A proposed framework for health and health care policies.
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Mental health quality improvement: what about ethics?
Nurses are increasingly developing and coordinating quality improvement projects under the auspices of state, area health service and organization policies, however, ethical frameworks are commonly absent. This study aims to define key terms, provide an overview of current policy in relation to ethics and outline some procedures and processes for mental health nurses involved in such projects. The use of appropriate ethical frameworks has the potential to foster participation and safeguard participants by providing a greater assurance of integrity and confidentiality regarding quality improvement data collection, utilization and dissemination.
Attitude of Health Personnel↗
Breast cancer in Canada: to screen or not to screen?
Lomas (1988) and Sabatier (1987) have suggested models by which to examine the roles that values, scientific knowledge, institutions, and the learning process play in the formulation of both national and clinical health-care policies. Utilizing their frameworks, this article offers an explanation for the development of high-volume screening mammography policies in Canada, despite the suggested inefficacy of screening technologies for 'unavoidable' illnesses such as carcinoma in the breast. The preliminary results of Canada's National Breast Screening Study further complicate this tissue. Inappropriate framing of the 'problem' in the policy-making process, by actors highly influenced by societal values and scientific evidence, is identified as the reason for present and planned policies and practices contradicting the first principles of health-policy analysis.
Adult↗
The key to the boardroom door: policies for volunteer programs.
Writing and updating policies for volunteer programs is a key strategy to gain the attention and recognition of board and senior administrators for volunteer programs and for managers of volunteers. Further, in light of the recent and rapid growth in volunteering and in the complexity of volunteer work itself, policy development has become an indispensable element in risk management and liability reduction. Managers of volunteers are encouraged to involve their boards and CEOs in policy development. Building the framework of beliefs, values, and rules through policies will ensure both safe and satisfying involvement for the volunteer, and effective service for the client.
Governing Board↗
A critical examination of the hospital restructuring process in Ontario, Canada.
Little work has been done to consider the roles of different forms of knowledge and civil society actors in health policy development. Research on the role of knowledge in policy change has focussed on the contributions of social science knowledge and social scientists. This view assumes that the perspectives and knowledge of experts are the only valid input into the process and is non-critical in its analysis of health policy and health inequities. This paper challenges the reliance upon certain types of knowledge that are brought to bear on the health policy change process, and that knowledge and its creation are impartial activities. This paper presents a conceptual framework of health policy change that incorporates broad concepts of knowledge and civil society actors as contributing to health policy development. It also demonstrates the different dynamics that impinge upon knowledge and its use in health policy change. A case study on hospital restructuring in Toronto, Canada, is presented. Women's College Hospital fought recommended closure and merging of its inpatient services with Sunnybrook Health Science Centre. The case study examined the selection and use of knowledge by the Hospital in building its case against closure.
Health Facility Closure↗
Optimal intervention for an epidemic model under parameter uncertainty.
We will be concerned with optimal intervention policies for a continuous-time stochastic SIR (susceptible-->infective-->removed) model for the spread of infection through a closed population. In previous work on such optimal policies, it is common to assume that model parameter values are known; in reality, uncertainty over parameter values exists. We shall consider the effect upon the optimal policy of changes in parameter estimates, and of explicitly taking into account parameter uncertainty via a Bayesian decision-theoretic framework. We consider policies allowing for (i) the isolation of any number of infectives, or (ii) the immunisation of all susceptibles (total immunisation). Numerical examples are given to illustrate our results.
Algorithms↗
Doing better with "bad kids": explaining the policy-research gap with conduct disorder in Canada.
Conduct disorder (severe and persistent antisocial behaviour in children and youth) is an important community mental health problem in Canada and has been the focus of considerable recent public policy debate. Good research evidence is available on effective (and ineffective) interventions for conduct disorder. Paradoxically, however, relatively little of the research evidence is incorporated into policy decision-making. There is a policy-research gap. An example (Hamilton, Ontario) is used to illustrate this gap. The gap is then explained using a framework for health policy analysis that incorporates values, institutional structures, and information. Values and institutional structures greatly outweigh research evidence in influencing current Canadian policy-making for the problem of conduct disorder. Possibilities for improving the situation are suggested.
Canada↗
Post-war smoking policy in the UK and the redefinition of public health.
Current analyses of UK smoking policy within two frameworks--the 'heroes and villains' view of journalist accounts and a political science emphasis on rival 'producer' and 'issue' networks in policy making. It is often assumed that the US experience provides a universal historical model. This paper sees smoking policy in the UK as a case study in the relationship between 'scientific fact creation' and policy, which has also been emblematic of wider changes in public health ideology. The issue of smoking and lung cancer symbolized the post-war shift from infectious to chronic disease and the rise of a new 'lifestyle'-oriented public health. In the 1980s passive smoking brought a revival of environmentalism; in the 1990s the rediscovered concept of addiction symbolized developments in public health in which curative and preventive initiatives were entwined. Despite the rise of a militant 'healthism' within both anti-smoking and public health since the 1970s, British policy retained a dual focus, an emphasis on risk reduction as well as risk elimination in which policy networks were entwined rather than distinct. Some public health scientists worked in policy milieux, notably the expert committee, which crossed this apparent divide and which linked with industry. Connections between government and industry changed as public health 'treatment' brought the pharmaceutical industry into the picture.
Health Policy↗
"Don't ask, don't tell, don't pursue": military policy and the construction of heterosexual masculinity.
This paper presents a description and analysis of military policy excluding lesbians and gay men. First, we discuss the current policy, review its official rationale, and outline the various criticisms that have been made against it. Next, we suggest an alternative framework for the policy's persistence. Drawing on work in feminist theory, we argue that the military's restrictions on the service of lesbians and gay men reflects an institutional and cultural privileging of a heterosexual masculine ideal. We conclude by speculating on the interests that lie behind the perpetuation of this ideal of soldiering.
Female↗
Economic and health risk trade-offs of swim closures at a Lake Michigan beach.
This paper presents a framework for analyzing the economic, health, and recreation implications of swim closures related to high fecal indicator bacteria (FIB) levels. The framework utilizes benefit transfer policy analysis to provide a practical procedure for estimating the effectiveness of recreational water quality policies. Evaluation criteria include the rates of intended and unintended management outcomes, whether the chosen protocols generate closures with positive net economic benefits to swimmers, and the number of predicted illnesses the policy is able to prevent. We demonstrate the framework through a case study of a Lake Michigan freshwater beach using existing water quality and visitor data from 1998 to 2001. We find that a typical closure causes a net economic loss among would-be swimmers totaling dollars 1274-37,030/day, depending on the value assumptions used. Unnecessary closures, caused by high indicator variability and a 24-h time delay between when samples are taken and the management decision can be made, occurred on 14 (12%) out of 118 monitored summer days. Days with high FIB levels when the swim area is open are also common but do relatively little economic harm in comparison. Also, even if the closure policy could be implemented daily and perfectly without error, only about 42% of predicted illnesses would be avoided. These conclusions were sensitive to the relative values and risk preferences that swimmers have for recreation access and avoiding health effects, suggesting a need for further study of the impacts of recreational water quality policies on individuals.
Bathing Beaches↗
Decentralization, aging policy, and the age of Clinton.
This article examines the recent trends in decentralization and their implications for aging policy in the Clinton presidency. It first discusses a decade-long trend toward decentralizing policy and then examines some recent federal enactments that promote more discretion by state and local policymakers, suggesting that these may set the framework for aging policy during most of Clinton's first term. A basic premise of the discussion is, however, that the degree of flexibility varies with the policy area being analyzed-housing, transportation, health and social services--and whether these are "old" (pre-1980s) or "new" (post-1980s) policies. It concludes with the suggestion that a dual-centered, shared federal-state solution may provide the best approach to the premier issue in aging policy today-long-term care.
Aged↗
The rehabilitation of disabled people: towards a framework for future developments.
Structural changes in the economic and social climate require rehabilitation and other social provisions to review their values, goals and strategies in order to maintain relevance and effectiveness and improve "productivity". This raises the need for conceptual and operational frameworks of rehabilitation policies and practices to take account of foreseeable social and economic trends, needs and opportunities in society. The study set out to outline frameworks for future developments and to assess the feasibility of their implementation in a specific rehabilitation system in a Member State of the European Economic Community. It examined national and european assessments of short term economic, demographic and technological trends and their implications for the disabled and their rehabilitation towards economic and social integration. A limited survey of the existing system identified strengths and potentials which were used as a basis for an operational framework and a plan of action for changes and extensions to the system. The study revealed that the system has the capacity to change in the direction indicated by the framework which is expected to improve quality and "productivity" of the provision.
Persons with Disabilities↗
Comparative assessment of transport risks--how it can contribute to health impact assessment of transport policies.
Health impact assessment (HIA) and comparative risk assessment (CRA) are important tools with which governments and communities can compare and integrate different sources of information about various health impacts into a single framework for policy-makers and planners. Both tools have strengths that may be combined usefully when conducting comprehensive assessments of decisions that affect complex health issues, such as the health risks and impacts of transport policy and planning activities. As yet, however, HIA and CRA have not been applied widely to the area of transport. We draw on the limited experience of the application of these tools in the context of road transport to explore how comparative assessment of transport risks can contribute to HIA of transport policies.
Environmental Health↗
A framework for evidence-based mental health care and policy.
OBJECTIVE: Care planning integrates a growing number of disciplines, research fields and analysis techniques. A framework of the main areas of interest with regard to evidence-based health care in mental health is provided here. METHOD: The framework is based on the experience of working with data analysts and health and social decision makers at the PSICOST/RIRAG network, a Spanish research association which includes psychiatrists, health economists and health policy experts, as well as on a review of the literature. RESULTS: Three main areas have been identified and described here: outcomes management, knowledge discovery from data, and decision support systems. Their use in mental health care is reviewed. CONCLUSION: It is important to promote bridging strategies among these new fields in order to enhance communication and information transfer between the different parts involved in mental health decision making: i) clinicians and epidemiologists, ii) data analysts, iii) care policy makers and other end-users.
Evidence-Based Medicine↗
Continuing care: developing a policy analysis for nursing.
Continuing care: developing a policy analysis for nursing Many authors have commented on the invisibility of nursing in policy development, implementation and analysis. Some of this invisibility may be attributed to the lack of an easily accessible framework to assist analysis of policy from a nursing perspective. In this paper we offer a framework for nursing policy analysis based on the domain concepts of nursing. We use continuing care for older people, a topical policy issue and fundamental nursing specialty, as a case study to demonstrate the utility and potential of such a framework in action. The resulting analysis helps identify areas of potential policy interest to nurses, raises questions for further policy analysis and offers a coherent position statement for action.
Aged↗
Pharmaceutical policy in Italy: towards a structural change?
Italian pharmaceutical policy has recently moved towards a "two lanes" approach, with regulation differing according to a drug's patent status. This study analyses the Italian regulatory framework, focusing on policies related to "off-patent" drugs. Three main regulatory innovations have been examined: (i) generics, introduced in Italy for the first time in 1996; (ii) the reference pricing (RP) scheme, under which consumers pay part of the cost of high-priced products; (iii) pharmacists' right of substitution, supported by a regressive margins system. The recent reforms are already producing some worthwhile results, at least in terms of competitive pressure on the (few) substances that run out of patent protection. However, further intervention could be required to achieve long-term sustainability.
Cost Control↗
Health outcomes as an organisation-wide quality initiative.
Since the burgeoning of the 'health outcomes' movement there has been an ever-increasing body of literature on health outcomes policy debates, directions, frameworks and tools for implementing health outcome-directed initiatives. There is a significant gap in the literature, however, in regard to translating a comprehensive health outcomes policy into practice at a local level. This paper addresses that gap. It describes the local implementation of a comprehensive health outcomes approach which works across the continuum of care. It identifies those organisation-wide structures and processes that support successful progress, thereby providing a useful guide to other organisations wishing to institutionalise the health outcomes approach.
Community Networks↗
Long-term care research and policy.
This article provides a framework for understanding how long-term care (LTC) research contributes to policy, develops a typology of research contributions to policy with examples of each type, and suggests ways to ensure that contributions continue in the future. The article draws on in-depth interviews with LTC experts working at the interface between research and policy, as well as a small, informal Internet survey and the relevant political science and health policy literature. LTC research makes important contributions to policy, but its contributions easily go unrecognized because they are subtle and often depend on research investments made many years before policy is affected. Thus, it is important to consider what investments in LTC research initiatives and infrastructure are needed to ensure the future contributions of research to policy and to identify barriers to funding such investments. A number of steps that researchers can take to enhance the future contribution of research to LTC policy are proposed.
Activities of Daily Living↗