The rise and fall of a National Safety Promotion Programme – The case of Sweden

In 1982, when Sweden got a new Health Service Act, the health sector was given a new role – to collect, analyse and actively disseminate the knowledge it gained. A National Safety Promotion Programme was build up by the National Board for Health and Welfare, and a National Inter-sector Cooperation Group and medical advisory board were established. In 1992, the programme was transferred to the National Institute of Public Health. Later the Institute was given a new role and therefore the programme was relocated to the Swedish Rescue Service Agency. In some aspects we can see a parallel with the paradigm that was behind the Civil Protection Act 2003 and the Health Service Act 1982. It was a logic consequence to move the national programme to the rescue service sector. Within the National Rescue Service Agency the programme ended up in the line organisation, which lacked a cross-sector work orientation. The programme was closed down. In the article the reason for the decisions is described and also the background and the possibilities for the programme to act in different national boards as well as the preconditions for an inter-sector group.     

Connecting U.S. Health Expenditures with the Health Sector Workforce

The National Health Expenditure Accounts (NHEA) produced by the Centers for Medicare and Medicaid Services report that U.S. health care spending was $2.6 trillion in 2010. More recent estimates from Altarum Institute confirm that the health sector represents 17.9 percent of our national output. The data from the Bureau of Labor Statistics show that the health sector continued to create jobs throughout the recession and recovery and now accounts for nearly one in nine jobs. For the first time, we link the workforce by occupation to national spending on health care services by aligning data sets from the BLS and Bureau of Economic Analysis with the NHEA. We find $1 trillion, or 57 percent of the $1.78 trillion spent on personal health care services, went to health sector labor. Characterizing the health sector workforce and its contribution to health expenditures informs the potential for spending reductions and the implications of such reductions on employment.     

In difficult times: influences of attitudes and expectations on training and redeployment opportunities in a hospital contraction programme

This article explores reasons behind the low take–up of training and redeployment opportunities in a three–year downsizing programme in a National Health Service (NHS) mental health hospital. It examines these from an interpretive paradigm, identifying social–psychological effects on barriers and motivation to training and redeployment. In reporting factors that inhibit the movement of staff from the hospital the findings indicate that the direction of even a well–planned and positively intentioned programme can be confounded by the responses of employees faced with an uncertain future. When drawing up restructuring programmes involving retraining and redeployment, managers need to take into account the anticipated profound reactions of those affected.     

Anreizregulierung für Schienenwegbetreiber — ein kleiner Schritt in die richtige Richtung

Resulting from the entry into force of the “Act to strengthen competition in the railway sector” in 2016, railway infrastructure charges will be subject to a new regulation regime. As of 2019, the Federal Network Agency must set annual price caps for the infrastructure managers in order to incentivise increases in efficiency. As compared to the situation prior to 2016, new components for reducing costs have been introduced to the regulation regime. However, it is doubtful that the intended incentive regulation will bring about the expected reductions in costs.     

Mentoring: a model for leadership development?

There appears to be a paucity of research on mentoring senior leaders (Hobson & Sharp, 2005) and yet a growing interest in the development of leadership through experience (Abra et al., 2003; McCauley et al., 1998). This paper therefore presents and evaluates a case study of a pilot mentoring scheme and programme for Directors of Finance (DoFs) in the UK National Health Service. The paper reviews DoFs’ leadership needs within the three broad categories of pragmatism, effectiveness and sustainability, and provides a case study detailing the pilot mentoring scheme and programme. Values and challenges posed by this initiative as a model for leadership development are considered, and lead to the identification of eight cross‐cutting tensions connected to mentoring senior leaders. This analysis provides lessons for the ongoing initiative and indicates key learning about managing mentoring and mentoring senior leaders that it is hoped will be of value beyond the scope of this study.     

Embedding consumer culture in health and social care education – a university office's perspective

Health and social care services are changing – and this change is radical. Service user and carer involvement has been a key aspect of health and social care policy for a number of years. In terms of the National Health Service (NHS), this has been significantly strengthened by the report ‘High Quality Care for All’. The NHS will no longer be a monolith dictating what services it offers. It is beginning to take seriously the views of its consumers: the patients, service users and carers. The NHS is starting to put the patient experience at the centre of everything it does, and its regulators are asking for evidence of public and patient involvement. This process may yet prove to be one of the NHS' greatest challenges as it transforms to prioritize the consumer viewpoint. Social care, though further down the line in relation to involvement, is now responding to the relatively new personalization agenda. This paper will consider what the university sector can do to embed the consumer and service culture within the education of health and social care professionals. It looks at the challenges of involvement and required culture change, highlighting the key points to address in the early and middle stages of involvement from a university office's perspective. It includes examples of consumer involvement in teaching, assessment and the selection of students and how their input is starting to make a difference. Finally, the paper outlines what is needed in a development office to establish and support effective service user and carer involvement on health and social care courses in higher education. The article concludes by acknowledging that there is much more work that needs to be done in this field to embed the work of a development office, but that early steps have been promising.     

Conflicting concerns over the privacy of electronic medical records in the NHSnet

The privacy and security of computerised medical data have become a major concern in Britain since the launch of the national electronic network for the National Health Service (NHSnet). A stakeholder analysis approach helps identify the wide range of the concerns which are involved, and this contributes to understanding the broader context within which technological developments take place and ethical concerns arise. The author is a member of the Information Systems Department of London School of Economics and Political Science [LSE], Houghton Street, London WC2A 2AE, England; email A.Pouloudi@lse.ac.uk     

Impressions of action and critical action learning: exploring the leadership development of senior doctors in an English healthcare organization

This paper aims to explore the influence of one cycle of a learning set experience in a postgraduate medical leadership development programme. It does so from two perspectives: first, from the self‐reports of nine senior doctors working in leadership roles in England in the National Health Service; and second from a researcher perspective as we present our research process, findings and perceptions on the use of action learning (AL) and critical action learning (CAL) for leadership development in the complex and unpredictable context of that service. The paper affirms other study findings that CAL in the development of participants’ collective reflexivity has the potential to deal with emotions and power relations in organizational life. An original contribution lies in advancing the idea that CAL can help build resilience in doctor leaders and groups in uncertain conditions such that they are able to challenge current care delivery and effect change in organizational performance.     

Consumer choice for hearing aids and listening devices: newspaper advertisements for UK private sector provision

In the UK there can be several ways to access health care and this is true of hearing aid provision. Although there may appear to be a well‐defined distinction between the National Health Service (NHS) and independent dispenser hearing aid provision, there have been many examples of overlap between the two and recent government policy initiatives mean that distinctions have become less clear. This article outlines the changing relationship between the two sectors and the problems that potential consumers face accessing information on private sector options for amplification devices. A 1‐year sample of newspaper advertisements was content‐analysed for clarity of information provided. The analysis highlighted a range of provision, from well‐known hearing aid dispensers to the greyer areas of listening device retailers and intermediary services. Some advertisements were found to have been reported to the Advertising Standards Authority. Sufficiently misleading adverts may also infringe consumer protection legislation. The article concludes there is the possibility of consumer confusion about products and their potential for amelioration.     

Electrical deaths in the US construction: an analysis of fatality investigations

Electrocution is among the ‘fatal four’ in US construction according to the Occupational Safety and Health Administration. Learning from failures is believed to be an effective path to success, with deaths being the most serious system failures. This paper examined the failures in electrical safety by analysing all electrical fatality investigations (N = 132) occurring between 1989 and 2010 from the Fatality Assessment and Control Evaluation programme that is completed by the National Institute of Occupational Safety and Health. Results reveal the features of the electrical fatalities in construction and disclose the most common electrical safety challenges on construction sites. This research also suggests the sociotechnical system breakdowns and the less effectiveness of current safety training programmes may significantly contribute to worker's unsafe behaviours and electrical fatality occurrences.     

The Emergence of a New Regime: Business Management and Office Mechanisation in the Dutch Financial Sector in the 1920s

During the 1920s the methods, procedures and technologies used in the Dutch office workers' sector to conduct administrative processes underwent sweeping changes. New management styles, office methods and information technologies were introduced. These changes were closely related to each other, and served as a new organisational model for large-scale office activities. We may therefore speak of the emergence of a new ‘regime’ of office organisation. Important elements of the new regime were the standardisation and formalisation of internal communication flows, the introduction of systematic analyses of office operations and the use of punched card technology. In this article the causes, characteristics and consequences of this regime shift are traced by closely examining a couple of reorganisation projects that took place in the 1920s at two different Dutch financial institutions, one of which was successful and one of which amounted to a failure. These institutions were the Rotterdamsche Bankvereeniging (Robaver) and the national Giro Service. The cases demonstrate that the different elements of the new regime were closely connected, and that the new management styles and office methods were indispensable for the successful introduction of the new information technology.     

Consumer education in the UK: new developments in policy,strategy and implementation

Consumer education is an integral part of the European Community's consumer policy. It plays a key role in consumer empowerment, helping consumers gain the skills, attitudes and knowledge they need to be able to gear the choices they make as consumers to their economic interests and to protect their health and safety. In its policy statement, the Directorate General for Health and Consumer Protection states that the European Community is aware that joint measures at national and Community levels should be more structured, in order to achieve maximum effectiveness. This paper aims to set out the current policy and strategic context for consumer education and empowerment in the UK; review the role of UK government bodies and other agencies concerned with developments; review recent literature; present the results of interviews with an extensive range of key stakeholders and the results of a survey of service heads for trading standards throughout the UK. It will consider implementation, partnership, resources, ideas and opportunities. The research found that the agenda for consumer education in the UK is at an interesting stage of development. The Enterprise Act 2002 gives the Office of Fair Trading (OFT) a statutory power to carry out educational activities. Consumer education is also moving up the agenda in the trading standards service. In addition, the teaching of citizenship in English schools is already stimulating new developments in consumer education. The paper will consider the need for organizations like these to work together to build on these policy developments and ensure that consumer education gains the profile it needs to influence consumer attitudes and behaviour.     

实施生殖健康和计划生育服务项目的优先领域--一项选题组讨论法的应用研究

描述分析了在山西临县收集的8个选题组讨论(Nominal Group)资料,归纳了实施生殖健康和计划生育服务项目的优先领域,并解释了选题组讨论法的基本步骤.     

Management training for women: International experiences and lessons for Canada

In Canada, there is growing recognition that women play an increasingly important role in the working world. Management training programs for women have been considered as a route to prepare women to be more effective managers. This paper highlights some of the major issues and concerns being discussed outside Canada by those engaged in management education and training for women — objectives and content of programs, nature of participants, training methods, choice of trainers, organization and evaluation of programs. References are made to a few international programs to illustrate how some of these concerns have been addressed. Implications for training programs in Canada, from both practical as well as research points of view, are discussed.Natalie Lam teaches organizational behaviour, human resources management, and organizational communication at the University of Ottawa. Research interests in cross-cultural management, women in management, and inter-disciplinary research (e.g. organizational issues of physical distribution and materials management). Consultant for private and public sector organizations, such as the Canadian International Development Agency, Bell Northern Research, Institute of Canadian Bankers, and the Canadian Police College.     

Incentivising public service contracts: a methodology and recommendations

In October 1995 HM Treasury set up a number of working groups to examine the feasibility of applying the aspects for change listed in the White Paper ‘Setting New Standards’. The aspect of incentivisation was examined by a highly defined Research Group. The major findings of the group are contained within this case study. The Research Group was chaired by the author and the organisations represented on the group were: The Department of Transport, The Department of the Environment, HM Treasury, National Rivers Authority, The NHS Supplies Authority, Inland Revenue, The Defence Research Agency and the National Audit Office. The work the author previously published in the EJPSM (Jones, 1997) made reference to traditional Government and Public Sector contracting models that have been applied. The fixed price/cost plus type of contracts were seen to have limitations. Incentivisation within public sector contracts was suggested as a way forward for developing Government purchasing.This suggestion poses the question of how we perceive, judge and assess the use of incentives in contracts; what concepts are at the root of the term? The author chaired a UK Government Research Group which considered the concept, suggested a methodology for application and recommended action. In following this process the concept of incentives in contracts proved the most difficult to pin down. The task was completed and accepted by the UK Government. This article explains the general detail of the work, commencing with concepts of incentivisation.     

Modernizing times: UK hearing‐impaired consumers at the policy crossroads

Although there is now a long‐standing belief in the UK that free consumer choice improves market efficiency, the supply of some consumer products and services remained controlled by the state. In the interests of consumers, it regards as vulnerable to misdirection and malpractice or unlikely to have the technical expertise to make informed decisions. Historically, the supply of hearings aids has been restricted to the National Health Service and specific licensed practitioners in the independent sector. Recent changes to both product and service provision have brought about a radical alteration to this situation, and to the framework of control. This case study of a changing healthcare system demonstrates more generally the difficulties experienced by people trying to improve or maintain auditory functions for speech communication. Access to appropriate technological solutions may be precluded by cost, distribution arrangements or lack of knowledge. Overarching these difficulties, regional health policy variations within the UK mean that consumer experiences vary according to where they live. Consumer influence over the direction and scope of changes to the hearing aid market is limited despite the rhetoric of choice. This article examines the emerging ‘liberalized’ market and its contradictions.     

FOCUS: Ethics and the NHS Reforms in the UK

"In the UK a so-called internal market has been operating within the government-run National Health Service since 1991." Analysing the ethical tensions to which this gives rise is Tom Sorell, Editor of this FOCUS , author with John Hendry of Business Ethics (Butterworth Heinemann 1994), Professor of Philosophy at the University of Essex and Fellow in the Ethics and the Professions Program at Harvard for 1996/97.     

Neck injuries among the elderly in Sweden

Neck injuries are some of the most important injuries as they have the potential to influence the spinal cord. A previous national survey of neck injuries in Sweden revealed that injury incidence was increasing for the population over 65 years of age, although it was decreasing for the population as a whole. The aim of this study was therefore to further clarify the magnitude, severity, and external causes of neck injuries in the elderly people in Sweden. A national incidence study, with focus on the age group above 65 years, was undertaken with data from the injury surveillance program at the Swedish National Board of Health and Welfare. The investigation includes cervical vertebral fractures reported between 1987 and 1999, and cervical soft tissue injuries from 1997 to 1999. Data in the hospital discharge register were reported in ICD9 from 1987 to 1996, while data from 1997 to 1999 were reported in ICD10. During the study period 4168 cervical injuries occurred of which 341 were fatal. People above 65 years of age made up 17% of the population and sustained 30% of all cervical injuries and 43% of all fatal cervical injuries. Half of the cervical injuries were axis (C2) fractures. Lower vertebral fractures occurred in 16% of the cases and atlas (C1) fractures in 11%. The cervical soft tissue injuries amount to 19% of all injuries. Fall accidents account for the majority (71%) of the accidents. There is an increasing trend for fall accidents resulting in neck injuries. The male population has a higher incidence for neck fractures than females, disregarding the external cause of injury. The upper cervical injuries are the most common, have the longest hospital treatments, and seem to be caused mainly by low energy falls. Further research is needed to understand the mechanisms of these injuries and in this aspect engineering could contribute with valuable knowledge, through accident simulations with numerical models. The increasing incidence of fall injuries calls for further preventive actions. The public sector should implement preventive strategies to reduce the number of extrinsic accidents, while the health care sector should focus on preventing intrinsic accidents with individual actions for each patient.     

Patterns of inter-organizational purchasing: Evolution of consortia-based purchasing amongst GP fundholders

In the last few years there have been considerable changes in the National Health Service in the United Kingdom. Arguably the most significant of these has been the introduction of competition into health care with the split of the health service into purchasers and providers of care. Central to this development has been the introduction of General Practice fundholding, whereby practices purchase health care for their patients directly from competing suppliers. Those practices that have become fundholders have faced considerable challenges in developing their purchasing function given the complexities of contracting within the context of the NHS internal market. Although one of the original aims of GP fundholding was to facilitate locally responsive purchasing, such have been the complexities of contracting that many fundholding practices have attempted to reduce the managerial demands of purchasing through membership of purchasing consortia. Based on an in-depth study of GP fundholders across Scotland, this paper explores the development of consortia-based purchasing in terms of the managerial implications for the participant practices of purchasing through such inter-organizational networks.