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David Kernick

Publications and source records attributed to David Kernick.

10 recordsLinked to original sources
PubMed2002

Clinical evaluation: constructing a new model for post-normal medicine.

The current paradigm in medicine is served by an explanatory model based on scientific positivism. We argue that there are inherent weaknesses in this model: its basis on reductionism, its reliance on linear thinking and its failure to incorporate human values invite a revision of our thinking about knowledge in medicine. We propose that a fresh explanatory model should be based on complexity theory, and argue that this better suits the new era of post-normal medicine, where analytical and predictive power are obtained by stepping back and looking at the relationships and overall context of a system rather than forcing reality into a preferred disciplinary framework. Better at times to be vaguely right, we argue, rather than precisely wrong.

Medicine↗
PubMed2002

The demise of linearity in managing health services: a call for post normal health care.

The emerging science of complex adaptive systems offers a complementary perspective on organisational analysis and is already finding an application within health care. The emphasis moves away from the features of normal science (analysis, prediction and control) to focus instead on the configuration of relationships among the system's components and an understanding of what creates patterns of order and behaviour among them. The important features are connectivity, recursive feedback, diversity and the existence of self-ordering rules that give systems the capacity to emerge to new patterns of order. This paper describes some of these complexity insights and their application to health care delivery and development.

Decision Making, Organizational↗
PubMed2002

Economic approaches to doctor/nurse skill mix: problems, pitfalls, and partial solutions.

Against a background of government calls for a radical change in the way the medical workforce is planned and trained, the concept of skill mix seeks to match clinical presentation to an intervention based on an appropriate level of skill and training. Health economics is not the only framework within which these changes can be analysed. However unless the economic issues are thought through clearly there is a danger that resources may be used inefficiently. The aims of this paper are to outline the economic issues in the area of doctor/nurse skill mix and the problems of obtaining correct solutions from the perspective of efficiency. It concludes by offering a pragmatic framework which can facilitate decisions in this area. Although this paper is written from the perspective of primary care, it is equally relevant to skill mix in the secondary care sector.

Clinical Competence↗
PubMed2002

Headache.

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Headache Disorders↗