed graph. A 'core' subnetwork containing only 13-17% of all edges channelled 83-90% of the patient flow, while an 'ephemeral' network constituted the remainder. Unsupervised cluster analysis and differential network analysis identified sub-networks where traffic is most associated with A&E performance. Increased flow to clinical decision units was associated with the best A&E performance in both sites. The component analysis also detected a weekend effect on patient transfers which was not associated with performance. We have performed the first data-driven hypothesis-free analysis of patient flow which can enhance understanding of whole healthcare systems. Such analysis can drive transformation in healthcare as it has in industries such as manufacturing.

A clean bill of health? The efficacy of an NHS commissioned outsourced police custody healthcare service.

Science.gov (United States)

de Viggiani, Nick

2013-08-01

Police custody healthcare services for detainees in the UK are most commonly outsourced to independent healthcare providers who employ custody nurses and forensic physicians to deliver forensic healthcare services. A pilot was introduced in 2008 by the Department of Health to explore the efficacy of commissioning custody healthcare via the NHS, in the wake of the 2005-2006 shift of prison healthcare to the NHS. The objective was to improve quality and accountability through NHS commissioning and the introduction of NHS governance to the management and delivery of custody healthcare. This article discusses key themes that arose from the project evaluation, which focused on the commissioning relationship between the police, the NHS commissioner and the private healthcare provider. The evaluation observed an evolving relationship between the police, the local NHS and the front-line nurses, which was complicated by the quite distinctive professional values and ideologies operating, with their contrasting organisational imperatives and discordant values and principles. A key challenge for commissioners is to develop synergy between operational and strategically located stakeholders so that they can work effectively towards common goals. Government policy appears to remain focused on creating safe, supportive and humane custody environments that balance criminal justice and health imperatives and support the rights and needs of detainees, victims, professionals and the public. This remains an ambitious agenda and presents a major challenge for new criminal justice health partnerships. Copyright © 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Market-driven production of biospecimens and the role of NHS hospital-led biobanks.

Science.gov (United States)

Timmons, Stephen; Vezyridis, Paraskevas

2017-09-01

Biobanks are vital for biospecimen production in research, despite the regulatory, recruitment and commercial difficulties they face. We conducted interviews with clinicians, researchers, volunteers who recruit biobank participants, regulators and NHS managers about the integration of a biobank into an NHS hospital. We show that medical waste collected for biomedical research acquires its socio-ethical and economic value from the level of integration (both technologically and organisationally) of the biobank into the NHS hospital. There is extensive investment in a range of intellectual and commercial relationships and labour among stakeholders involved in the production of biospecimens. It is not only the boundaries of research, clinical care and commercialisation of biospecimens that blur but also those of volunteerism and citizenship. Hospital-led biobanks provide an opportunity to study the intertwining of biomedical innovation and healthcare. © 2017 Foundation for the Sociology of Health & Illness.

Investigating suspected acute pulmonary embolism - what are hospital clinicians thinking?

International Nuclear Information System (INIS)

McQueen, A.S.; Worthy, S.; Keir, M.J.

2008-01-01

Aims: To assess local clinical knowledge of the appropriate investigation of suspected acute pulmonary embolism (PE) and this compare with the 2003 British Thoracic Society (BTS) guidelines as a national reference standard. Methods: A clinical questionnaire was produced based on the BTS guidelines. One hundred and eight-six participants completed the questionnaires at educational sessions for clinicians of all grades, within a single NHS Trust. The level of experience amongst participants ranged from final year medical students to consultant physicians. Results: The clinicians were divided into four groups based on seniority: Pre-registration, Junior, Middle, and Senior. Forty-six point eight percent of all the clinicians correctly identified three major risk factors for PE and 25.8% recognized the definition of the recommended clinical probability score from two alternatives. Statements regarding the sensitivity of isotope lung imaging and computed tomography pulmonary angiography (CTPA) received correct responses from 41.4 and 43% of participants, respectively, whilst 81.2% recognized that an indeterminate ventilation-perfusion scintigraphy (V/Q) study requires further imaging. The majority of clinicians correctly answered three clinical scenario questions regarding use of D-dimers and imaging (78, 85, and 57.5%). There was no statistically significant difference between the four groups for any of the eight questions. Conclusions: The recommended clinical probability score was unfamiliar to all four groups of clinicians in the present study, and the majority of doctors did not agree that a negative CTPA or isotope lung scintigraphy reliably excluded PE. However, questions based on clinical scenarios received considerably higher rates of correct responses. The results indicate that various aspects of the national guidelines on suspected acute pulmonary embolism are unfamiliar to many UK hospital clinicians. Further research is needed to identify methods to improve

Investigating and learning lessons from early experiences of implementing ePrescribing systems into NHS hospitals: a questionnaire study.

Directory of Open Access Journals (Sweden)

Kathrin Cresswell

Full Text Available ePrescribing systems have significant potential to improve the safety and efficiency of healthcare, but they need to be carefully selected and implemented to maximise benefits. Implementations in English hospitals are in the early stages and there is a lack of standards guiding the procurement, functional specifications, and expected benefits. We sought to provide an updated overview of the current picture in relation to implementation of ePrescribing systems, explore existing strategies, and identify early lessons learned.A descriptive questionnaire-based study, which included closed and free text questions and involved both quantitative and qualitative analysis of the data generated.We obtained responses from 85 of 108 NHS staff (78.7% response rate. At least 6% (n = 10 of the 168 English NHS Trusts have already implemented ePrescribing systems, 2% (n = 4 have no plans of implementing, and 34% (n = 55 are planning to implement with intended rapid implementation timelines driven by high expectations surrounding improved safety and efficiency of care. The majority are unclear as to which system to choose, but integration with existing systems and sophisticated decision support functionality are important decisive factors. Participants highlighted the need for increased guidance in relation to implementation strategy, system choice and standards, as well as the need for top-level management support to adequately resource the project. Although some early benefits were reported by hospitals that had already implemented, the hoped for benefits relating to improved efficiency and cost-savings remain elusive due to a lack of system maturity.Whilst few have begun implementation, there is considerable interest in ePrescribing systems with ambitious timelines amongst those hospitals that are planning implementations. In order to ensure maximum chances of realising benefits, there is a need for increased guidance in relation to implementation strategy

Standardising school nursing practice: developing and implementing a care pathways package.

Science.gov (United States)

Turney, Nicy; Clarke, Maggie; Stevenson, Emily

2012-11-01

The NHS has a longstanding relationship with care pathways for managing clinical processes and patient outcomes. Care pathways are an effective mechanism to improve the delivery of services in managing children's health. However, few individual NHS trusts have successfully developed and implemented local pathways. This paper describes the development and implementation of a comprehensive care pathways package for school nursing in a community health services trust in the East Midlands.

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

Mutations in a novel gene, NHS, cause the pleiotropic effects of Nance-Horan syndrome, including severe congenital cataract, dental anomalies, and mental retardation.

Science.gov (United States)

Burdon, Kathryn P; McKay, James D; Sale, Michèle M; Russell-Eggitt, Isabelle M; Mackey, David A; Wirth, M Gabriela; Elder, James E; Nicoll, Alan; Clarke, Michael P; FitzGerald, Liesel M; Stankovich, James M; Shaw, Marie A; Sharma, Shiwani; Gajovic, Srecko; Gruss, Peter; Ross, Shelley; Thomas, Paul; Voss, Anne K; Thomas, Tim; Gécz, Jozef; Craig, Jamie E

2003-11-01

Nance-Horan syndrome (NHS) is an X-linked disorder characterized by congenital cataracts, dental anomalies, dysmorphic features, and, in some cases, mental retardation. NHS has been mapped to a 1.3-Mb interval on Xp22.13. We have confirmed the same localization in the original, extended Australian family with NHS and have identified protein-truncating mutations in a novel gene, which we have called "NHS," in five families. The NHS gene encompasses approximately 650 kb of genomic DNA, coding for a 1,630-amino acid putative nuclear protein. NHS orthologs were found in other vertebrates, but no sequence similarity to known genes was identified. The murine developmental expression profile of the NHS gene was studied using in situ hybridization and a mouse line containing a lacZ reporter-gene insertion in the Nhs locus. We found a complex pattern of temporally and spatially regulated expression, which, together with the pleiotropic features of NHS, suggests that this gene has key functions in the regulation of eye, tooth, brain, and craniofacial development.

An investigation into the content validity of the Antimicrobial Self-Assessment Toolkit for NHS Trusts (ASAT v15a) using cognitive interviews with antimicrobial pharmacists.

Science.gov (United States)

Bailey, C; Tully, M; Cooke, J

2015-04-01

The Antimicrobial Self-Assessment Toolkit for NHS Trusts (ASAT) was developed to evaluate the organizational strategies used to implement hospital-based antimicrobial stewardship programmes. An iterative approach was used to develop ASAT v15a, which has been previously investigated for face validity; however, further investigation into other types of validity was required. Therefore, the aim of this study was to investigate the content validity of ASAT v15a and hence modify and improve the content validity of the toolkit. A purposive sample of eight antimicrobial pharmacists was interviewed using cognitive interviewing techniques from within the former North-west Strategic Health Authority in England. Respondents were asked to 'think aloud' and to verbally express their thought processes as they generated responses to each question with the ASAT. There were no cognitive difficulties reported by respondents in response to 26/83 (31·3%) questions within the ASAT. However, cognitive difficulties were reported by respondents at each stage of the cognitive processing pathway in response to 57/83 (68·7%) questions. These difficulties were comprehension/interpretation in 27/83 (32·5%) questions, information retrieval in 10/83 (12%) questions, judgment/decision in 6/83 (7·2%) questions and response generation/formatting in 13/83 (15·7%) questions. Other findings included disagreement with the weightings applied to 13/83 (15·7%) questions. Respondents recommended that these questions should be modified to reflect their impact on hospital-based antimicrobial stewardship programmes (ASPs). Based on these findings, modifications were made to ASAT v15a to produce the next iteration (ASAT v16). Furthermore, respondents indicated that the role of clinical microbiologists was underrepresented in the current version of the toolkit; therefore, seven proposed questions were drafted, based on a literature review. Cognitive interviews were effectively able to detect problems

The National Health Service (NHS) at 70: Bevan's double-edged legacy.

Science.gov (United States)

Klein, Rudolf

2018-01-08

The paper analyses the achievements and problems stemming from Nye Bevan's model of a tax funded national health care system, on the assumption that only so could equity be achieved. The evidence shows that indeed the National Health Service (NHS) scores highly on equity, so vindicating Bevan's vision. The price paid is that fiscal crises are the norm for the NHS, with ever more centralisation, intensive regulation and performance management. Successive reorganisations represent attempts to square the circle - to combine the strengths of Bevan's model and those of a less hierarchic system - but have so far failed to deliver and can be expected to continue.

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.

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

Directory of Open Access Journals (Sweden)

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.

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...

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...

Caseload of NHS plastic surgeons in Scotland, 2005-2006: analysis of Scottish hospital activity data.

Science.gov (United States)

Brewster, Colin T; Shoaib, Taimur

2009-04-01

To assess the contemporary caseload of NHS plastic surgeons. Descriptive study. Scotland. Analysis of routinely collected NHS hospital activity data relating to the financial year 2005-2006. Number of inpatient/day-case episodes and bed-days by principal diagnosis and main operative procedure. During the study period, 12,844 inpatient and 9439 day-case episodes were recorded in 19,166 patients, accounting for 36,300 bed-days. There were more female patients, especially among middle-age groups. Socioeconomic deprivation was more common than expected (P accounted for a higher proportion of bed-days (37.3%) than neoplasms (23.8%). Only approximately half of all surgical procedures were assigned to the skin chapter of the OPCS-4 classification. Despite some limitations, this study provides an insight into the current caseload of NHS plastic surgeons working in Scotland. The data suggest that cosmetic surgery for purely aesthetic reasons represents a relatively small part of NHS plastic surgery activity in Scotland, and that the majority of caseload is in reconstructive plastic surgery.

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...

First evaluation of the NHS direct online clinical enquiry service: A nurse-led web chat triage service for the public

NARCIS (Netherlands)

Eminovic, Nina; Wyatt, Jeremy C.; Tarpey, Aideen M.; Murray, Gerard; Ingrams, Grant J.

2004-01-01

Background: NHS Direct is a telephone triage service used by the UK public to contact a nurse for any kind of health problem. NHS Direct Online (NHSDO) extends NHS Direct, allowing the telephone to be replaced by the Internet, and introducing new opportunities for informing patients about their

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.

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:

Outcomes of domestic violence screening at an acute London trust: are there missed opportunities for intervention?

Science.gov (United States)

Warren-Gash, Charlotte; Bartley, Angela; Bayly, Jude; Dutey-Magni, Peter; Edwards, Sarah; Madge, Sara; Miller, Charlotte; Nicholas, Rachel; Radhakrishnan, Sheila; Sathia, Leena; Swarbrick, Helen; Blaikie, Dee; Rodger, Alison

2016-01-04

Domestic violence screening is advocated in some healthcare settings. Evidence that it increases referral to support agencies or improves health outcomes is limited. This study aimed to (1) investigate the proportion of hospital patients reporting domestic violence, (2) describe characteristics and previous hospital attendances of affected patients and (3) assess referrals to an in-house domestic violence advisor from Camden Safety Net. A series of observational studies. Three outpatient clinics at the Royal Free London NHS Foundation Trust. 10,158 patients screened for domestic violence in community gynaecology, genitourinary medicine (GUM) and HIV medicine clinics between 1 October 2013 and 30 June 2014. Also 2253 Camden Safety Net referrals over the same period. (1) Percentage reporting domestic violence by age group gender, ethnicity and clinic. (2) Rates of hospital attendances in the past 3 years for those screening positive and negative. (3) Characteristics, uptake and risk assessment results for hospital in-house domestic violence referrals compared with Camden Safety Net referrals from other sources. Of the 10,158 patients screened, 57.4% were female with a median age of 30 years. Overall, 7.1% reported ever-experiencing domestic violence, ranging from 5.7% in GUM to 29.4% in HIV services. People screening positive for domestic violence had higher rates of previous emergency department attendances (rate ratio (RR) 1.63, 95% CI 1.09 to 2.48), emergency inpatient admissions (RR 2.27, 95% CI 1.37 to 3.84) and day-case admissions (RR 2.03, 95% CI 1.23 to 3.43) than those screening negative. The 77 hospital referrals to the hospital-based domestic violence advisor during the study period were more likely to be taken up and to be classified as high risk than referrals from elsewhere. Selective screening for domestic violence in high-risk hospital clinic populations has the potential to identify affected patients and promote good uptake of referrals for in

Radical 10-point plan to refocus NHS estate.

Science.gov (United States)

Ellis, Conor; Baldwin, Ed; Dick, Rachel

2010-11-01

Conor Ellis, head of health, Ed Baldwin, partner, and Rachel Dick, consultant, at international built asset consultancy EC Harris, present a "10-step guide" to help the NHS achieve radical efficiency savings, optimise the use of its estate, maximise the value of under-utilised land, buildings, and other assets, and harness better value from its existing FM operations.

Lack of language skills and knowledge of local culture in international medical graduates: Implications for the NHS.

Science.gov (United States)

Hamarneh, Ashraf

2015-01-01

International Medical Graduates (IMGs) form a coherent part of the National Health Service (NHS). Nearly 25% of the doctors working in the NHS are IMGs who obtained their primary medical degree from outside the EU. Moving to a different country that holds a different set of values and belief systems can be very challenging for IMGs, which in turn could have a significant effect on the service provided to NHS patients. This article will address the issue of effective communication skills within the IMG population and will explore the underlying issues behind this problem.

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....

Barriers and opportunities for enhancing patient recruitment and retention in clinical research: findings from an interview study in an NHS academic health science centre.

Science.gov (United States)

Adams, Mary; Caffrey, Louise; McKevitt, Christopher

2015-03-12

In the UK, the recruitment of patients into clinical research is a national health research and development policy priority. There has been limited investigation of how national level factors operate as barriers or facilitators to recruitment work, particularly from the perspective of staff undertaking patient recruitment work. The aim of this study is to identify and examine staff views of the key organisational barriers and facilitators to patient recruitment work in one clinical research group located in an NHS Academic Health Science Centre. A qualitative study utilizing in-depth, one-to-one semi-structured interviews with 11 purposively selected staff with particular responsibilities to recruit and retain patients as clinical research subjects. Thematic analysis classified interview data by recurring themes, concepts, and emergent categories for the purposes of establishing explanatory accounts. The findings highlight four key factors that staff perceived to be most significant for the successful recruitment and retention of patients in research and identify how staff located these factors within patients, studies, the research centre, the trust, and beyond the trust. Firstly, competition for research participants at an organisational and national level was perceived to undermine recruitment success. Secondly, the tension between clinical and clinical research workloads was seen to interrupt patient recruitment into studies, despite national funding arrangements to manage excess treatment costs. Thirdly, staff perceived an imbalance between personal patient burden and benefit. Ethical committee regulation, designed to protect patients, was perceived by some staff to detract from clarification and systematisation of incentivisation strategies. Finally, the structure and relationships within clinical research teams, in particular the low tacit status of recruitment skills, was seen as influential. The results of this case-study, conducted in an exemplary NHS

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

Moral Legitimacy: The Struggle Of Homeopathy in the NHS.

Science.gov (United States)

Crawford, Louise

2016-02-01

This article deploys a well-established theoretical model from the accountability literature to the domain of bioethics. Specifically, homeopathy is identified as a controversial industry and the strategic action of advocates to secure moral legitimacy and attract public funding is explored. The Glasgow Homeopathic Hospital (GHH) is used as the location to examine legitimizing strategies, from gaining legitimacy as a National Health Service (NHS) hospital in 1948, followed by maintaining and repairing legitimacy in response to government enquires in 2000 and 2010. An analysis of legitimizing strategies leads to the conclusion that advocates have been unsuccessful in maintaining and repairing moral legitimacy for homeopathy, thus threatening continued public funding for this unscientific medical modality. This is an encouraging development towards open and transparent NHS accountability for targeting limited public resources in pursuit of maximizing society's health and well-being. Policy implications and areas for future research are suggested. © 2016 John Wiley & Sons Ltd.

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.

Trust in vehicle technology

OpenAIRE

Walker, Guy, H.; Stanton, Neville, A.; Salmon, Paul

2016-01-01

Driver trust has potentially important implications for how vehicle technology is used and interacted with. In this paper it will be seen how driver trust functions and how it can be understood and manipulated by insightful vehicle design. It will review the theoretical literature to define steps that can be taken establish trust in vehicle technology in the first place, maintain trust in the long term, and even re-establish trust that has been lost along the way. The implication throughout i...

TRUST AND DISTRUST: TWO NECESSARY FACTORS FOR THE DEVELOPMENT OF THE SOCIAL TRUST

Directory of Open Access Journals (Sweden)

RODRIGO YÁÑEZ GALLARDO

2006-01-01

Full Text Available Recent investigations argue that distrust is the absence of trust and it would be assumed that bothattitudes are independent; that would allow to distinguish between the naïve attitude and the wise attitudein the trust. It has been built a scale to measure the disposition to trust and the relationship has beenexamined among naïve and wise attitude when trusting. The sample was constituted by 575 universitystudents of both sexes, of four faculties and of different years of study. Through a factorial analysis itwas found that trust and distrust correspond to different factors. It was discussed the importance ofincrease an optimal trust in order to develop social abilities and to stimulate the social participation. Itwas questioned the validity of traditional surveys that measure the social trust.

The Trust Project - Symbiotic Human Machine Teams: Social Cueing for Trust and Reliance

Science.gov (United States)

2016-06-30

AFRL-RH-WP-TR-2016-0096 THE TRUST PROJECT - SYMBIOTIC HUMAN-MACHINE TEAMS: SOCIAL CUEING FOR TRUST & RELIANCE Susan Rivers, Monika Lohani, Marissa...30 JUN 2012 – 30 JUN 2016 4. TITLE AND SUBTITLE THE TRUST PROJECT - SYMBIOTIC HUMAN-MACHINE TEAMS: SOCIAL CUEING FOR TRUST & RELIANCE 5a. CONTRACT

Can conditional health policies be justified? A policy analysis of the new NHS dental contract reforms.

Science.gov (United States)

Laverty, Louise; Harris, Rebecca

2018-06-01

Conditional policies, which emphasise personal responsibility, are becoming increasingly common in healthcare. Although used widely internationally, they are relatively new within the UK health system where there have been concerns about whether they can be justified. New NHS dental contracts include the introduction of a conditional component that restricts certain patients from accessing a full range of treatment until they have complied with preventative action. A policy analysis of published documents on the NHS dental contract reforms from 2009 to 2016 was conducted to consider how conditionality is justified and whether its execution is likely to cause distributional effects. Contractualist, paternalistic and mutualist arguments that reflect notions of responsibility and obligation are used as justification within policy. Underlying these arguments is an emphasis on preserving the finite resources of a strained NHS. We argue that the proposed conditional component may differentially affect disadvantaged patients, who do not necessarily have access to the resources needed to meet the behavioural requirements. As such, the conditional component of the NHS dental contract reform has the potential to exacerbate oral health inequalities. Conditional health policies may challenge core NHS principles and, as is the case with any conditional policy, should be carefully considered to ensure they do not exacerbate health inequities. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Effect of Some Synthetic Parameters on Size and Polydispersity Index of Gelatin Nanoparticles Cross-Linked by CDI/NHS System

Directory of Open Access Journals (Sweden)

S. Zinatloo-Ajabshir

2015-04-01

Full Text Available In our previous work, the effect of use of a water soluble CDI/NHS system as nontoxic cross-linking agent on fabrication of gelatin nanoparticles was investigated. In this research, the effect of variation in some synthetic parameters of gelatin nanoparticles cross-linked by CDI/NHS system such as type of gelatin and formulation of cross- linking agent on their size and distribution was examined. The conventional two step desolvation method was used for preparation of gelatin nanoparticles. The morphology, mean size and size distribution of the formed nanoparticles were evaluated and compared with each other. In addition, intrinsic viscosities of all the nanoparticles were measured and compared under different conditions. The results showed that the presence of more NHS and absence of NHS catalyst in CDI/NHS system lead to the large particle size and broad size distribution of nanoparticles that were attributed to the fast and slow cross-linking rate, respectively.

Trustful societies, trustful individuals, and health: An analysis of self-rated health and social trust using the World Value Survey.

Science.gov (United States)

Jen, Min Hua; Sund, Erik R; Johnston, Ron; Jones, Kelvyn

2010-09-01

This study analyses the relationships between self-rated health and both individual and mean national social trust, focusing on a variant of Wilkinson's hypothesis that individuals will be less healthy the greater the lack of social cohesion in a country. It employs multilevel modelling on World Values Survey data across 69 countries with a total sample of 160,436 individuals. The results show that self-rated health are positively linked to social trust at both country and individual levels after controlling for individual socio-demographic and income variables plus individual social trust; increased trust is associated with better health. Moreover, this analysis of social trust gives some insight into distinctive results for the former Soviet Bloc countries, which have high reported levels of poor health, alongside the Scandinavian countries which have high levels of trust and better health situations. Our results support and extend the Wilkinson hypothesis that the level of trust, an indicator of social cohesion, is predictive of individuals' health. Copyright 2010 Elsevier Ltd. All rights reserved.

Trust and automation: the influence of automation malfunctions and system feedback on operator trust

International Nuclear Information System (INIS)

Strand, Stine

2001-10-01

Level of operator trust in an automatic system, which is not in accordance with the reliability of the system, might impose serious threats concerning issues of safety, productivity and the well being of the operator. Operator trust is therefore regarded as an important variable in man-machine interaction. The focus of this study was the influence of automatic malfunctions and amount of feedback provided by the automatic system on level of operator trust. The study was conducted in conjunction with the Human Centred Automation 2000-experiment. Two questionnaires attempting to measure operator trust were developed, designed to reflect the dimensions of predictability, dependability and faith. Analysis of the questionnaires demonstrated that they were reliable tools for measurement of operator trust. Factor analysis did not completely confirm the theoretical dimensions of trust, but indicated partial support. Operator trust correlated negatively with workload across situations, and positively with performance in complex situations. The results of the hypotheses tests demonstrated that operator trust gradually decreased after introduction of malfunctions. The effect of different malfunctions was however the opposite of what was expected, with obvious malfunctions reducing trust more than more camouflaged and safety critical malfunctions. Trust in the automatic system in general was lower than trust in specific malfunctioning components. Different interfaces providing different amount of feedback to the operator did not significantly influence level of operator trust. (Author)

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 in Strategic Alliances

DEFF Research Database (Denmark)

Nielsen, Bo

2011-01-01

This article examines the dynamic and multi-dimensional nature of trust in strategic alliances. Adopting a co-evolutionary approach, I developed a framework to show how trust, conceptualised in different forms, plays distinct roles at various evolutionary stages of the alliance relationship....... Emphasising the multi-dimensional and dynamic role of trust, the framework illustrates how initial levels of a particular type of trust may co-evolve with the alliance and influence subsequent phases of the relationship – either on its own or in combination with other types or dimensions of trust....... The theoretical distinction between trust as antecedent, moderator and outcome during the evolution of the alliance relationship leads to research questions that may guide future empirical research....

Trust-Building in Electronic Markets: Relative Importance and Interaction Effects of Trust-Building Mechanisms

Science.gov (United States)

Tams, Stefan

We examine the relative and complementary effectiveness of trust-building strategies in online environments. While prior research has examined various antecedents to trust, we investigated two trust-building mechanisms more in depth: Web site trust and vendor reputation. We tried to understand the relative effectiveness of these two important mechanisms to provide online businesses with a clear recommendation of how to establish trust in an effective and efficient manner. Drawing from the literature on trust, we proposed vendor reputation to be more effective than Web site trust. Moreover, we examined a potential complementary effect of these mechanisms so as to provide online businesses with a deeper understanding of how to derive superior trust. We hypothesize a small such effect. The study proposes a laboratory experiment to test the model.

Capitalising on leadership fellowships for clinicians in the NHS.

Science.gov (United States)

Nicol, Edward D

2011-04-01

Clinical leadership has become a primary focus of the NHS with many leadership programmes, particularly those aimed at junior clinicians, being developed. This article illustrates the potential of these programmes but also urges caution when assessing the success of these schemes both from an individual and organisational perspective.

Delivery of core medical training: the role of a local faculty group.

Science.gov (United States)

Black, David; Dewhurst, Graeme

2011-10-01

All physicians who are training young doctors of the future recognise the current challenge of doing this in the NHS. The recently published Temple Report documents the challenge and some of the solutions. For Kent, Surrey and Sussex (KSS) Deanery, one of the responses was to implement a new structure and process at local level--the local faculty groups (LFGs)--to ensure appropriate curriculum delivery. This paper sets out the history, structure and purpose of LFGs, describes what happens during a LFG meeting in both open and closed sessions and presents feedback of learning from two years in action across 11 acute trusts in the South East Coast (SEC) strategic health authority area. The experience of trainers in SEC is that the local faculty group structure and associated processes is one strand in the more effective delivery of education in the current NHS environment.

Trust transitivity in social networks.

Directory of Open Access Journals (Sweden)

Oliver Richters

Full Text Available Non-centralized recommendation-based decision making is a central feature of several social and technological processes, such as market dynamics, peer-to-peer file-sharing and the web of trust of digital certification. We investigate the properties of trust propagation on networks, based on a simple metric of trust transitivity. We investigate analytically the percolation properties of trust transitivity in random networks with arbitrary in/out-degree distributions, and compare with numerical realizations. We find that the existence of a non-zero fraction of absolute trust (i.e. entirely confident trust is a requirement for the viability of global trust propagation in large systems: The average pair-wise trust is marked by a discontinuous transition at a specific fraction of absolute trust, below which it vanishes. Furthermore, we perform an extensive analysis of the Pretty Good Privacy (PGP web of trust, in view of the concepts introduced. We compare different scenarios of trust distribution: community- and authority-centered. We find that these scenarios lead to sharply different patterns of trust propagation, due to the segregation of authority hubs and densely-connected communities. While the authority-centered scenario is more efficient, and leads to higher average trust values, it favours weakly-connected "fringe" nodes, which are directly trusted by authorities. The community-centered scheme, on the other hand, favours nodes with intermediate in/out-degrees, in detriment of the authorities and its "fringe" peers.

Trust Transitivity in Social Networks

Science.gov (United States)

Richters, Oliver; Peixoto, Tiago P.

2011-01-01

Non-centralized recommendation-based decision making is a central feature of several social and technological processes, such as market dynamics, peer-to-peer file-sharing and the web of trust of digital certification. We investigate the properties of trust propagation on networks, based on a simple metric of trust transitivity. We investigate analytically the percolation properties of trust transitivity in random networks with arbitrary in/out-degree distributions, and compare with numerical realizations. We find that the existence of a non-zero fraction of absolute trust (i.e. entirely confident trust) is a requirement for the viability of global trust propagation in large systems: The average pair-wise trust is marked by a discontinuous transition at a specific fraction of absolute trust, below which it vanishes. Furthermore, we perform an extensive analysis of the Pretty Good Privacy (PGP) web of trust, in view of the concepts introduced. We compare different scenarios of trust distribution: community- and authority-centered. We find that these scenarios lead to sharply different patterns of trust propagation, due to the segregation of authority hubs and densely-connected communities. While the authority-centered scenario is more efficient, and leads to higher average trust values, it favours weakly-connected “fringe” nodes, which are directly trusted by authorities. The community-centered scheme, on the other hand, favours nodes with intermediate in/out-degrees, in detriment of the authorities and its “fringe” peers. PMID:21483683

Trust is a must: What is involved in trusting those who manage forest fires?

Science.gov (United States)

Adam Liljeblad; Bill Borrie; Alan Watson

2010-01-01

Trust is a complicated emotion. In the past, many social scientists have studied trust. They discovered that trust involves a number of beliefs and emotions. The scientists in this study were interested in learning more about trust. They believed that forest managers can do a better job if people trust them to do what is best for citizens and the environment (figure 1...

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.

Treatment of dengue fever

OpenAIRE

Rajapakse, Senaka; Rodrigo,Chaturaka; Rajapakse,Anoja Chamarie

2012-01-01

Senaka Rajapakse,1,2 Chaturaka Rodrigo,1 Anoja Rajapakse31Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka; 2Lincoln County Hospital, United Lincolnshire NHS Trust, Lincoln, UK; 3Kings Mill Hospital, Sherwood Forest NHS Foundation Trust, Mansfield, UKAbstract: The endemic area for dengue fever extends over 60 countries, and approximately 2.5 billion people are at risk of infection. The incidence of dengue has multiplied many times over the last five decad...

Topiramate-induced maculopathy in IgG4-related disease

OpenAIRE

DaCosta, Joanna; Younis, Saad

2016-01-01

Joanna DaCosta,1,2 Saad Younis1 1Ophthalmology Department, Imperial College Healthcare NHS Trust, Western Eye Hospital, 2Barts Health NHS Trust, Whipps Cross University Hospital, London, UK Abstract: This report describes a case of reversible topiramate-induced maculopathy in a 32-year-old female patient with IgG4-related disease. The patient presented with decreased vision associated with anterior uveitis and cystoid macula edema, which was unresponsive to oral and topical steroids. Followi...

Social Trust and Fractionalization:

DEFF Research Database (Denmark)

Bjørnskov, Christian

2008-01-01

This paper takes a closer look at the importance of fractionalization for the creation of social trust. It first argues that the determinants of trust can be divided into two categories: those affecting individuals' trust radii and those affecting social polarization. A series of estimates using...... a much larger country sample than in previous literature confirms that fractionalization in the form of income inequality and political diversity adversely affects social trust while ethnic diversity does not. However, these effects differ systematically across countries, questioning standard...... interpretations of the influence of fractionalization on trust....

The Process of Trust Development

DEFF Research Database (Denmark)

Jagd, Søren; Højland, Jeppe

in management among employees. Trust is found to be higher among employees interacting regularly with managers, as in the project coordination group. It is found that personal relations are very important for the development of trust. The success of the project may be explained by the involvement of an ‘elite...... and discuss with colleagues from other departments and develop personal knowledge of each other....... by high trust and co-operation? In this paper we explore the process of trust development during an organisational change project in a Danish SME by looking at two kinds of trust relations: employee trust in management and trust relations among employees. We find substantial differences in trust...

Trust Discovery in Online Communities

Science.gov (United States)

Piorkowski, John

2014-01-01

This research aims to discover interpersonal trust in online communities. Two novel trust models are built to explain interpersonal trust in online communities drawing theories and models from multiple relevant areas, including organizational trust models, trust in virtual settings, speech act theory, identity theory, and common bond theory. In…

Barriers and facilitators to using NHS Direct: a qualitative study of 'users' and 'non-users'.

Science.gov (United States)

Cook, Erica J; Randhawa, Gurch; Large, Shirley; Guppy, Andy; Chater, Angel M; Ali, Nasreen

2014-10-25

NHS Direct, introduced in 1998, has provided 24/7 telephone-based healthcare advice and information to the public in England and Wales. National studies have suggested variation in the uptake of this service amongst the UK's diverse population. This study provides the first exploration of the barriers and facilitators that impact upon the uptake of this service from the perspectives of both 'users' and 'non- users'. Focus groups were held with NHS Direct 'users' (N = 2) from Bedfordshire alongside 'non-users' from Manchester (N = 3) and Mendip, Somerset (N = 4). Each focus group had between five to eight participants. A total of eighty one people aged between 21 and 94 years old (M: 58.90, SD: 22.70) took part in this research. Each focus group discussion lasted approximately 90 minutes and was audiotape-recorded with participants' permission. The recordings were transcribed verbatim. A framework approach was used to analyse the transcripts. The findings from this research uncovered a range of barriers and facilitators that impact upon the uptake of NHS Direct. 'Non-users' were unaware of the range of services that NHS Direct provided. Furthermore, 'non-users' highlighted a preference for face-to face communication, identifying a lack of confidence in discussing healthcare over the telephone. This was particularly evident among older people with cognitive difficulties. The cost to telephone a '0845' number from a mobile was also viewed to be a barrier to access NHS Direct, expressed more often by 'non-users' from deprived communities. NHS Direct 'users' identified that awareness, ease of use and convenience were facilitators which influenced their decision to use the service. An understanding of the barriers and facilitators which impact on the access and uptake of telephone-based healthcare is essential to move patients towards the self-care model. This research has highlighted the need for telephone-based healthcare services to increase public awareness; through

Refinement of the NHS locus on chromosome Xp22.13 and analysis of five candidate genes.

Science.gov (United States)

Toutain, Annick; Dessay, Benoît; Ronce, Nathalie; Ferrante, Maria-Immacolata; Tranchemontagne, Julie; Newbury-Ecob, Ruth; Wallgren-Pettersson, Carina; Burn, John; Kaplan, Josseline; Rossi, Annick; Russo, Silvia; Walpole, Ian; Hartsfield, James K; Oyen, Nina; Nemeth, Andrea; Bitoun, Pierre; Trump, Dorothy; Moraine, Claude; Franco, Brunella

2002-09-01

Nance-Horan syndrome (NHS) is an X-linked condition characterised by congenital cataracts, dental abnormalities, dysmorphic features, and mental retardation in some cases. Previous studies have mapped the disease gene to a 2 cM interval on Xp22.2 between DXS43 and DXS999. We report additional linkage data resulting from the analysis of eleven independent NHS families. A maximum lod score of 9.94 (theta=0.00) was obtained at the RS1 locus and a recombination with locus DXS1195 on the telomeric side was observed in two families, thus refining the location of the gene to an interval of around 1 Mb on Xp22.13. Direct sequencing or SSCP analysis of the coding exons of five genes (SCML1, SCML2, STK9, RS1 and PPEF1), considered as candidate genes on the basis of their location in the critical interval, failed to detect any mutation in 12 unrelated NHS patients, thus making it highly unlikely that these genes are implicated in NHS.

Building trusted national identity management systems: Presenting the privacy concern-trust (PCT) model

DEFF Research Database (Denmark)

Adjei, Joseph K.; Olesen, Henning

This paper discusses the effect of trust and information privacy concerns on citizens’ attitude towards national identity management systems. We introduce the privacyconcerns- trust model, which shows the role of trust in mediating and moderating citizens’ attitude towards identity management...... systems. We adopted a qualitative research approach in our analysis of data that was gathered through a series of interviews and a stakeholder workshop in Ghana. Our findings indicate that, beyond the threshold level of trust, societal information privacy concern is low; hence, trust is high, thereby...

Addressing current and future challenges for the NHS: the role of good leadership.

Science.gov (United States)

Elton, Lotte

2016-10-03

Purpose This paper aims to describe and analyse some of the ways in which good leadership can enable those working within the National Health Service (NHS) to weather the changes and difficulties likely to arise in the coming years, and takes the format of an essay written by the prize-winner of the Faculty of Medical Leadership and Management's Student Prize. The Faculty of Medical Leadership and Management ran its inaugural Student Prize in 2015-2016, which aimed at medical students with an interest in medical leadership. In running the Prize, the Faculty hoped to foster an enthusiasm for and understanding of the importance of leadership in medicine. Design/methodology/approach The Faculty asked entrants to discuss the role of good leadership in addressing the current and future challenges faced by the NHS, making reference to the Leadership and Management Standards for Medical Professionals published by the Faculty in 2015. These standards were intended to help guide current and future leaders and were grouped into three categories, namely, self, team and corporate responsibility. Findings This paper highlights the political nature of health care in the UK and the increasing impetus on medical professionals to navigate debates on austerity measures and health-care costs, particularly given the projected deficit in NHS funding. It stresses the importance of building organisational cultures prizing transparency to prevent future breaches in standards of care and the value of patient-centred approaches in improving satisfaction for both patients and staff. Identification of opportunities for collaboration and partnership is emphasised as crucial to assuage the burden that lack of appropriate social care places on clinical services. Originality/value This paper offers a novel perspective - that of a medical student - on the complex issues faced by the NHS over the coming years and utilises a well-regarded set of standards in conceptualising the role that health

Fabulous award for staffing app.

Science.gov (United States)

2015-12-02

A safe staffing app giving up-to-date information on the number of nurses on the wards at Nottingham University Hospitals NHS Trust scooped top prize at the inaugural Academy of Fabulous NHS Stuffawards in London last week.

The suitability of ISO 9001 as a quality system for a medical illustration department.

Science.gov (United States)

Fleming, C M; Armes, F M

2001-12-01

The Medical illustration Department within Bradford Hospitals NHS Trust is typical of many such units in the UK that are facing increasing competition from the commercial sector and Private Finance Initiatives, and at the same time, being driven by NHS initiatives towards having a demonstrable quality system. It was considered that having a recognized quality management system would ensure that the service provided was more efficient and effective, improve quality, guard against competition, be an asset if the organization was benchmarked against others, and provide evidence of quality assurance to our customers. This paper summarizes the history of quality management, discusses a number of quality systems in the NHS in general, and in Bradford Hospitals NHS Trust in particular, and puts forward the reasons for choosing ISO9001. Finally, the process leading to accreditation is described.

The limits of market-based reforms in the NHS: the case of alternative providers in primary care

Science.gov (United States)

2013-01-01

Background Historically, primary medical care in the UK has been delivered by general practitioners who are independent contractors, operating under a contract, which until 2004 was subject to little performance management. In keeping with the wider political impetus to introduce markets and competition into the NHS, reforms were introduced to allow new providers to bid for contracts to provide primary care services in England. These contracts known as ‘Alternative Provider Medical Services’, were encouraged by two centrally-driven rounds of procurement (2007/8 and 2008/9). This research investigated the commissioning and operation of such Alternative Providers of Primary Care (APPCs). Methods Two qualitative case studies were undertaken in purposively sampled English Primary Care Trusts (PCTs) and their associated APPCs over 14 months (2009-10). We observed 65 hours of meetings, conducted 23 interviews with PCT and practice staff, and gathered relevant associated documentation. Results and conclusions We found that the procurement and contracting process was costly and time-consuming. Extensive local consultation was undertaken, and there was considerable opposition in some areas. Many APPCs struggled to build up their patient list sizes, whilst over-performing on walk-in contracts. Contracting for APPCs was ‘transactional’, in marked contrast to the ‘relational’ contracting usually found in the NHS, with APPCs subject to tight performance management. These complicated and costly processes contrast to those experienced by traditionally owned GP partnerships. However, managers reported that the perception of competition had led existing practices to improve their services. The Coalition Government elected in 2010 is committed to ‘Any Qualified Provider’ of secondary care, and some commentators argue that this should also be applied to primary care. Our research suggests that, if this is to happen, a debate is needed about the operation of a market

Understanding Trust in Financial Services

DEFF Research Database (Denmark)

Hansen, Torben

2012-01-01

Although the financial crisis has elevated the interest for factors such as consumer financial healthiness, broad-scope trust, financial knowledge, and consumer relationship satisfaction, no existing model describes how these factors may influence consumer financial relationship trust...... healthiness, broad-scope trust, knowledge, and satisfaction positively affect narrow-scope trust in financial services. Furthermore, it is found that broad-scope trust negatively moderates the relationships between financial healthiness and narrow-scope trust and between satisfaction and narrow-scope trust....... This research extends prior research by developing a conceptual framework explaining how these constructs affect consumers' trust in their financial service provider. Based on two surveys comprising 764 pension consumers and 892 mortgage consumers, respectively, the results of this study indicate that financial...

The Condition for Generous Trust.

Directory of Open Access Journals (Sweden)

Obayashi Shinya

Full Text Available Trust has been considered the "cement" of a society and is much studied in sociology and other social sciences. Most studies, however, have neglected one important aspect of trust: it involves an act of forgiving and showing tolerance toward another's failure. In this study, we refer to this concept as "generous trust" and examine the conditions under which generous trust becomes a more viable option when compared to other types of trust. We investigate two settings. First, we introduce two types of uncertainties: uncertainty as to whether trustees have the intention to cooperate, and uncertainty as to whether trustees have enough competence to accomplish the entrusted tasks. Second, we examine the manner in which trust functions in a broader social context, one that involves matching and commitment processes. Since we expect generosity or forgiveness to work differently in the matching and commitment processes, we must differentiate trust strategies into generous trust in the matching process and that in the commitment process. Our analytical strategy is two-fold. First, we analyze the "modified" trust game that incorporates the two types of uncertainties without the matching process. This simplified setting enables us to derive mathematical results using game theory, thereby giving basic insight into the trust mechanism. Second, we investigate socially embedded trust relationships in contexts involving the matching and commitment processes, using agent-based simulation. Results show that uncertainty about partner's intention and competence makes generous trust a viable option. In contrast, too much uncertainty undermines the possibility of generous trust. Furthermore, a strategy that is too generous cannot stand alone. Generosity should be accompanied with moderate punishment. As for socially embedded trust relationships, generosity functions differently in the matching process versus the commitment process. Indeed, these two types of generous

The clinician impact and financial cost to the NHS of litigation over pregabalin: a cohort study in English primary care.

Science.gov (United States)

Croker, Richard; Smyth, Darren; Walker, Alex J; Goldacre, Ben

2018-06-07

Following litigation over pregabalin's second-use medical patent for neuropathic pain, National Health Service (NHS) England was required by the court to instruct general practitioners (GPs) to prescribe the branded form (Lyrica) for pain. Pfizer's patent was found invalid in 2015, a ruling subject to ongoing appeals. If the Supreme Court appeal in February 2018, whose judgement is awaited, is unsuccessful, the NHS can seek to reclaim excess prescribing costs. We set out to describe the variation in prescribing of pregabalin as branded Lyrica, geographically and over time; to determine how clinicians responded to the NHS England instruction to GPs; and to model excess costs to the NHS attributable to the legal judgements. English primary care. English general practices. Variation in prescribing of branded Lyrica across the country before and after the NHS England instruction, by practice and by Clinical Commissioning Group; excess prescribing costs. The proportion of pregabalin prescribed as Lyrica increased from 0.3% over 6 months before the NHS England instruction (September 2014 to February 2015) to 25.7% afterwards (April to September 2015). Although 70% of pregabalin is estimated to be for pain, including neuropathic pain, only 11.6% of practices prescribed Lyrica at this level; the median proportion prescribed as Lyrica was 8.8% (IQR 1.1%-41.9%). If pregabalin had come entirely off patent in September 2015, and Pfizer had not appealed, we estimate the NHS would have spent £502 million less on pregabalin to July 2017. NHS England instructions to GPs regarding branded prescription of pregabalin were widely ignored and have created much debate around clinical independence in prescribing. Protecting revenue from 'skinny labels' will pose a challenge. If Pfizer's final appeal on the patent is unsuccessful, the NHS can seek reimbursement of excess pregabalin prescribing costs, potentially £502 million. © Article author(s) (or their employer(s) unless

NHS-Esters As Versatile Reactivity-Based Probes for Mapping Proteome-Wide Ligandable Hotspots.

Science.gov (United States)

Ward, Carl C; Kleinman, Jordan I; Nomura, Daniel K

2017-06-16

Most of the proteome is considered undruggable, oftentimes hindering translational efforts for drug discovery. Identifying previously unknown druggable hotspots in proteins would enable strategies for pharmacologically interrogating these sites with small molecules. Activity-based protein profiling (ABPP) has arisen as a powerful chemoproteomic strategy that uses reactivity-based chemical probes to map reactive, functional, and ligandable hotspots in complex proteomes, which has enabled inhibitor discovery against various therapeutic protein targets. Here, we report an alkyne-functionalized N-hydroxysuccinimide-ester (NHS-ester) as a versatile reactivity-based probe for mapping the reactivity of a wide range of nucleophilic ligandable hotspots, including lysines, serines, threonines, and tyrosines, encompassing active sites, allosteric sites, post-translational modification sites, protein interaction sites, and previously uncharacterized potential binding sites. Surprisingly, we also show that fragment-based NHS-ester ligands can be made to confer selectivity for specific lysine hotspots on specific targets including Dpyd, Aldh2, and Gstt1. We thus put forth NHS-esters as promising reactivity-based probes and chemical scaffolds for covalent ligand discovery.

Evidence-based policy-making in the NHS: exploring the interface between research and the commissioning process.

Science.gov (United States)

Harries, U; Elliott, H; Higgins, A

1999-03-01

The UK National Health Service (NHS) R&D strategy acknowledges the importance of developing an NHS where practice and policy is more evidence-based. This paper is based on a qualitative study which aimed to identify factors which facilitate or impede evidence-based policy-making at a local level in the NHS. The study involved a literature review and case studies of social research projects which were initiated by NHS health authority managers or general practitioner (GP) fundholders in one region of the NHS. Data were collected through in-depth interviews with lead policy-makers, GPs and researchers working on each of the case studies and analysis of project documentation. An over-arching theme from the analysis was that of the complexity of R&D in purchasing. The two worlds of research and health services management often sit uncomfortably together. For this reason it was not possible to describe a 'blueprint' for successful R&D, although several important issues emerged. These include sharing an appropriate model for research utilization, the importance of relationships in shaping R&D, the importance of influence and commitment in facilitating evidence-based change, and the resourcing of R&D in purchasing. These issues have important implications for the strategic development of R&D as well as for individual project application. Moving beyond the rhetoric of evidence-based policy-making is more likely if both policy-makers and researchers openly acknowledge this complexity and give due concern to the issues outlined.

ReTrust: attack-resistant and lightweight trust management for medical sensor networks.

Science.gov (United States)

He, Daojing; Chen, Chun; Chan, Sammy; Bu, Jiajun; Vasilakos, Athanasios V

2012-07-01

Wireless medical sensor networks (MSNs) enable ubiquitous health monitoring of users during their everyday lives, at health sites, without restricting their freedom. Establishing trust among distributed network entities has been recognized as a powerful tool to improve the security and performance of distributed networks such as mobile ad hoc networks and sensor networks. However, most existing trust systems are not well suited for MSNs due to the unique operational and security requirements of MSNs. Moreover, similar to most security schemes, trust management methods themselves can be vulnerable to attacks. Unfortunately, this issue is often ignored in existing trust systems. In this paper, we identify the security and performance challenges facing a sensor network for wireless medical monitoring and suggest it should follow a two-tier architecture. Based on such an architecture, we develop an attack-resistant and lightweight trust management scheme named ReTrust. This paper also reports the experimental results of the Collection Tree Protocol using our proposed system in a network of TelosB motes, which show that ReTrust not only can efficiently detect malicious/faulty behaviors, but can also significantly improve the network performance in practice.

Social Trust and Value Similarity: the Relationship between Social Trust and Human Values in Europe

Directory of Open Access Journals (Sweden)

Mai Beilmann

2015-12-01

Full Text Available The purpose of the current paper is to test whether value similarity may foster social trust in society and whether people have higher levels of social trust when they emphasise the same values that prevail in their country. The relationship between social trust and human values was examined in a sample of 51,308 people across 29 European countries using data from the European Social Survey round 6. Results suggest that value similarity is more important in generating individual level social trust in countries where the overall levels of social trust are higher. There is a stronger positive relationship between value similarity and social trust in Scandinavian countries, which have high social trust levels, while in countries with a low level of social trust, congruity of the personal value structure with the country level value structure tends to decrease the individuals trustfulness

DualTrust: A Trust Management Model for Swarm-Based Autonomic Computing Systems

Energy Technology Data Exchange (ETDEWEB)

Maiden, Wendy M. [Washington State Univ., Pullman, WA (United States)

2010-05-01

Trust management techniques must be adapted to the unique needs of the application architectures and problem domains to which they are applied. For autonomic computing systems that utilize mobile agents and ant colony algorithms for their sensor layer, certain characteristics of the mobile agent ant swarm -- their lightweight, ephemeral nature and indirect communication -- make this adaptation especially challenging. This thesis looks at the trust issues and opportunities in swarm-based autonomic computing systems and finds that by monitoring the trustworthiness of the autonomic managers rather than the swarming sensors, the trust management problem becomes much more scalable and still serves to protect the swarm. After analyzing the applicability of trust management research as it has been applied to architectures with similar characteristics, this thesis specifies the required characteristics for trust management mechanisms used to monitor the trustworthiness of entities in a swarm-based autonomic computing system and describes a trust model that meets these requirements.

Trust and School Life: The Role of Trust for Learning, Teaching, Leading, and Bridging

Science.gov (United States)

Van Maele, Dimitri, Ed.; Forsyth, Patrick B., Ed.; Van Houtte, Miek, Ed.

2014-01-01

This book samples recent and emerging trust research in education including an array of conceptual approaches, measurement innovations, and explored determinants and outcomes of trust. The collection of pathways explores the phenomenon of trust and establishes the significance of trust relationships in school life. It emboldens the claim that…

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 ...

A healthy dose of trust: the relationship between interpersonal trust and health

NARCIS (Netherlands)

Schneider, I.K.; Konijn, E.A.; Righetti, F.; Rusbult, C.E.

2011-01-01

The positive effects of trust are manifold. Recent research has shown that trust levels may even influence physical health. The current work explores this issue and aims to shed light on the mechanisms underlying the relationship between trust and health in a 5-wave longitudinal data set. Results

A Model of Trusted Measurement Model

OpenAIRE

Ma Zhili; Wang Zhihao; Dai Liang; Zhu Xiaoqin

2017-01-01

A model of Trusted Measurement supporting behavior measurement based on trusted connection architecture (TCA) with three entities and three levels is proposed, and a frame to illustrate the model is given. The model synthesizes three trusted measurement dimensions including trusted identity, trusted status and trusted behavior, satisfies the essential requirements of trusted measurement, and unified the TCA with three entities and three levels.

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...

Trust and Influence

Science.gov (United States)

2013-03-06

the behavior or attitudes of others). LIST SUB-AREAS IN PORTFOLIO: Science of Reliance • Trust in Autonomous Systems/ Autonomy – identify the...error •Humans have trust biases (Lyons & Stokes, 2012) •Little is known about how human trust principles apply to autonomy /robotics...for the model in western context (Colquitt et al., 2007) • Some evidence that benevolence is favored by collectivist culture (Branzei et al., 2007

Trust Models in Ubiquitous Computing

DEFF Research Database (Denmark)

Nielsen, Mogens; Krukow, Karl; Sassone, Vladimiro

2008-01-01

We recapture some of the arguments for trust-based technologies in ubiquitous computing, followed by a brief survey of some of the models of trust that have been introduced in this respect. Based on this, we argue for the need of more formal and foundational trust models.......We recapture some of the arguments for trust-based technologies in ubiquitous computing, followed by a brief survey of some of the models of trust that have been introduced in this respect. Based on this, we argue for the need of more formal and foundational trust models....

An Operational Semantics for Trust Policies

DEFF Research Database (Denmark)

Krukow, Karl

2006-01-01

In the trust-structure framework for trust management, principals specify their trusting relationships in terms of trust policies. In their paper on trust structures, Carbone et al. present a language for such policies, and provide a suitable denotational semantics. The semantics ensures that for......In the trust-structure framework for trust management, principals specify their trusting relationships in terms of trust policies. In their paper on trust structures, Carbone et al. present a language for such policies, and provide a suitable denotational semantics. The semantics ensures...... that for any collection of policies, there is always a unique global trust-state, compatible with all the policies, specifying everyone's degree of trust in everyone else. However, as the authors themselves point out, the language lacks an operational model: the global trust-state is a well......-defined mathematical object, but it is not clear how principals can actually compute it. This becomes even more apparent when one considers the intended application environment: vast numbers of autonomous principals, distributed and possibly mobile. We provide a compositional operational semantics for a language...

UK doctors and equal opportunities in the NHS: national questionnaire surveys of views on gender, ethnicity and disability.

Science.gov (United States)

Lambert, Trevor; Surman, Geraldine; Goldacre, Michael

2014-10-01

To seek doctors' views about the NHS as an employer, our surveys about doctors' career intentions and progression, undertaken between 1999 and 2013, also asked whether the NHS was, in their view, a good 'equal opportunities' employer for women doctors, doctors from ethnic minority groups and doctors with disabilities. Surveys undertaken in the UK by mail and Internet. UK medical graduates in selected graduation years between 1993 and 2012. Respondents were asked to rate their level of agreement with three statements starting 'The NHS is a good equal opportunities employer for…' and ending 'women doctors', 'doctors from ethnic minorities' and 'doctors with disabilities'. Of first-year doctors surveyed in 2013, 3.6% (78/2158) disagreed that the NHS is a good equal opportunities employer for women doctors (1.7% of the men and 4.7% of the women); 2.2% (44/1968) disagreed for doctors from ethnic minorities (0.9% of white doctors and 5.8% of non-white doctors) and 12.6% (175/1387) disagreed for doctors with disabilities. Favourable perceptions of the NHS in these respects improved substantially between 1999 and 2013; among first-year doctors of 2000-2003, combined, the corresponding percentages of disagreement were 23.5% for women doctors, 23.1% for doctors from ethnic minorities and 50.6% for doctors with disabilities. Positive views about the NHS as an equal opportunities employer have increased in recent years, but the remaining gap in perception of this between women and men, and between ethnic minority and white doctors, is a concern. © The Royal Society of Medicine.

A Matter of Trust

DEFF Research Database (Denmark)

Blach-Ørsten, Mark; Hartley, Jannie Møller; Wittchen, Maria Bendix

; Hindman, 2005), we find that the Danish news media tried to distance themselves from the journalists involved in the scandals and describe them as ‘bad apples’ (Cecil, 2002). But, in both scandals, we also find that the Danish news media went to great lengths to investigate the accusations, document......In 2015 two major journalistic scandals hit the Danish news media. One was a plagiarism scandal in which a freelance foreign correspondent was found to have plagiarized parts of the stories she had filed from other international news media. The other scandal involved a sports journalist who...... was found to have invented a large number of the sources that were quoted in his stories and had made up false co-bylines. In a time of diminishing trust in the news media (Blach-Ørsten & Burkal, 2013; Reuters, 2016) these scandals represented a significant and acute credibility problem for the news media...

Reliable Design Versus Trust

Science.gov (United States)

Berg, Melanie; LaBel, Kenneth A.

2016-01-01

This presentation focuses on reliability and trust for the users portion of the FPGA design flow. It is assumed that the manufacturer prior to hand-off to the user tests FPGA internal components. The objective is to present the challenges of creating reliable and trusted designs. The following will be addressed: What makes a design vulnerable to functional flaws (reliability) or attackers (trust)? What are the challenges for verifying a reliable design versus a trusted design?

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.

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…

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.

Trust, values and false consensus

OpenAIRE

Butler, Jeffrey V.; Giuliano, Paola; Guiso, Luigi

2012-01-01

Trust beliefs are heterogeneous across individuals and, at the same time, persistent across generations. We investigate one mechanism yielding these dual patterns: false consensus. In the context of a trust game experiment, we show that individuals extrapolate from their own type when forming trust beliefs about the same pool of potential partners – i.e., more (less) trustworthy individuals form more optimistic (pessimistic) trust beliefs - and that this tendency continues to color trust beli...

A formalization of computational trust

NARCIS (Netherlands)

Güven - Ozcelebi, C.; Holenderski, M.J.; Ozcelebi, T.; Lukkien, J.J.

2018-01-01

Computational trust aims to quantify trust and is studied by many disciplines including computer science, social sciences and business science. We propose a formal computational trust model, including its parameters and operations on these parameters, as well as a step by step guide to compute trust

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.

Fording Canadian Coal Trust

Energy Technology Data Exchange (ETDEWEB)

Popowich, J.; Millos, R. [Elk Valley Coal Corporation, Calgary, AB (Canada)

2004-07-01

This is the first of five slide/overhead presentations presented at the Fording Canadian Coal Trust and Tech Cominco Ltd. investor day and mine tour. The Fording Canadian Coal Trust is described. The Trust's assets comprise six Elk Valley metallurgical coal mines and six wollastonite operations (in the NYCO Group). Trust structure, corporate responsibility, organizational structure, reserves and resources, management philosophy, operating strategies, steel market dynamics, coal market, production expansion, sales and distribution are outlined. 15 figs., 5 tabs.

Trust metrics in information fusion

Science.gov (United States)

Blasch, Erik

2014-05-01

Trust is an important concept for machine intelligence and is not consistent across many applications. In this paper, we seek to understand trust from a variety of factors: humans, sensors, communications, intelligence processing algorithms and human-machine displays of information. In modeling the various aspects of trust, we provide an example from machine intelligence that supports the various attributes of measuring trust such as sensor accuracy, communication timeliness, machine processing confidence, and display throughput to convey the various attributes that support user acceptance of machine intelligence results. The example used is fusing video and text whereby an analyst needs trust information in the identified imagery track. We use the proportional conflict redistribution rule as an information fusion technique that handles conflicting data from trusted and mistrusted sources. The discussion of the many forms of trust explored in the paper seeks to provide a systems-level design perspective for information fusion trust quantification.

The social context of trust relations

Directory of Open Access Journals (Sweden)

Kojić Milena

2017-01-01

Full Text Available In the widest sense, this paper focuses on the problematization (and operationalization of the concept of trust and its social context, with a special emphasis on its multiple meanings, the ways of establishing trust, as well as its functions. After pointing to the various definitions of trust that highlight its cognitive, behavioral, and relational groundings, we proceed to examine the aspects of 'social embeddedness' of trust. In this context, we highlight the structural aspect of trust relations, their institutional embeddedness, mediation through cultural meanings, as well as the wider context of social circumstances and limitations. We place a special emphasis on the concept of 'trust culture', its morphogenesis and functions, as well as the significance of trust culture in the context of diminishing the social uncertainty that arises in the situations when trust is demonstrated. Finally, we point to the social functions of trust on the macro level, the functional substitutes for trust, as well as the relationship between trust and social capital.

Weight Watchers on prescription: An observational study of weight change among adults referred to Weight Watchers by the NHS

Directory of Open Access Journals (Sweden)

Aston Louise M

2011-06-01

Full Text Available Abstract Background The scale of overweight and obesity in the UK places a considerable burden on the NHS. In some areas the NHS has formed partnerships with commercial companies to offer weight management services, but there has been little evaluation of these schemes. This study is an independent audit of the Weight Watchers NHS Referral scheme and evaluates the weight change of obese and overweight adults referred to Weight Watchers (WW by the NHS. Method Data was obtained from the WW NHS Referral Scheme database for 29,326 referral courses started after 2nd April 2007 and ending before 6th October 2009 [90% female; median age 49 years (IQR 38 - 61 years; median BMI 35.1 kg/m2 (IQR 31.8 - 39.5 kg/m2. Participants received vouchers (funded by the PCT following referral by a healthcare professional to attend 12 WW meetings. Body weight was measured at WW meetings and relayed to the central database. Results Median weight change for all referrals was -2.8 kg [IQR -5.9 - -0.7 kg] representing -3.1% initial weight. 33% of all courses resulted in loss of ≥5% initial weight. 54% of courses were completed. Median weight change for those completing a first course was -5.4 kg [IQR -7.8 - -3.1 kg] or -5.6% of initial weight. 57% lost ≥5% initial weight. Conclusions A third of all patients who were referred to WW through the WW NHS Referral Scheme and started a 12 session course achieved ≥5% weight loss, which is usually associated with clinical benefits. This is the largest audit of NHS referral to a commercial weight loss programme in the UK and results are comparable with other options for weight loss available through primary care.

Complementary therapy use by patients and parents of children with asthma and the implications for NHS care: a qualitative study

Directory of Open Access Journals (Sweden)

Sharp Debbie

2006-06-01

Full Text Available Abstract Background Patients are increasingly using complementary therapies, often for chronic conditions. Asthma is the most common chronic condition in the UK. Previous research indicates that some asthma patients experience gaps in their NHS care. However, little attention has been given to how and why patients and parents of children with asthma use complementary therapies and the implications for NHS care. Methods Qualitative study, comprising 50 semi-structured interviews with a purposeful sample of 22 adults and 28 children with asthma (plus a parent, recruited from a range of NHS and non-NHS settings in Bristol, England. Data analysis was thematic, drawing on the principles of constant comparison. Results A range of complementary therapies were being used for asthma, most commonly Buteyko breathing and homeopathy. Most use took place outside of the NHS, comprising either self-treatment or consultation with private complementary therapists. Complementary therapies were usually used alongside not instead of conventional asthma treatment. A spectrum of complementary therapy users emerged, including "committed", "pragmatic" and "last resort" users. Motivating factors for complementary therapy use included concerns about conventional NHS care ("push factors" and attractive aspects of complementary therapies ("pull factors". While participants were often uncertain whether therapies had directly helped their asthma, breathing techniques such as the Buteyko Method were most notably reported to enhance symptom control and enable reduction in medication. Across the range of therapies, the process of seeking and using complementary therapies seemed to help patients in two broad ways: it empowered them to take greater personal control over their condition rather than feel dependant on medication, and enabled exploration of a broader range of possible causes of their asthma than commonly discussed within NHS settings. Conclusion Complementary therapy

An Operational Semantics for Trust Policies

DEFF Research Database (Denmark)

Krukow, Karl Kristian

2005-01-01

In the trust-structure model of trust management, principals specify their trusting relationships with other principals in terms of trust policies. In their paper on trust structures, Carbone et al. present a language for trust policies, and provide a suitable denotational semantics. The semantics...... ensures that for any collection of trust policies, there is always a unique global trust-state, compatible with all the policies, specifying everyone's degree of trust in everyone else. However, as the authors themselves point out, the language lacks an operational model: the global trust-state is a well......-defined mathematical object, but it is not clear how principals can actually compute it. This becomes even more apparent when one considers the intended application environment: vast numbers of autonomous principals, distributed and possibly mobile. We provide a compositional operational semantics for a language...

Generalized Trust and Trust in Institutions in Confucian Asia

Science.gov (United States)

Tan, Soo Jiuan; Tambyah, Siok Kuan

2011-01-01

This study examines generalized trust and trust in institutions in Confucian Asia, covering six countries namely, China, Japan, Singapore, South Korea, Taiwan and Vietnam, and one dependent region, Hong Kong. Using data from the 2006 AsiaBarometer Survey, our study affirms the reliability and validity of using a two-item scale to measure…

NHS health checks through general practice: randomised trial of population cardiovascular risk reduction

Directory of Open Access Journals (Sweden)

Cochrane Thomas

2012-11-01

Full Text Available Abstract Background The global burden of the major vascular diseases is projected to rise and to remain the dominant non-communicable disease cluster well into the twenty first century. The Department of Health in England has developed the NHS Health Check service as a policy initiative to reduce population vascular disease risk. The aims of this study were to monitor population changes in cardiovascular disease (CVD risk factors over the first year of the new service and to assess the value of tailored lifestyle support, including motivational interview with ongoing support and referral to other services. Methods Randomised trial comparing NHS Health Check service only with NHS Health Check service plus additional lifestyle support in Stoke on Trent, England. Thirty eight general practices and 601 (365 usual care, 236 additional lifestyle support patients were recruited and randomised independently between September 2009 and February 2010. Changes in population CVD risk between baseline and one year follow-up were compared, using intention-to-treat analysis. The primary outcome was the Framingham 10 year CVD risk score. Secondary outcomes included individual modifiable risk measures and prevalence of individual risk categories. Additional lifestyle support included referral to a lifestyle coach and free sessions as needed for: weight management, physical activity, cook and eat and positive thinking. Results Average population CVD risk decreased from 32.9% to 29.4% (p Conclusions The NHS Health Check service in Stoke on Trent resulted in significant reduction in estimated population CVD risk. There was no evidence of further benefit of the additional lifestyle support services in terms of absolute CVD risk reduction.

Trust Drives Internet Use

DEFF Research Database (Denmark)

Ljunge, Jan Martin

This paper estimates the effect of trust on internet use by studying the general population as well as second generation immigrants in 29 European countries with ancestry in 87 nations. There is a significant positive effect of trust on internet use. The positive trust effect is not universal...

Trust and Distrust in E-Commerce

Directory of Open Access Journals (Sweden)

Suk-Joo Lee

2018-03-01

Full Text Available Trust is the key ingredient for sustainable transactions. In the concept of trust, the trustor trusts the trustees. In e-commerce, the trustor is the buyer and the trustees are the intermediaries and the seller. Intermediaries provide the web-based infrastructure that enables buyers and sellers to make transactions. Trust is the buyer’s judgment and comprises two distinct concepts; both trust and distrust reside in the trustor. The purpose of this study was to examine the complicated effects of trust and distrust on a buyer’s purchase intentions. Previous studies have provided theoretical frameworks illustrating co-existent trust and distrust, trust transfers from one to another, and trust in buyer-intermediary-seller relationships. Based on these frameworks, this study (i presented a holistic model that contained the judgment of buyers resulting in trust or distrust in the intermediary and the seller; (ii investigated trust and distrust transfer from the intermediary to the seller, and (iii explored the effects of various antecedents that affect trust and distrust. To validate the proposed model, we employed Partial Least Squares (PLS. A summary of key findings are as follows. First, buyer’s trust in an intermediary positively affected his or her trust in the seller, positively influencing purchase intention. In other words, we found the trust transfer from an intermediary to its seller. Second, distrust in an intermediary directly impacted on the buyer’s perceived risk, negatively influencing his or her purchase intentions. Third, structural assurance and perceived website quality of an intermediary gave a positive impact on buyer’s trust in the intermediary. The results of this study shed light on the necessity of managing both trust and distrust to facilitate sales in e-commerce.

A general definition of trust

OpenAIRE

O'Hara, Kieron

2012-01-01

In this paper a definition and conceptual analysis of trust is given in terms of trustworthiness. Its focus will be as wide as possible, and will not be restricted to any particular type of trust. The aim is to show the key parameters that enable us to investigate and understand trust, thereby facilitating the development of systems, institutions and technologies to support, model or mimic trust. The paper will also show the strong connection between trust and trustworthiness, showing how the...

Trust and Sensemaking in Organizations

DEFF Research Database (Denmark)

Fuglsang, Lars; Jagd, Søren; Olsen, Poul Bitsch

The literature on trust and the literature on sensemaking constitute two separate streams of literature that are both seen as highly relevant to understanding organisational processes in modern complex high-trust organisations. However, though a few studies have argued for the relevance of linkin...... help furthering the understanding of trust processes in organizations. The variety of links between sensemaking and trust processes is illustrated by the intertwining of trust and four processes of sensemaking: arguing, expecting, committing and manipulation identified by Karl Weick....

The productivity of trust

DEFF Research Database (Denmark)

Bjørnskov, Christian; Méon, Pierre-Guillaume

This paper returns to one of the early questions of the literature on social trust, whether trust affects total factor productivity (TFP). Using both development and growth accounting, we find strong evidence of a causal effect of trust on the level and growth of TFP. Using a three-stage least...

A question of trust

Science.gov (United States)

2010-04-01

Trust lies at the heart of modern science. As scientists, we trust that the papers we read are honest and correct as far as the data, results, techniques and theories in them are concerned. We trust that our colleagues and collaborators are acting properly and ethically - and not being devious, secretive or sloppy. But perhaps even more important is the public's trust in science. After all, much research is funded by taxpayers, who, quite rightly, want to know that the work will not harm them and, preferably, do them some good.

25 CFR 1000.360 - Is the trust evaluation standard or process different when the trust asset is held in trust for...

Science.gov (United States)

2010-04-01

... 25 Indians 2 2010-04-01 2010-04-01 false Is the trust evaluation standard or process different when the trust asset is held in trust for an individual Indian or Indian allottee? 1000.360 Section 1000.360 Indians OFFICE OF THE ASSISTANT SECRETARY, INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR ANNUAL FUNDING AGREEMENTS UNDER THE TRIBAL SELF-GOVERNMEN...

An economic evaluation of introducing a skills mix approach to CT head reporting in clinical practice

International Nuclear Information System (INIS)

Lockwood, P.

2016-01-01

Background: Computed Tomography (CT) head examinations are a common diagnostic examination in National Health Service (NHS) acute hospital trusts. Current NHS England and Royal College of Radiologist (RCR) reports estimate the year on year increase of examinations to be 10%, with the designated workforce of radiologists disproportionate to the increase in demand of imaging reporting. Objective: To determine an economic evaluation of cost, risk and feasibility of introducing skills mix CT head reporting by radiographers. Design: Applying a PICO framework study to evaluate the patient workflow demand from retrospective audit data of CT head examination attendance (n = 7266) at an acute NHS district general hospital (DGH) to model an example workflow demand over 12 months. Reviewing potential outcome risk data (diagnostic thresholds), and feasibility (workforce capacity) of both interventions. The economic evaluation calculated hourly unit costs for comparison estimation of consultant radiologists and reporting radiographers using Netten et al.'s Ready Reckoner. Report unit costs were calculated utilising the Gishen's Ready Reckoner to estimate the uninterrupted time of reporting a non-complex CT report using RCR, Centre for Workforce Intelligence (CfWI) and Department of Health (DoH) estimates for both interventions. Conclusions: The economic evaluation of introducing a skills mix reporting service model to the benefit of service delivery with the NHS has shown a potential £299,359–£124,514 per annum cost saving using a generic acute DGH workload model. Research into recorded discrepancy/error audit data for potential detrimental risk to patient outcomes identified a paucity of evidence, and recommends further research is needed. - Highlights: • There was 5.2 million CT scans from April 2013 to March 2014 in the UK. • In 2015 the RCR estimated there were up to 3693 unreported CT scans. • Comparison of workforce, reference standards, unit costs

Reducing the risk, managing safety.

Science.gov (United States)

Aldridge, Peter

2016-02-01

Fire safety in healthcare premises has always been a challenge to those that discharge this duty. Statutory compliance should be a matter of course, but in an ever increasingly challenged NHS, even this is not a given. While the NHS is driven by managing very complex risk to deliver cutting edge healthcare, providers cannot be risk averse. Which risk, however, takes priority? Here Peter Aldridge, fire and corporate services manager at Leeds Teaching Hospitals NHS Trust, and Secretary to the National Association of Healthcare Fire Officers (NAHFO)--which will this month and next jointly stage fire safety seminars with IHEEM; see page 8--considers the key issues, with input from a fire officer at a leading mental health and community Trust.

Social Trust: Croatia 1995-2003.

Directory of Open Access Journals (Sweden)

Berto Šalaj

2005-01-01

Full Text Available In this paper the author deals with the concept of social trust. It is the author’s view that this concept has been neglected in past political science research in Croatia; consequently, he wishes to present it to the academic and professional political science public, thus creating a basis for its future use. Moreover, through application of a secondary dana analysis the author describes the state of social trust in Croatia. First, he contextualises the concept of social trust with regard to the dominant research approaches in political science; then he points to the distinctiveness of social trust in relation to other types of trust; fi nally, he provides an overview of the most relevant works on the importance and functions of social trust. In the concluding part of the paper, an analysis of the levels of social trust is conducted, revealing that Croatia is a society with markedly low levels of social trust. In the author’s opinion, this could present an obstacle to further political and economic development.

Changing the Ties That Bind? The Emerging Roles and Identities of General Practitioners and Managers in the New Clinical Commissioning Groups in the English NHS

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Julia Segar

2014-10-01

Full Text Available The English National Health Service (NHS is undergoing significant reorganization following the 2012 Health and Social Care Act. Key to these changes is the shift of responsibility for commissioning services from Primary Care Trusts (PCTs to general practitioners (GPs working together in Clinical Commissioning Groups (CCGs. This article is based on an empirical study that examined the development of emerging CCGs in eight case studies across England between September 2011 and June 2012. The findings are based on interviews with GPs and managers, observations of meetings, and reading of related documents. Scott’s notion that institutions are constituted by three pillars—the regulative, normative, and cognitive–cultural—is explored here. This approach helps to understand the changing roles and identities of doctors and managers implicated by the present reforms. This article notes the far reaching changes in the regulative pillar and questions how these changes will affect the normative and cultural–cognitive pillars.

Cancer patients’ trust in their oncologist

OpenAIRE

Hillen, M.A.

2013-01-01

In this thesis we aimed to unravel cancer patients’ trust in their oncologist. We investigated patients’ explanations of trust in-depth, and developed an oncology-specific questionnaire to assess trust. Using the resulting Trust in Oncologist Scale, we experimentally established the influence of oncologist communication on trust. Specifically, patients report stronger trust if the oncologist expresses medical competence, communicates in an open and honest manner, and conveys involvement and c...

25 CFR 115.815 - How does a tribe request trust funds from a tribal trust account?

Science.gov (United States)

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false How does a tribe request trust funds from a tribal trust account? 115.815 Section 115.815 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR FINANCIAL ACTIVITIES TRUST FUNDS FOR TRIBES AND INDIVIDUAL INDIANS Tribal Accounts Withdrawing Tribal Trust Funds § 115.815 How does a tribe request trust...

Modeling trust context in networks

CERN Document Server

Adali, Sibel

2013-01-01

We make complex decisions every day, requiring trust in many different entities for different reasons. These decisions are not made by combining many isolated trust evaluations. Many interlocking factors play a role, each dynamically impacting the others.? In this brief, 'trust context' is defined as the system level description of how the trust evaluation process unfolds.Networks today are part of almost all human activity, supporting and shaping it. Applications increasingly incorporate new interdependencies and new trust contexts. Social networks connect people and organizations throughout

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

Science.gov (United States)

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.

Assess and enhance public trust

Science.gov (United States)

Patricia Winter; James Absher; Alan Watson

2007-01-01

Trust is a form of social capital, facilitating effective land management, communication and collaboration. Although trust in the Forest Service is at least moderately high for most publics, evidence of a lack of trust and outright distrust has been found in some communities. However, the amount, types, and conditions of trust necessary for effective management to...

Competition Fosters Trust

DEFF Research Database (Denmark)

Huck, Steffen; Lünser, Gabriele; Tyran, Jean-Robert Karl

2012-01-01

We study the effects of reputation and competition in a trust game. If trustees are anonymous, outcomes are poor: trustees are not trustworthy, and trustors do not trust. If trustees are identifiable and can, hence, build a reputation, efficiency quadruples but is still at only a third of the first...... best. Adding more information by granting trustors access to all trustees' complete history has, somewhat surprisingly, no effect. On the other hand, we find that competition, coupled with some minimal information, eliminates the trust problem almost completely...

Corneal Stromal Cell Growth on Gelatin/Chondroitin Sulfate Scaffolds Modified at Different NHS/EDC Molar Ratios

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Jui-Yang Lai

2013-01-01

Full Text Available A nanoscale modification strategy that can incorporate chondroitin sulfate (CS into the cross-linked porous gelatin materials has previously been proposed to give superior performance for designed corneal keratocyte scaffolds. The purpose of this work was to further investigate the influence of carbodiimide chemistry on the characteristics and biofunctionalities of gelatin/CS scaffolds treated with varying N-hydroxysuccinimide (NHS/1-ethyl-3-(3-dimethyl aminopropyl carbodiimide hydrochloride (EDC molar ratios (0-1 at a constant EDC concentration of 10 mM. Results of Fourier transform infrared spectroscopy and dimethylmethylene blue assays consistently indicated that when the NHS to EDC molar ratio exceeds a critical level (i.e., 0.5, the efficiency of carbodiimide-mediated biomaterial modification is significantly reduced. With the optimum NHS/EDC molar ratio of 0.5, chemical treatment could achieve relatively high CS content in the gelatin scaffolds, thereby enhancing the water content, glucose permeation, and fibronectin adsorption. Live/Dead assays and interleukin-6 mRNA expression analyses demonstrated that all the test samples have good cytocompatibility without causing toxicity and inflammation. In the molar ratio range of NHS to EDC from 0 to 0.5, the cell adhesion ratio and proliferation activity on the chemically modified samples significantly increased, which is attributed to the increasing CS content. Additionally, the materials with highest CS content (0.143 ± 0.007 nmol/10 mg scaffold showed the greatest stimulatory effect on the biosynthetic activity of cultivated keratocytes. These findings suggest that a positive correlation is noticed between the NHS to EDC molar ratio and the CS content in the biopolymer matrices, thereby greatly affecting the corneal stromal cell growth.

The NHS could learn from inspiring leaders like Barack Obama.

Science.gov (United States)

Coghill, Yvonne

2017-02-01

I remember November 2008 like it was yesterday. I was the lead for the NHS Leadership Academy's national Breaking Through programme for black and minority ethnic staff, and recall being at our annual conference bursting with pride at the news that Barack Obama had been elected president of the United States.

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

Science.gov (United States)

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.

Development-based Trust: Proposing and Validating a New Trust Measurement Model for Buyer-Seller Relationships

Directory of Open Access Journals (Sweden)

José Mauro da Costa Hernandez

2010-04-01

Full Text Available This study proposes and validates a trust measurement model for buyer-seller relationships. Baptized as development-based trust, the model encompasses three dimensions of trust: calculus-based, knowledge-based and identification-based. In addition to recognizing that trust is a multidimensional construct, the model also assumes that trust can evolve to take on a different character depending on the stage of the relationship. In order to test the proposed model and compare it to the characteristic-based trust measurement model, the measure most frequently used in the buyer-seller relationship literature, data were collected from 238 clients of an IT product wholesaler. The results show that the scales are valid and reliable and the proposed development-based trust measurement model is superior to the characteristic-based trust measurement model in terms of its ability to explain certain variables of interest in buyer-seller relationships (long-term relationship orientation, information sharing, behavioral loyalty and future intentions. Implications for practice, limitations and suggestions for future studies are discussed.

Homo economicus belief inhibits trust.

Directory of Open Access Journals (Sweden)

Ziqiang Xin

Full Text Available As a foundational concept in economics, the homo economicus assumption regards humans as rational and self-interested actors. In contrast, trust requires individuals to believe partners' benevolence and unselfishness. Thus, the homo economicus belief may inhibit trust. The present three experiments demonstrated that the direct exposure to homo economicus belief can weaken trust. And economic situations like profit calculation can also activate individuals' homo economicus belief and inhibit their trust. It seems that people's increasing homo economicus belief may serve as one cause of the worldwide decline of trust.

Homo Economicus Belief Inhibits Trust

Science.gov (United States)

Xin, Ziqiang; Liu, Guofang

2013-01-01

As a foundational concept in economics, the homo economicus assumption regards humans as rational and self-interested actors. In contrast, trust requires individuals to believe partners’ benevolence and unselfishness. Thus, the homo economicus belief may inhibit trust. The present three experiments demonstrated that the direct exposure to homo economicus belief can weaken trust. And economic situations like profit calculation can also activate individuals’ homo economicus belief and inhibit their trust. It seems that people’s increasing homo economicus belief may serve as one cause of the worldwide decline of trust. PMID:24146907

Employee engagement within the NHS: a cross-sectional study

Science.gov (United States)

Jeve, Yadava Bapurao; Oppenheimer, Christina; Konje, Justin

2015-01-01

Background: Employee engagement is the emotional commitment of the employee towards the organisation. We aimed to analyse baseline work engagement using Utrecht Work Engagement Scale (UWES) at a teaching hospital. Methods: We have conducted a cross-sectional study within the National Health Service (NHS) Teaching Hospital in the UK. All participants were working age population from both genders directly employed by the hospital. UWES has three constituting dimensions of work engagement as vigor, dedication, and absorption. We conducted the study using UWES-9 tool. Outcome measures were mean score for each dimension of work engagement (vigor, dedication, absorption) and total score compared with control score from test manual. Results: We found that the score for vigor and dedication is significantly lower than comparison group (Pemployees. Vigor and dedication are significantly lower, these are characterised by energy, mental resilience, the willingness to invest one’s effort, and persistence as well as a sense of significance, enthusiasm, inspiration, pride, and challenge. The NHS employees are immersed in work. Urgent need to explore strategies to improve work engagement as it is vital for improving productivity, safety and patient experience PMID:25674571

The disposal of redundant teletherapy units from NHS hospitals

International Nuclear Information System (INIS)

Gaffka, A.P.; Ord, M.A.

1994-01-01

The removal/disposal of redundant teletherapy units from NHS hospitals is described, detailing the operational procedures and the transport package background. The Harwell section of the Transport Technology Department has been carrying out these operations since 1991, where initially the service was just offered to the NHS; however, today their specialist transport service has significantly widened and is now offered to other business sectors. Due to the level of radioactivity found in each teletherapy unit, it was necessary to design a special transport packaging to meet the requirements for shipment of these units. Approval was sought from the Department of Transport to adapt a standard Type B package as no other packaging could be found to comply with the necessary requirements. All work undertaken on the removal and disposal of these units complied with an approved scheme of work and was carried out in accordance with a Quality Assurance workplan. However, to keep abreast of modern standards in a manner which is cost effective to customers and acceptable to the general public, the full development of a new Type B packaging is taking place, which is specifically designed to undertake these removal/disposal duties. (author)

Attack-Resistant Trust Metrics

Science.gov (United States)

Levien, Raph

The Internet is an amazingly powerful tool for connecting people together, unmatched in human history. Yet, with that power comes great potential for spam and abuse. Trust metrics are an attempt to compute the set of which people are trustworthy and which are likely attackers. This chapter presents two specific trust metrics developed and deployed on the Advogato Website, which is a community blog for free software developers. This real-world experience demonstrates that the trust metrics fulfilled their goals, but that for good results, it is important to match the assumptions of the abstract trust metric computation to the real-world implementation.

Designing High-Trust Organizations

DEFF Research Database (Denmark)

Jagd, Søren

The specific problem considered in this paper is what are the key issues to consider for managers involved in designing high-trust organizations, a design problem still not properly explored. This paper intends to take the first step in filling this lacuna. In the paper, I first present...... the existing management and research literature on building high-trust organizations. Then I explore Alan Fox’s (1974) analysis of low-trust vs. high-trust dynamics which, I argue, may serve as a theoretically stronger basis for understanding the issues management have to consider when designing hightrust...... organizations...

Trust vs. Crisis

DEFF Research Database (Denmark)

Mogensen, Kirsten

2014-01-01

The three social phenomena -- norms, trust, and crisis -- are in this paper combined into one model that illustrates their function and relationship. Crisis is seen as a reaction to serious violations of expectations that leave people disoriented, insecure about situational norms, and unable...... to judge whom to trust. One logical solution to a crisis is to rebuild a shared understanding of the norms involved in any given context. Banking is used as a case. Central concepts are borrowed from Niklas Luhmann Trust (1968), Alf Ross Directives and Norms (1967), and Arthur G. Neal National Trauma...

Forms, Sources and Processes of Trust

NARCIS (Netherlands)

Nooteboom, B.

2006-01-01

This chapter reviews some key points in the analysis of trust, based on Nooteboom (2002)i.The following questions are addressed.What can we have trust in?What is the relation between trust and control?What are the sources of trust? And what are its limits?By what process is trust built up and broken

The Effects of Immigration on NHS Waiting Times

OpenAIRE

Giuntella, Osea; Nicodemo, Catia; Vargas-Silva, Carlos

2015-01-01

This paper analyses the effects of immigration on waiting times in the National Health Service (NHS) in England. Linking administrative records from the Hospital Episode Statistics (2003-2012) with immigration data drawn from the UK Labour Force Survey, we find that immigration reduced waiting times for outpatient referrals and did not have significant effects on waiting times in Accident and Emergency (A&E) and elective care. These results are explained by the fact that immigration increases...

Trust in prescription drug brand websites: website trust cues, attitude toward the website, and behavioral intentions.

Science.gov (United States)

Huh, Jisu; Shin, Wonsun

2014-01-01

Direct-to-consumer (DTC) prescription drug brand websites, as a form of DTC advertising, are receiving increasing attention due to the growing number and importance as an ad and a consumer information source. This study examined consumer trust in a DTC website as an important factor influencing consumers' attitude toward the website and behavioral intention. Applying the conceptual framework of website trust, the particular focus of investigation was the effect of the website trust cue factor on consumers' perceived DTC website trust and subsequent attitudinal and behavioral responses. Results show a significant relation between the website trust cue factor and consumers' perceived DTC website trust. Perceived DTC website trust, in turn, was found to be significantly associated with consumers' attitude toward the DTC website and behavioral intention.

SERVANT LEADERSHIP AND ORGANIZATIONAL TRUST: THE MEDIATING EFFECT OF THE LEADER TRUST AND ORGANIZATIONAL COMMUNICATION

Directory of Open Access Journals (Sweden)

Morad Rezaei

2012-01-01

Full Text Available The purpose of this paper aims to clarify the relationship between servant leadership and organizational trust, and tries to demonstrate the mediator role of leader trust and organizational communication in this relationship. The study sample included 258 employees of Guilan province Tax Administration and for sampling we used cluster method. Previous studies have also focused on the positive impact of servant leadership in organizational trust and in this article the results show that there is a significant relationship between servant leadership, organizational trust, leader trust and organizational communication.

Trust and control interrelatedness: New perspectives on the trust-control nexus in organizational relations

NARCIS (Netherlands)

Costa, A.C.; Bijlsma-Frankema, K.M.

2007-01-01

This article introduces the special issue on New Perspectives on the Trust-Control Nexus in Organizational Relations. Trust and control are interlinked processes commonly seen as key to reach effectiveness in inter- and intraorganizational relations. The relation between trust and control is,

NHS Gene Mutations in Ashkenazi Jewish Families with Nance-Horan Syndrome.

Science.gov (United States)

Shoshany, Nadav; Avni, Isaac; Morad, Yair; Weiner, Chen; Einan-Lifshitz, Adi; Pras, Eran

2017-09-01

To describe ocular and extraocular abnormalities in two Ashkenazi Jewish families with infantile cataract and X-linked inheritance, and to identify their underlying mutations. Seven affected members were recruited. Medical history, clinical findings, and biometric measurements were recorded. Mutation analysis of the Nance-Horan syndrome (NHS) gene was performed by direct sequencing of polymerase chain reaction-amplified exons. An unusual anterior Y-sutural cataract was documented in the affected male proband. Other clinical features among examined patients included microcorneas, long and narrow faces, and current or previous dental anomalies. A nonsense mutation was identified in each family, including a previously described 742 C>T, p.(Arg248*) mutation in Family A, and a novel mutation 2915 C>A, p.(Ser972*) in Family B. Our study expands the repertoire of NHS mutations and the related phenotype, including newly described anterior Y-sutural cataract and dental findings.

Tracing experiences of NHS change in England: a process philosophy perspective.

Science.gov (United States)

McMurray, Robert

2010-01-01

For over three decades public services have been the subject of unprecedented change. Nowhere has this been more evident than in the English National Health Service (NHS) where despite the effort expended on change there is growing evidence that such restructuring is largely ineffective. Drawing on a study of culture modification in the English NHS, this paper utilizes Chia's (1999) account of the metaphysics of processual change to consider why attempts to restructure public services are not always successful. The paper contributes to our understanding of public management reform by considering how an ontology of becoming, and a loosening of control, might alter how we approach reforming. Further, the paper offers a theoretical justification for the use of standard research methods for novel processual ends. The paper concludes with a reflection on the implications of a processual perspective for the future management, organization and study of change in public administration.

Analysis on trust influencing factors and trust model from multiple perspectives of online Auction

Science.gov (United States)

Yu, Wang

2017-10-01

Current reputation models lack the research on online auction trading completely so they cannot entirely reflect the reputation status of users and may cause problems on operability. To evaluate the user trust in online auction correctly, a trust computing model based on multiple influencing factors is established. It aims at overcoming the efficiency of current trust computing methods and the limitations of traditional theoretical trust models. The improved model comprehensively considers the trust degree evaluation factors of three types of participants according to different participation modes of online auctioneers, to improve the accuracy, effectiveness and robustness of the trust degree. The experiments test the efficiency and the performance of our model under different scale of malicious user, under environment like eBay and Sporas model. The experimental results analysis show the model proposed in this paper makes up the deficiency of existing model and it also has better feasibility.

Constitutional Verbosity and Social Trust

DEFF Research Database (Denmark)

Bjørnskov, Christian; Voigt, Stefan

2014-01-01

A common argument in the trust literature is that high-trust cultures allow efficient commercial contracts to be shorter, covering fewer contingencies. We take this idea to the topic of social contracts. Specifically, we ask whether social trust affects the length and detail of constitutions. Cross......-country estimates suggest that national trust levels are indeed robustly and negatively associated with the length of countries’ constitutions....

Online Consumer Trust: Trends in Research

Directory of Open Access Journals (Sweden)

Antonina Bauman

2017-07-01

Full Text Available This paper presents the literature review of studies published in 2004-2014 (Web 2.0 period in the area of consumer online trust. Based on the content analysis of 138 papers, this study highlights three major research themes: (1 trust models, (2 technological, and (3 social factors impacting online trust. It also explores topics in each major theme found in direct studies of online consumer trust. Since this literature review uses the concept-centric approach, it points out not only the major trends in research but also three understudied areas: (1 green trust, (2 trust recovery, and (3 the role of ethics in developing online trust.

ITrace: An implicit trust inference method for trust-aware collaborative filtering

Science.gov (United States)

He, Xu; Liu, Bin; Chen, Kejia

2018-04-01

The growth of Internet commerce has stimulated the use of collaborative filtering (CF) algorithms as recommender systems. A CF algorithm recommends items of interest to the target user by leveraging the votes given by other similar users. In a standard CF framework, it is assumed that the credibility of every voting user is exactly the same with respect to the target user. This assumption is not satisfied and thus may lead to misleading recommendations in many practical applications. A natural countermeasure is to design a trust-aware CF (TaCF) algorithm, which can take account of the difference in the credibilities of the voting users when performing CF. To this end, this paper presents a trust inference approach, which can predict the implicit trust of the target user on every voting user from a sparse explicit trust matrix. Then an improved CF algorithm termed iTrace is proposed, which takes advantage of both the explicit and the predicted implicit trust to provide recommendations with the CF framework. An empirical evaluation on a public dataset demonstrates that the proposed algorithm provides a significant improvement in recommendation quality in terms of mean absolute error.

From NHS Choices to the integrated customer service platform.

Science.gov (United States)

Gann, Bob; Grant, Maria J

2013-03-01

In 2013 the NHS Commissioning Board launches its new integrated customer service platform. The new service utilises the full range of channels (web, telephone, apps etc) to provide access to information to support transparency, participation and transactions. Digital health services have proven benefits in informed choice, shared decision making and patient participation. © 2013 The authors. Health Information and Libraries Journal © 2013 Health Libraries Group.

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.

Towards trusted tradelanes

NARCIS (Netherlands)

Hulstijn, Joris; Hofman, W.; Zomer, G.; Tan, Yao-Hua; Scholl, H. J.; Glassey, O.; Janssen, M.

Customs administrations are exploring system-based approaches to regulatory supervision, taking the entire set of controls in a process into account. In addition to Trusted Traders, which are recognized by a certification process, customs are considering to identify so called Trusted Trade Lanes:

Relationship between lung function and grip strength in older hospitalized patients: a pilot study

Directory of Open Access Journals (Sweden)

Holmes SJ

2017-04-01

Full Text Available Sarah J Holmes,1 Stephen C Allen,2,3 Helen C Roberts4,5 1Medicine and Elderly Care, Hampshire Hospitals NHS Foundation Trust, Winchester, 2Medicine and Geriatrics, The Royal Bournemouth Hospital and Christchurch Hospitals NHS Foundation Trust, Bournemouth, 3Centre of Postgraduate Medical Research and Education, Bournemouth University, Poole, 4Academic Geriatric Medicine, University of Southampton, 5University Hospital Southampton NHS Foundation Trust, Southampton, UK Objective: Older people with reduced respiratory muscle strength may be misclassified as having COPD on the basis of spirometric results. We aimed to evaluate the relationship between lung function and grip strength in older hospitalized patients without known airways disease.Methods: Patients in acute medical wards were recruited who were aged ≥70 years; no history, symptoms, or signs of respiratory disease; Mini Mental State Examination ≥24; willing and able to consent to participate; and able to perform hand grip and forced spirometry. Data including lung function (forced expiratory volume in 1 second [FEV1], forced vital capacity [FVC], FEV1/FVC, peak expiratory flow rate [PEFR], and slow vital capacity [SVC], grip strength, age, weight, and height were recorded. Data were analyzed using descriptive statistics and linear regression unadjusted and adjusted (for age, height, and weight.Results: A total of 50 patients (20 men were recruited. Stronger grip strength in men was significantly associated with greater FEV1, but this was attenuated by adjustment for age, height, and weight. Significant positive associations were found in women between grip strength and both PEFR and SVC, both of which remained robust to adjustment.Conclusion: The association between grip strength and PEFR and SVC may reflect stronger patients generating higher intrathoracic pressure at the start of spirometry and pushing harder against thoracic cage recoil at end-expiration. Conversely, patients with

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

Towards Trust-based Cognitive Networks: A Survey of Trust Management for Mobile Ad Hoc Networks

Science.gov (United States)

2009-06-01

of trust. First, social trust refers to properties derived from social relationships . Examples of social networks are strong social ... relationships such as colleagues or relatives or loose social relationships such as school alumni or friends with common interests [44]. Social trust may...also use social relationships in evaluating the trust metric among group members by employing the concept of social networks. Yu et al. [44] define

Duncan Tanner Essay Prize Winner 2014. Against the 'Sacred Cow': NHS Opposition and the Fellowship for Freedom in Medicine, 1948-72.

Science.gov (United States)

Seaton, Andrew

2015-01-01

This essay recovers organized opposition to the National Health Service (NHS) by considering the Fellowship for Freedom in Medicine (FFM), a conservative organization of doctors who challenged the 'Sacred Cow' of nationalized healthcare in the 1950s and 1960s. While there has been little interest in anti-NHS politics because of shortcomings in the institution's historiography, this study suggests ways a new history of the service can be written. Central to that project is taking the broader ideological and emotive quality of the NHS seriously, and appreciating the way, for all sides of the political spectrum, as well as the general public, the service has always been a contested symbol of post-war British identity. This essay argues that two NHS 'crises'--panics over costs, and disillusionment within general practice--were not merely disagreements over budgets and pay-packets but politically charged moments infused with conservative anxieties over Britain's post-war trajectory. The FFM imagined the NHS as an economically dangerous bureaucratic machine that crushed medical independence and risked pushing the country towards dictatorship. Allies within the Conservative Party, private health insurance industry, and free-market 'think-tanks' worked with the FFM to challenge defences of both the service's operation and meaning. To appreciate why the NHS remains 'the closest thing the English have to a religion', one must consider the apostates as well as the faithful.

Trust vs. Crisis

Directory of Open Access Journals (Sweden)

Kirsten Mogensen

2014-06-01

Full Text Available The three social phenomena -- norms, trust, and crisis -- are in this paper combined into one model that illustrates their function and relationship. Crisis is seen as a reaction to serious violations of expectations that leave people disoriented, insecure about situational norms, and unable to judge whom to trust. One logical solution to a crisis is to rebuild a shared understanding of the norms involved in any given context. Banking is used as a case. Central concepts are borrowed from Niklas Luhmann Trust (1968, Alf Ross Directives and Norms (1967, and Arthur G. Neal National Trauma & Collective Memory (1998.

Trust and Credit

DEFF Research Database (Denmark)

Harste, Gorm

The present paper is an answer to the question, how did trust and credit emerge. The systems of trust and credit reduce the environmental and contextual complexities in which trust and credit are embedded. The paper analyses the forms of this reduction in a number of stages in the evolution...... of history from the present risk of modern systems back to early modernity, the Reformation and the high medieval Revolutions in law, organization and theology. It is not a history of economics, but a history of the conditions of some communication codes used in economic systems....

Providing NHS staff with height-adjustable workstations and behaviour change strategies to reduce workplace sitting time: protocol for the Stand More AT (SMArT) Work cluster randomised controlled trial.

Science.gov (United States)

O'Connell, S E; Jackson, B R; Edwardson, C L; Yates, T; Biddle, S J H; Davies, M J; Dunstan, D; Esliger, D; Gray, L; Miller, P; Munir, F

2015-12-09

High levels of sedentary behaviour (i.e., sitting) are a risk factor for poor health. With high levels of sitting widespread in desk-based office workers, office workplaces are an appropriate setting for interventions aimed at reducing sedentary behaviour. This paper describes the development processes and proposed intervention procedures of Stand More AT (SMArT) Work, a multi-component randomised control (RCT) trial which aims to reduce occupational sitting time in desk-based office workers within the National Health Service (NHS). SMArT Work consists of 2 phases: 1) intervention development: The development of the SMArT Work intervention takes a community-based participatory research approach using the Behaviour Change Wheel. Focus groups will collect detailed information to gain a better understanding of the most appropriate strategies, to sit alongside the provision of height-adjustable workstations, at the environmental, organisational and individual level that support less occupational sitting. 2) intervention delivery and evaluation: The 12 month cluster RCT aims to reduce workplace sitting in the University Hospitals of Leicester NHS Trust. Desk-based office workers (n = 238) will be randomised to control or intervention clusters, with the intervention group receiving height-adjustable workstations and supporting techniques based on the feedback received from the development phase. Data will be collected at four time points; baseline, 3, 6 and 12 months. The primary outcome is a reduction in sitting time, measured by the activPAL(TM) micro at 12 months. Secondary outcomes include objectively measured physical activity and a variety of work-related health and psycho-social measures. A process evaluation will also take place. This study will be the first long-term, evidence-based, multi-component cluster RCT aimed at reducing occupational sitting within the NHS. This study will help form a better understanding and knowledge base of facilitators and

Marketing. The Dawn of the fan.

Science.gov (United States)

Shepherd, Stuart

2008-08-21

The government and NHS are using websites such as YouTube and Facebook to communicate with the public. Trusts believe such websites help them keep in touch with younger people better than other methods. They are open to abuse with unofficial groups appearing in the name of NHS organisations.

Use of programme budgeting and marginal analysis to set priorities for local NHS dental services: learning from the north east of England.

Science.gov (United States)

Holmes, R D; Steele, J G; Exley, C; Vernazza, C R; Donaldson, C

2018-05-03

Priority setting is necessary where competing demands exceed the finite resources available. The aim of the study was to develop and test a prioritization framework based upon programme budgeting and marginal analysis (PBMA) as a tool to assist National Health Service (NHS) commissioners in their management of resources for local NHS dental services. Twenty-seven stakeholders (5 dentists, 8 commissioners and 14 patients) participated in a case-study based in a former NHS commissioning organization in the north of England. Stakeholders modified local decision-making criteria and applied them to a number of different scenarios. The majority of financial resources for NHS dental services in the commissioning organization studied were allocated to primary care dental practitioners' contracts in perpetuity, potentially constraining commissioners' abilities to shift resources. Compiling the programme budget was successful, but organizational flux and difficulties engaging local NHS commissioners significantly impacted upon the marginal analysis phase. NHS dental practitioners' contracts resemble budget-silos which do not facilitate local resource reallocation. 'Context-specific' factors significantly challenged the successful implementation and impact of PBMA. A local PBMA champion embedded within commissioning organizations should be considered. Participants found visual depiction of the cost-value ratio helpful during their initial priority setting deliberations.

Trust Transitivity in Social Networks

OpenAIRE

Richters, Oliver; Peixoto, Tiago P.

2011-01-01

Non-centralized recommendation-based decision making is a central feature of several social and technological processes, such as market dynamics, peer-to-peer file-sharing and the web of trust of digital certification. We investigate the properties of trust propagation on networks, based on a simple metric of trust transitivity. We investigate analytically the percolation properties of trust transitivity in random networks with arbitrary in/out-degree distributions, and compare with numerical...

Extending trust to immigrants: Generalized trust, cross-group friendship and anti-immigrant sentiments in 21 European societies.

Directory of Open Access Journals (Sweden)

Meta van der Linden

Full Text Available The aim of this study is twofold. First, we expand on the literature by testing whether generalized trust is negatively related to anti-immigrant sentiments in Europe. Second, we examine to what extent the relation between generalized trust and anti-immigrant sentiments is dependent upon cross-group friendships. We apply multilevel linear regression modeling to representative survey data enriched with levels of ethnic diversity covering 21 European countries. Results show that both generalized trust and cross-group friendship are negatively related to anti-immigrant sentiments. However, there is a negligible positive relation between generalized trust and cross-group friendship (r = .10, and we can clearly observe that they operate independently from one another. Hence, trusting actors are not more likely to form more cross-group friendships, and cross-group friendship do not lead to the development of more generalized trust. Instead, the findings show that generalized trust leads immigrants too to be included in the radius of trusted others and, as a consequence, the benign effects of generalized trust apply to them as well. We conclude that the strength of generalized trust is a form of generalization, beyond the confines of individual variations in intergroup experiences.

Cancer patients’ trust in their oncologist

NARCIS (Netherlands)

Hillen, M.A.

2013-01-01

In this thesis we aimed to unravel cancer patients’ trust in their oncologist. We investigated patients’ explanations of trust in-depth, and developed an oncology-specific questionnaire to assess trust. Using the resulting Trust in Oncologist Scale, we experimentally established the influence of

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...

Trust-Based Leadership in the Making

DEFF Research Database (Denmark)

Bentzen, Tina Øllgaard; Jagd, Søren

I spite of the popularity of trust-based leadership in consultancy and popular management writings empirical research on the transformation from traditional top-down to trust-based leadership is still limited. In this paper we study the implementation of a trust-based leadership reform in the City...... of Copenhagen taking place since 2012. We focus on understanding the trust dynamics in this major transformation. We show that the implementation of trust-based leadership should be seen as an emergent process involving a variety of actors within the organization. The case study reveals that the Trust Reform...... indicates that the implementation of a radical management reform involves a complex interplay of trust relations between actors at multiple levels of the organization....

Do Reputation Systems Undermine Trust? Divergent Effects of Enforcement Type on Generalized Trust and Trustworthiness.

Science.gov (United States)

Kuwabara, Ko

2015-03-01

Research shows that enforcing cooperation using contracts or tangible sanctions can backfire, undermining people's intrinsic motivation to cooperate: when the enforcement is removed, people are less trusting or trustworthy than when there is no enforcement to begin with. The author examines whether reputation systems have similar consequences for generalized trust and trustworthiness. Using a web-based experiment simulating online market transactions (studies 1 and 2), he shows that reputation systems can reinforce generalized trust and trustworthiness, unlike contractual enforcement or relational enforcement based on repeated interactions. In a survey experiment (study 3), he finds that recalling their eBay feedback scores made participants more trusting and trustworthy. These results are predicated on the diffuse nature of reputational enforcement to reinforce perceptions of trust and trustworthiness. These results have implications for understanding how different forms of governance affect generalized trust and trustworthiness.

Trust It or Trash It?

Science.gov (United States)

Trust It or Trash It? About | Contact | Español Tab 1 Tab 2 What is Trust It or Trash It? This is a tool ... be true, it may be. (See the second “Trust it” statement above). Click on each element below ...

Modelling biased human trust dynamics

NARCIS (Netherlands)

Hoogendoorn, M.; Jaffry, S.W.; Maanen, P.P. van; Treur, J.

2013-01-01

Abstract. Within human trust related behaviour, according to the literature from the domains of Psychology and Social Sciences often non-rational behaviour can be observed. Current trust models that have been developed typically do not incorporate non-rational elements in the trust formation

Trusting Relationships in International Politics

DEFF Research Database (Denmark)

Keating, Vincent Charles; Ruzicka, Jan

2014-01-01

How can trusting relationships be identified in international politics? The recent wave of scholarship on trust in International Relations answers this question by looking for one or the combination of three indicators – the incidence of cooperation; discourses expressing trust; or the calculated...

Racial and Religious Discrimination in Charitable Trusts: A Current Analysis of Constitutional and Trust Law Solutions

Science.gov (United States)

Adams, Roy M.

1976-01-01

The process by which constitutional and trust law have blended together in the charitable trust field is examined. Focus is on whether a settlor can expect racial and religious restrictions in a charitable trust to be allowed, how to deal with them if they are, and what happens to the trust property if they are not. (LBH)

African migrant patients' trust in Chinese physicians: a social ecological approach to understanding patient-physician trust.

Science.gov (United States)

McLaughlin, Megan M; Simonson, Louis; Zou, Xia; Ling, Li; Tucker, Joseph D

2015-01-01

Patient trust in physicians is a critical determinant of health seeking behaviors, medication adherence, and health outcomes. A crisis of interpersonal trust exists in China, extending throughout multiple social spheres, including the healthcare system. At the same time, with increased migration from Africa to China in the last two decades, Chinese physicians must establish mutual trust with an increasingly diverse patient population. We undertook a qualitative study to identify factors affecting African migrants' trust in Chinese physicians and to identify potential mechanisms for promoting trust. We conducted semi-structured, in-depth interviews with 40 African migrants in Guangzhou, China. A modified version of the social ecological model was used as a theoretical framework. At the patient-physician level, interpersonal treatment, technical competence, perceived commitment and motive, and language concordance were associated with enhanced trust. At the health system level, two primary factors influenced African migrants' trust in their physicians: the fee-for-service payment system and lack of continuity with any one physician. Patients' social networks and the broader socio-cultural context of interactions between African migrants and Chinese locals also influenced patients' trust of their physicians. These findings demonstrate the importance of factors beyond the immediate patient-physician interaction and suggest opportunities to promote trust through health system interventions.

African migrant patients' trust in Chinese physicians: a social ecological approach to understanding patient-physician trust.

Directory of Open Access Journals (Sweden)

Megan M McLaughlin

Full Text Available Patient trust in physicians is a critical determinant of health seeking behaviors, medication adherence, and health outcomes. A crisis of interpersonal trust exists in China, extending throughout multiple social spheres, including the healthcare system. At the same time, with increased migration from Africa to China in the last two decades, Chinese physicians must establish mutual trust with an increasingly diverse patient population. We undertook a qualitative study to identify factors affecting African migrants' trust in Chinese physicians and to identify potential mechanisms for promoting trust.We conducted semi-structured, in-depth interviews with 40 African migrants in Guangzhou, China. A modified version of the social ecological model was used as a theoretical framework. At the patient-physician level, interpersonal treatment, technical competence, perceived commitment and motive, and language concordance were associated with enhanced trust. At the health system level, two primary factors influenced African migrants' trust in their physicians: the fee-for-service payment system and lack of continuity with any one physician. Patients' social networks and the broader socio-cultural context of interactions between African migrants and Chinese locals also influenced patients' trust of their physicians.These findings demonstrate the importance of factors beyond the immediate patient-physician interaction and suggest opportunities to promote trust through health system interventions.

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

African Journals Online (AJOL)

Kahabi Isangula

Conclusion: The findings suggest that trust in patient-doctor relationship ... Improving trust in the patient - doctor relationship may be one of the important lenses ...... World Bank. (2015) Country and Lending Groups. (Internet). Available at.

Towards Trust Engineering for Opportunistic Cloud Services

DEFF Research Database (Denmark)

Kuada, Eric

2014-01-01

The systematic review methodology has been employed to review trust related studies in cloud computing. It was observed that trusted computing technologies and reputation based approaches are the main approaches to trust engineering in cloud computing. Also, trusted third party approaches...... and the deployment model play a significant role in enhancing trust between service providers and consumers. It was observed that the concept of trust is used loosely without any formal specification in cloud computing discussions and trust engineering in general. As a first step towards addressing this problem, we...... have contextualized the formal trust specification in multi-agent environments for cloud computing....

Computationally Modeling Interpersonal Trust

Directory of Open Access Journals (Sweden)

Jin Joo eLee

2013-12-01

Full Text Available We present a computational model capable of predicting—above human accuracy—the degree of trust a person has toward their novel partner by observing the trust-related nonverbal cues expressed in their social interaction. We summarize our prior work, in which we identify nonverbal cues that signal untrustworthy behavior and also demonstrate the human mind’s readiness to interpret those cues to assess the trustworthiness of a social robot. We demonstrate that domain knowledge gained from our prior work using human-subjects experiments, when incorporated into the feature engineering process, permits a computational model to outperform both human predictions and a baseline model built in naivete' of this domain knowledge. We then present the construction of hidden Markov models to incorporate temporal relationships among the trust-related nonverbal cues. By interpreting the resulting learned structure, we observe that models built to emulate different levels of trust exhibit different sequences of nonverbal cues. From this observation, we derived sequence-based temporal features that further improve the accuracy of our computational model. Our multi-step research process presented in this paper combines the strength of experimental manipulation and machine learning to not only design a computational trust model but also to further our understanding of the dynamics of interpersonal trust.

Organizational trust or beyond appearances

Directory of Open Access Journals (Sweden)

Maria Dromereschi

2010-12-01

Full Text Available People and organizations to whom I am giving life to have an enormous need to trust and be trustworthy. Trust represents a fragile asset who needs to be invested in, which is difficult to obtain and takes time to obtain it, but which can be easily broken. Paradoxically, it is a universal trade currency, world-widely understood and appreciated. The relations based on trust are those which determine a company to grow and create a competitive advantage. Trust generates trust. It is the one that inspires and motivates, requires the preservation of a certain set of values, mainly sincerity, fairness, perseverance and a real preoccupation for meeting the needs of other people.

Trust in health information websites: A systematic literature review on the antecedents of trust.

Science.gov (United States)

Kim, Yeolib

2016-06-01

Health websites are important sources of information for consumers. In choosing websites, trust in websites largely determines which website to access and how to best utilize the information. Thus, it is critical to understand why consumers trust certain websites and distrust others. A systematic literature review was conducted with the goal of identifying the antecedents of trust in health information websites. After four rounds of screening process, 20 articles between 2000 and 2013 were harvested. Factors that determine trust are classified into individual difference antecedents, website-related antecedents, and consumer-to-website interaction-related antecedents. The most frequently studied antecedents were socio-demographics, information quality, appearance, and perceived reputation of the website. Each antecedent of trust are discussed in detail and future research directions are proposed. © The Author(s) 2014.

Social Capital, Institutions and Trust

NARCIS (Netherlands)

Nooteboom, B.

2006-01-01

This paper analyzes the relations between social capital, institutions and trust.These concepts are full of ambiguity and confusion.This paper attempts to dissolve some of the confusion, by distinguishing trust and control, and analyzing institutional and relational conditions of trust.It presents a

Lean and Six Sigma Methodologies in NHS Scotland: An Empirical Study and Directions for Future Research

Directory of Open Access Journals (Sweden)

Jiju Antony

2012-12-01

Full Text Available In recent years, the healthcare industry is constantly concerned to provide better quality of patient care with less waste of resources through application of continuous improvement (CI initiatives such as Lean and Six Sigma. The purpose of this paper is to evaluate the status of Lean and Six Sigma methodologies in the National Health Service (NHS Scotland. Data was collected using survey instrument to determine the status of these strategies within the NHS. Although the personnel of NHS do seem to have the basic skills to successfully implement Lean Six Sigma, there appears to be a failure on the part of senior management to successfully communicate the desires and needs of these powerful CI initiatives with personnel. Moreover, a lack of encouragement and motivation, resistance to change and blame culture are quite prevalent across the sector which prevents Lean and Six Sigma strategies from being utilized in a systematic manner.

Trust and Social Commerce

OpenAIRE

Julia Y. Lee

2016-01-01

Internet commerce has transformed the marketing of goods and services. The separation between point of sale and seller, and the presence of geographically dispersed sellers who do not engage in repeated transactions with the same customers challenge traditional mechanisms for building the trust required for commercial exchanges. In this changing environment, legal rules and institutions play a diminished role in building trust. Instead, new systems and methods are emerging to foster trust in ...

Vantage point - Prudent health care.

Science.gov (United States)

Ellis, Gemma

2014-09-25

DESPITE PRODUCTIVITY improvement programmes in the NHS, the Nuffield Trust warns us that the NHS in Wales is likely to face a funding gap of £2.5 billion by 2025. Obviously then, we need to keep searching for ways to ensure long-term sustainability that does not compromise quality.

Consumer Trust in E-commerce

OpenAIRE

Gustavsson, Malin; Johansson, Anne-Marie

2006-01-01

An often mentioned reason for consumers not purchasing from Internet vendors, is the lack of trust. The lack of physical clues and physical interaction in the online environment make it more difficult to establish trust with the consumers. So, it is important for companies to learn how to manage consumers’ trust in e-commerce. Although, building consumer trust on the Internet is a challenge for online vendors. The purpose with this dissertation was to get a better understanding of consumer t...

Can NHS politics, power and conflict ever be a good thing for nurses?

Science.gov (United States)

Lees, Carolyn

2016-07-14

This article explores how organisational politics, power and conflict have a positive role to play for nurses in NHS organisational change and improvement, rather than always leading to disagreement and dispute.

Trusted Computing Technologies, Intel Trusted Execution Technology.

Energy Technology Data Exchange (ETDEWEB)

Guise, Max Joseph; Wendt, Jeremy Daniel

2011-01-01

We describe the current state-of-the-art in Trusted Computing Technologies - focusing mainly on Intel's Trusted Execution Technology (TXT). This document is based on existing documentation and tests of two existing TXT-based systems: Intel's Trusted Boot and Invisible Things Lab's Qubes OS. We describe what features are lacking in current implementations, describe what a mature system could provide, and present a list of developments to watch. Critical systems perform operation-critical computations on high importance data. In such systems, the inputs, computation steps, and outputs may be highly sensitive. Sensitive components must be protected from both unauthorized release, and unauthorized alteration: Unauthorized users should not access the sensitive input and sensitive output data, nor be able to alter them; the computation contains intermediate data with the same requirements, and executes algorithms that the unauthorized should not be able to know or alter. Due to various system requirements, such critical systems are frequently built from commercial hardware, employ commercial software, and require network access. These hardware, software, and network system components increase the risk that sensitive input data, computation, and output data may be compromised.

Trust models in ubiquitous computing.

Science.gov (United States)

Krukow, Karl; Nielsen, Mogens; Sassone, Vladimiro

2008-10-28

We recapture some of the arguments for trust-based technologies in ubiquitous computing, followed by a brief survey of some of the models of trust that have been introduced in this respect. Based on this, we argue for the need of more formal and foundational trust models.

Incremental Trust in Grid Computing

DEFF Research Database (Denmark)

Brinkløv, Michael Hvalsøe; Sharp, Robin

2007-01-01

This paper describes a comparative simulation study of some incremental trust and reputation algorithms for handling behavioural trust in large distributed systems. Two types of reputation algorithm (based on discrete and Bayesian evaluation of ratings) and two ways of combining direct trust and ...... of Grid computing systems....

26 CFR 301.7701-4 - Trusts.

Science.gov (United States)

2010-04-01

... remediation trust if the organization is organized under state law as a trust; the primary purpose of the... federal, state, or local environmental laws; all contributors to the trust have (at the time of... federal, state, or local environmental laws for environmental remediation of the waste site; and the trust...

Trust Management - Building Trust for International Cross Disciplinary Collaboration on Climate Change

Science.gov (United States)

Oakley, K. V.; Gurney, R. J.

2014-12-01

Successful communication and collaboration entails mutual understanding, and transfer, of information. The risk of misunderstanding and/or miscommunication between collaborating groups is tackled in different ways around the globe; some are well documented whereas others may be unknown outside particular groups, whether defined geographically or by specialism. For example; in some countries legally binding contracts define the terms of collaboration. Some regions place greater emphasis on developing trust relationships, and sometimes an official agreement is implied, such as many electronic data transfers on the web. International collaboration on climate change increasingly involves electronic data exchange (e.g. open access publications, shared documents, data repositories etc.) and with this increased reliance on electronic data a need has arisen for scientists to collaborate both internationally and cross-disciplinarily particularly with information technology and data management specialists. Trust of data and metadata on the internet (e.g. privacy, legitimacy etc.) varies, possibly due to a lack of internationally agreed standards for data governance and management, leaving many national, regional and institutional practices tailored to the needs of that group only. It is proposed that building trust relationships between cross-disciplinary and international groups could help facilitate further communication, understanding and benefits from the relationship, while still maintaining independence as separate groups. Complex international cross-disciplinary group relationship dynamics are not easily mapped and producing a set of trust building rules that can be applied to any current and future collaboration with equal validity may be unfeasible. An alternative to such a set of rules may be found in a Trust Manager, whose role is to improve mutually beneficial knowledge exchange between groups, build trust and increase future collaborative potential. This

The Idea of Dialogue, Trust and Reconciliation in the Pilgrimage of Trust on Earth

Directory of Open Access Journals (Sweden)

Katarzyńska Agnieszka

2016-12-01

Full Text Available The purpose of this article is to present the Pilgrimage of Trust on Earth organized by the brothers of Taizé Community as an event building a relationship of dialogue, trust and reconciliation between nations and cultures. The article features an in-depth discussion of the elements of youth meetings and their impact on developing an attitude of dialogue and trust. We will briefly discuss the means used by the brothers to develop a dialogue between people, as well as the methods of spreading the idea of dialogue, trust and solidarity in interpersonal and international relations.

A Hybrid Artificial Reputation Model Involving Interaction Trust, Witness Information and the Trust Model to Calculate the Trust Value of Service Providers

Directory of Open Access Journals (Sweden)

Gurdeep Singh Ransi

2014-02-01

Full Text Available Agent interaction in a community, such as the online buyer-seller scenario, is often uncertain, as when an agent comes in contact with other agents they initially know nothing about each other. Currently, many reputation models are developed that help service consumers select better service providers. Reputation models also help agents to make a decision on who they should trust and transact with in the future. These reputation models are either built on interaction trust that involves direct experience as a source of information or they are built upon witness information also known as word-of-mouth that involves the reports provided by others. Neither the interaction trust nor the witness information models alone succeed in such uncertain interactions. In this paper we propose a hybrid reputation model involving both interaction trust and witness information to address the shortcomings of existing reputation models when taken separately. A sample simulation is built to setup buyer-seller services and uncertain interactions. Experiments reveal that the hybrid approach leads to better selection of trustworthy agents where consumers select more reputable service providers, eventually helping consumers obtain more gains. Furthermore, the trust model developed is used in calculating trust values of service providers.

Suspicion, Trust, and Automation

Science.gov (United States)

2017-01-08

Pool (IPIP; Goldberg et al., 2006; 87). A sample item is “I trust others.” Each propensity to trust item was assessed on a 7-point scale from 1...1754-6 Goldberg , L. R., Johnson, J. A., Eber, H. W., Hogan, R., Ashton, M. C., Cloninger, C. R., & Gough, H. C. (2006). The International...trust decision. When examining software inspections, Porter, et al. [6] identified one of the causes of variation in the outcome of the inspection

Medical Tourism: A Cost or Benefit to the NHS?

OpenAIRE

Hanefeld, Johanna; Horsfall, Daniel; Lunt, Neil; Smith, Richard

2013-01-01

'Medical Tourism' - the phenomenon of people travelling abroad to access medical treatment - has received increasing attention in academic and popular media. This paper reports findings from a study examining effect of inbound and outbound medical tourism on the UK NHS, by estimating volume of medical tourism and associated costs and benefits. A mixed methods study it includes analysis of the UK International Passenger Survey (IPS); interviews with 77 returning UK medical tourists, 63 policym...

Trust, Behavior, and High School Outcomes

Science.gov (United States)

Romero, Lisa S.

2015-01-01

Purpose: The purpose of this paper is to contribute to the literature on student trust and to examine the relationship between student trust, behavior, and academic outcomes in high school. It asks, first, does trust have a positive effect on high school outcomes? Second, does trust influence student behavior, exerting an indirect effect on…

Trust, Endangerment and Divine Vulnerability

DEFF Research Database (Denmark)

Christoffersen, Mikkel Gabriel

2017-01-01

Faith is trusting God in the midst of endangerment. Yet, human experience of excessive suffering has challenged any spontaneous trust in God. In this article, I reconsider the idea of faith as trust in God, adding an emphasis on the divine vulnerability in the incarnation, and I develop a more...

12 CFR 7.2022 - Voting trusts.

Science.gov (United States)

2010-01-01

... Practices § 7.2022 Voting trusts. The shareholders of a national bank may establish a voting trust under the applicable law of a state selected by the participants and designated in the trust agreement, provided the... 12 Banks and Banking 1 2010-01-01 2010-01-01 false Voting trusts. 7.2022 Section 7.2022 Banks and...

Heuritic Trust in IoT

DEFF Research Database (Denmark)

Kaur, Bipjeet; Tange, Henrik

2015-01-01

Increasing use of Internet of things in diverse fields has demanding association in security and trust of such services. The trust on the services cannot exist independent. It is greatly depended on the security of system at each layer. In this paper we analyze different existing trust algorithms...... to develop a combined reputation and trust algorithm. This algorithm is developed in view of developing trustworthy services in the agriculture field where the end users are cautious about their sensitive data but keen in trustworthy services to improve the efficiency of the product....

Governance, Trust, and Taxes

OpenAIRE

Schrøter Joensen, Juanna; Weihe, Guðrið

2013-01-01

This paper examines the role of social capital (trust) vis-à-vis the propensity of a country to be a tax haven. The empirical analysis corroborates that better governed countries have a higher ceteris paribus probability to be tax havens. However, social capital counteracts the effect of governance quality. This effect is so strong that the partial effect of governance quality is reversed for countries with the trust index in the top quartile – making these high trust countries le...

Analyzing Trust Perceptions in System Implementations

DEFF Research Database (Denmark)

Schlichter, Bjarne Rerup; Rose, Jeremy

2009-01-01

' perceptions of trust relations influence future actions, and in this way have both negative and positive consequences. We also conclude that Giddens' theories of trust provide a promising insight into the dynamic aspects of trust relations in implementation projects, which go further than trust theories...... a framework based on Giddens´ theory of modernity. The framework theorizes dynamic elements of the evolution of trust, not previously investigated in this context. The data collection involves 4 actors interviewed twice in 2006 and 2007; and the data analysis strategy is content analysis using Nvivo software...

Trust and the sociology of the professions.

OpenAIRE

Groenewegen, P.P.

2006-01-01

There is a fast-growing literature on trust in health care, especially interpersonal trust, reflecting the growing awareness in both the research and policy communities of the importance of trust. At a general level, trust as part of the broader concept of social capital is related to people's health and well-being. Trust within provider-patient relations is important for its non-specific treatment effects. Finally, trust is also important for the snooth functioning of societal institutions.(...

Education and Social Trust

DEFF Research Database (Denmark)

Oskarsson, Sven; Dinesen, Peter Thisted; Dawes, Christopher

2017-01-01

One of the clearest results in previous studies on social trust is the robust positive relationship with educational attainment. The most common interpretation is that education has a causal effect on social trust. The theoretical argument and empirical results in this article suggest a different...... interpretation. We argue that common preadult factors such as cognitive abilities and personality traits rooted in genes and early-life family environment may confound the relationship between educational attainment and social trust. We provide new evidence on this question by utilizing the quasi......-experiment of twinning. By looking at the relationship between education and social trust within monozygotic (MZ) twin pairs, we are able to avoid potential confounders rooted in genetic factors and common environmental influences because the monozygotic twins share both. The results suggest that when controlling...

Regulatory focus and generalized trust: the impact of prevention-focused self-regulation on trusting others.

Science.gov (United States)

Keller, Johannes; Mayo, Ruth; Greifeneder, Rainer; Pfattheicher, Stefan

2015-01-01

The current research suggests that taking self-regulatory mechanisms into account provides insights regarding individuals' responses to threats in social interactions. In general, based on the notion that a prevention-focused orientation of self-regulation is associated with a need for security and a vigilant tendency to avoid losses and other types of negative events we advocate that a prevention-focused orientation, both as a disposition as well as a situationally induced state, lowers generalized trust, thus hindering cooperation within social interactions that entail threats. Specifically, we found that the more individuals' habitual self-regulatory orientation is dominated by a prevention focus, the less likely they are to score high on a self-report measure of generalized trust (Study 1), and to express trust in a trust game paradigm as manifested in lower sums of transferred money (Studies 2 and 3). Similar findings were found when prevention focus was situationally manipulated (Study 4). Finally, one possible factor underlying the impact of prevention-focused self-regulation on generalized trust was demonstrated as individuals with a special sensitivity to negative information were significantly affected by a subtle prevention focus manipulation (versus control condition) in that they reacted with reduced trust in the trust game (Study 5). In sum, the current findings document the crucial relevance of self-regulatory orientations as conceptualized in regulatory focus theory regarding generalized trust and responses to threats within a social interaction. The theoretical and applied implications of the findings are discussed.

Regulatory Focus and Generalized Trust: The Impact of Prevention-focused Self-regulation on Trusting Others

Directory of Open Access Journals (Sweden)

Johannes eKeller

2015-03-01

Full Text Available The current research suggests that taking self-regulatory mechanisms into account provides insights regarding individuals’ responses to threats in social interactions. In general, based on the notion that a prevention-focused orientation of self-regulation is associated with a need for security and a vigilant tendency to avoid losses and other types of negative events we advocate that a prevention-focused orientation, both as a disposition as well as a situationally induced state, lowers generalized trust, thus hindering cooperation within social interactions that entail threats. Specifically, we found that the more individuals’ habitual self-regulatory orientation is dominated by a prevention focus, the less likely they are to score high on a self-report measure of generalized trust (Study 1, and to express trust in a trust game paradigm as manifested in lower sums of transferred money (Studies 2 and 3. Similar findings were found when prevention focus was situationally manipulated (Study 4. Finally, one possible factor underlying the impact of prevention-focused self-regulation on generalized trust was demonstrated as individuals with a special sensitivity to negative information were significantly affected by a subtle prevention focus manipulation (vs. control condition in that they reacted with reduced trust in the trust game (Study 5. In sum, the current findings document the crucial relevance of self-regulatory orientations as conceptualized in regulatory focus theory regarding generalized trust and responses to threats within a social interaction. The theoretical and applied implications of the findings are discussed.

Can centralized sanctioning promote trust in social dilemmas? A two-level trust game with incomplete information.

Science.gov (United States)

Wang, Raymond Yu; Ng, Cho Nam

2015-01-01

The problem of trust is a paradigmatic social dilemma. Previous literature has paid much academic attention on effects of peer punishment and altruistic third-party punishment on trust and human cooperation in dyadic interactions. However, the effects of centralized sanctioning institutions on decentralized reciprocity in hierarchical interactions remain to be further explored. This paper presents a formal two-level trust game with incomplete information which adds an authority as a strategic purposive actor into the traditional trust game. This model allows scholars to examine the problem of trust in more complex game theoretic configurations. The analysis demonstrates how the centralized institutions might change the dynamics of reciprocity between the trustor and the trustee. Findings suggest that the sequential equilibria of the newly proposed two-level model simultaneously include the risk of placing trust for the trustor and the temptation of short-term defection for the trustee. Moreover, they have shown that even a slight uncertainty about the type of the newly introduced authority might facilitate the establishment of trust and reciprocity in social dilemmas.

Can centralized sanctioning promote trust in social dilemmas? A two-level trust game with incomplete information.

Directory of Open Access Journals (Sweden)

Raymond Yu Wang

Full Text Available The problem of trust is a paradigmatic social dilemma. Previous literature has paid much academic attention on effects of peer punishment and altruistic third-party punishment on trust and human cooperation in dyadic interactions. However, the effects of centralized sanctioning institutions on decentralized reciprocity in hierarchical interactions remain to be further explored. This paper presents a formal two-level trust game with incomplete information which adds an authority as a strategic purposive actor into the traditional trust game. This model allows scholars to examine the problem of trust in more complex game theoretic configurations. The analysis demonstrates how the centralized institutions might change the dynamics of reciprocity between the trustor and the trustee. Findings suggest that the sequential equilibria of the newly proposed two-level model simultaneously include the risk of placing trust for the trustor and the temptation of short-term defection for the trustee. Moreover, they have shown that even a slight uncertainty about the type of the newly introduced authority might facilitate the establishment of trust and reciprocity in social dilemmas.

The Value of Trust to Nursing.

Science.gov (United States)

Rutherford, Marcella M

2014-01-01

Trust, one of nursing's intangible assets, impacts nurses' ability to form meaningful relationships with patients and this connection positively impacts health outcomes. Linking trust to the fabric of nursing and investing in its measurement will become essential to nursing's valuation and the resulting investment in nursing. Trust, as nursing's core value, should be fostered by nurse educators as they prepare the next generation of nurses. Nurse administrators should connect the trust a patient has for his or her nurse and patient cooperation and honest transparent communication between providers and the patient. Banking trust as a valuable nursing asset will substantiate nursing's marketing and support its worth. Nursing's trustworthiness is an intangible asset that warrants protection, as trust once lost is hard to recapture.

Trust: the sublime duty in health care leadership.

Science.gov (United States)

Piper, Llewellyn E

2010-01-01

Trust is the essence of human social existence. From the moment of birth, trust is the basic component in any human relationship and interaction. Trust is the Holy Grail for human confidence in others. From human survival to organizational survival, trust is the primordial bond. No organization is more dependent on trust than health care. This article views trust as the most basic fundamental quality for leadership. Trust is a sublime duty of a leader and the leadership of an organization. Leadership sets the culture of trust. Trust is the one quality that is essential for guiding an organization toward serving others. This article addresses trust from many perspectives. Trust is viewed from our subordinates, our peers, our superiors, and the public we serve. This article postulates how trust in an organization is the sublime duty of leadership that unites all human understanding and without it destroys all human relationships.

Hype and public trust in science.

Science.gov (United States)

Master, Zubin; Resnik, David B

2013-06-01

Social scientists have begun elucidating the variables that influence public trust in science, yet little is known about hype in biotechnology and its effects on public trust. Many scholars claim that hyping biotechnology results in a loss of public trust, and possibly public enthusiasm or support for science, because public expectations of the biotechnological promises will be unmet. We argue for the need for empirical research that examines the relationships between hype, public trust, and public enthusiasm/support. We discuss the complexities in designing empirical studies that provide evidence for a causal link between hype, public trust, and public enthusiasm/support, but also illustrate how this may be remedied. Further empirical research on hype and public trust is needed in order to improve public communication of science and to design evidence-based education on the responsible conduct of research for scientists. We conclude that conceptual arguments made on hype and public trust must be nuanced to reflect our current understanding of this relationship.

Recommendation based on trust diffusion model.

Science.gov (United States)

Yuan, Jinfeng; Li, Li

2014-01-01

Recommender system is emerging as a powerful and popular tool for online information relevant to a given user. The traditional recommendation system suffers from the cold start problem and the data sparsity problem. Many methods have been proposed to solve these problems, but few can achieve satisfactory efficiency. In this paper, we present a method which combines the trust diffusion (DiffTrust) algorithm and the probabilistic matrix factorization (PMF). DiffTrust is first used to study the possible diffusions of trust between various users. It is able to make use of the implicit relationship of the trust network, thus alleviating the data sparsity problem. The probabilistic matrix factorization (PMF) is then employed to combine the users' tastes with their trusted friends' interests. We evaluate the algorithm on Flixster, Moviedata, and Epinions datasets, respectively. The experimental results show that the recommendation based on our proposed DiffTrust + PMF model achieves high performance in terms of the root mean square error (RMSE), Recall, and F Measure.

The Relationship between Teamwork and Organizational Trust

Directory of Open Access Journals (Sweden)

Musab Işık

2015-04-01

Full Text Available The aim of this study is to investigate the relationship between teamwork and organizational trust. In the implementation section the data from the survey of 250 workers is employed in call centers in Erzurum by using relevant statistical methods. Consequently, it is found that there is a positive and significant relationship between teamwork and organizational trust. Thus, the hypothesis of the study is supported as it was expected. Besides, it is found that there are positive and significant relationships between communication, openness to innovation, participation-trust in teamwork and organizational trust, trust in management, trust in co-workers, and trust in workplace.

In Money we Trust? Trust Repair and the Psychology of Financial Compensations

NARCIS (Netherlands)

P.T.M. Desmet (Pieter)

2011-01-01

textabstractDespite the importance of trust in economic relations, people often engage in behavior that may violate their interaction partner’s trust. Given that transgressions in economic relations often result in distributive harm for the victim (i.e. loss of economic resources), a common approach

Creating trust through narrative strategy

NARCIS (Netherlands)

Gabbay, SM; Leenders, RTAJ

2003-01-01

In the rational model of trust, an actor's level of trust is a function of the expected gain and loss involved. As a consequence, if A can influence the gain and loss perceived by B, A can influence B's level of trust. In this article we study how A can do this through the strategic use of

Creating trust through narrative strategy

NARCIS (Netherlands)

Gabbay, SM; Leenders, RTAJ

In the rational model of trust, an actor's level of trust is a function of the expected gain and loss involved. As a consequence, if A can influence the gain and loss perceived by B, A can influence B's level of trust. In this article we study how A can do this through the strategic use of

Trust that binds: the impact of collective felt trust on organizational performance.

Science.gov (United States)

Salamon, Sabrina Deutsch; Robinson, Sandra L

2008-05-01

The impact of employees' collective perceptions of being trusted by management was examined with a longitudinal study involving 88 retail stores. Drawing on the appropriateness framework (March, 1994; Weber, Kopelman, & Messick, 2004), the authors develop and test a model showing that when employees in an organization perceive they are trusted by management, increases in the presence of responsibility norms, as well as in the sales performance and customer service performance of the organization, are observed. Moreover, the relationship between perceptions of being trusted and sales performance is fully mediated by responsibility norms. PsycINFO Database Record (c) 2008 APA, all rights reserved.

Trust in initial encounters : a motivational, cognitive theory

OpenAIRE

Johansen, Svein Tvedt

2007-01-01

In this dissertation I develop a theoretical model on the effects of risk on the formation of trust in the initial stages of a relationship. Risk is proposed to influence trust in two ways: First, risk exerts a direct influence on trust. Risk may decrease trust, increase trust, or increase trust under specific conditions. Second, risk may affect the level of trust indirectly by influencing the effect of social stimuli on the formation of trust. In this second indirect effect of risk, ri...

Effects of cognitive load on trusting behavior--an experiment using the trust game.

Directory of Open Access Journals (Sweden)

Katarzyna Samson

Full Text Available Last decades have witnessed a progressing decline of social trust, which has been predominantly linked to worsening economic conditions and increasing social inequality. In the present research we propose a different type of explanation for the observed decline - cognitive load related to technological development and the accelerating pace of modern life. In an experimental study participants played the trust game while performing one of two different secondary tasks - listening to a disturbing noise or memorizing a sequence of characters - or with no additional task in the control condition. Results show that in both cognitive load conditions participants expressed significantly less trust in the trust game than in case of no cognitive load. Additionally, when cognitive resources were limited, participants' behavior was more impulsive than when their resources were fully available.

Carbon reduction in the NHS : a role for finance

OpenAIRE

Brown, Steve

2009-01-01

HFMA briefing sponsored by ACCA NHS bodies’ performance on carbon reduction is increasingly having an impact on annual audit assessments, and a new energy efficiency scheme, involving the purchase and trading of carbon emissions allowances, will provide real financial consequences for under or over consumption of carbon. But perhaps the biggest driver for the finance community is the fact that carbon reduction should in fact help them meet their key challenge – the need for efficienc...

Trust as a Critical Concept

DEFF Research Database (Denmark)

Bordum, Anders

2004-01-01

In this articlei I will argue that trust is a fundamental and critical concept because trust is the direct or transcendental constitutive ground of most social phenomena, as well as applicable as an operational method in critical theory. There are two different but overlapping positions on trust I...... address in this article. One is the standpoint we find in business strategy, that trust is naïve to show, and control or contracts are presumed better. In the strategy game the idealistic good guys seems to lose (Arrow 1974), (Williamson 1975). The other position is the position taken by systems theory...

We Engage, Therefore They Trust? A Study of Social Media Engagement and Public Trust in Science

Science.gov (United States)

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

2017-12-01

Our society relies heavily on the trust that the public places in science to work. Given science's importance, the growing distrust in science is a cause for concern. Thanks to their participatory nature, social media have been touted as the promising tool for public engagement to restore public trust in science. These digital platforms have transformed the landscape of science communication yet little is known about their impact on public trust in science. This study probed several aspects of public trust in science as expressed on Twitter, 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 as our approach. Results indicated that the perceived contentiousness of a science issue has a significant impact on public trust. The level of distrust is higher in the climate change tweets than in the space science tweets, despite climate scientists being almost four times as active as space scientists in engaging with sceptics. However, people who engaged with scientists in the climate change network displayed a higher level of trust in science compared with those who did not. This effect was not observed in the space science network - in this network, there is no significant difference in trust levels between people who engaged with scientists and those who did not. Additionally, our machine learning study revealed that trust in science (as conveyed by tweets) can be predicted. The supervised learning algorithm that we developed was able to predict the trust labels of tweets in our sample with an accuracy of 84%. A further feature analysis indicated that similarity, presence of URL and authenticity are the properties of trust-inspiring tweets. Based on these findings, we argue that social media science communication is not as straightforward as `we engage, therefore they trust'. Public attitude towards science is often

Love Thy Neighbor: Bonding versus Bridging Trust

OpenAIRE

Poulsen, Odile; Svendsen, Gert Tinggaard

2005-01-01

We study how trust is generated in society. In a two-sector model, we analyze two communities. In the bonding community people do not trust people outside their regular networks. In the bridging community people choose to trust strangers when they meet them. The hypothesis is that when trust is only bonding, it cannot accumulate. Our theoretical contribution is to show that when trust is only bonding then the economy’s level of trust moves to an unstable equilibrium that may under certain con...

The role of private non-profit healthcare organizations in NHS systems: Implications for the Portuguese hospital devolution program.

Science.gov (United States)

Almeida, Álvaro S

2017-06-01

The national health services (NHS) of England, Portugal, Finland and other single-payer universalist systems financed by general taxation, are based on the theoretical principle of an integrated public sector payer-provider. However, in practice one can find different forms of participation of non-public healthcare providers in those NHS, including private for profit providers, but also third sector non-profit organizations (NPO). This paper reviews the role of non-public non-profit healthcare organizations in NHS systems. By crossing a literature review on privatization of national health services with a literature review on the comparative performance of non-profit and for-profit healthcare organizations, this paper assesses the impact of contracting private non-profit healthcare organizations on the efficiency, quality and responsiveness of services, in public universal health care systems. The results of the review were then compared to the existing evidence on the Portuguese hospital devolution to NPO program. The evidence in this paper suggests that NHS health system reforms that transfer some public-sector hospitals to NPO should deliver improvements to the health system with minimal downside risks. The very limited existing evidence on the Portuguese hospital devolution program suggests it improved efficiency and access, without sacrificing quality. Copyright © 2017 Elsevier B.V. All rights reserved.

Trust, Welfare States and Income Equality