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Political devolution and the health services in Great Britain.

This article reviews the effects of political devolution on health care in the countries of Great Britain at the end of the first term of the new political institutions created in 1999. In the light of the powers transferred, an assessment is made of the nature and extent of policy autonomy exercised by the devolved administrations. The author considers the question of whether political devolution is leading to local variations in health care provision that threaten established concepts of equity in a U.K. National Health Service. Policy areas discussed include the personal care of older people, mental health, governance, competition, the role of the private sector, and the health care workforce. Also discussed are the dynamics of intergovernmental relations in the longer term, including the effects of the developing European Union. The article concludes by assessing the extent to which the individual countries within Great Britain are likely to develop health care systems with distinctive identities.

Delivery of Health Care↗

Policy and ideology: the politics of post-reform health policy in the United Kingdom.

While it is commonly accepted that the broader political and economic climate directly influences the nature of any major changes in the provision of health care (witness the 1991 National Health Service reforms in the United Kingdom), there is less consideration of the effect of paradigm changes in health care and health care management themselves on wider political and ideological strategies. This article examines the recent health policy initiatives presented by Britain's Labour Party. The author argues that while the Conservatives' market-oriented reforms reflected the perceived political and economic realities of the 1980s, the rapidly increasing credibility of strategies of prevention within the health care sector (including an emphasis on the social determinants of ill-health, the need to plan a shift from acute to community care, and the desire for greater lay participation in policy-making) allows Labour to highlight the limitations of a strongly market-oriented system in the health care sector more so than in any other policy area.

Decision Making, Organizational↗

Psychological aspects of political tolerance among adolescents.

This study concerns 273 Spanish adolescents, aged between 14 and 17, 125 boys and 148 girls. The measured variables were political tolerance, liking for several groups, political experience, cognitive moral reasoning, support for democratic norms, support for violent groups, identification with a group of friends, identification with a religious group, and identification with a soccer team. The objectives of this work were (a) to establish groups of adolescents based on the relationship between their willingness to extend rights to several groups and their liking of these groups, (b) to know the personality characteristics of tolerant and intolerant adolescents, and (c) to set up correlations between age and total tolerance, total liking, and the variables correlated with tolerance. The main findings are that older and younger adolescents belong to different groups, with respect to tolerance, and something similar can be said about boys and girls. Intolerant adolescents perceive themselves as anxious, insecure, solitary, and obstinate. Significant positive correlations between age and political experience, rated support for democratic norms and ratings for identification with a group of friends were found. On the contrary, there were significant negative correlations between age and rated support for violent groups, identification with a religious group, and identification with a soccer team.

Adolescent↗

Incidence of having dreamed and conservative political attitudes.

The association of political attitudes of conservatives and reports of their having had a dream was investigated. 48 female graduate students in counseling psychology were given the KJP Dream Inventory and the Kerlinger Social Attitude Scale II. Scores on conservative political attitudes were positively correlated with having had Dreams of Falling (.40), Dream Discontentedness (.31), Dreams of Being Chased (.40), and Dreams of Being Famous (.30). Negative correlations were observed between scores showing a conservative political tendency and scores on Openness (-.35), and Uninhibitedness (-.50), as well as incidence of Dreams of Sex (-.29). The character of conservative dreaming is discussed along with the study's relevance to past and subsequent issues in research.

Adult↗

Educating nurses in political process: a growing need.

If we are to advance the profession of nursing, we must educate nurses to become key participants in the formulation of health policy. If we fail to do this, others will make decisions that affect our practice without our input. A growing number of nurses are recognizing the need to increase our power, and we understand that political participation provides a pathway to power. We must continue to increase the number of nurses who are politically astute and active in order to achieve our goal. The most effective way to accomplish this is to educate large numbers of staff nurses for this vital role. This article suggests educational strategies and methods that can be utilized in continuing education programs to begin the political education process.

Education, Nursing, Continuing↗

Political savvy in staff development: building an indispensable department.

Political savvy is not something with which one is born; instead it is a process that is learned, sometimes painfully, always demandingly. The purpose of this article is to identify strategies that will make a staff development department essential to organizational functioning and that will enhance both productivity and political survival. Critical to survival is the promotion of the three Vs of staff development: visibility, viability, and validity. Power and politics must be utilized to create an indispensable department.

Hospital Departments↗

Influencing the political process through coalitions: the Michigan Council for Maternal and Child Health.

Building a coalition with others is an effective tool for increasing influence at the state level of the political process. It allows for the hiring of a staff who are able to maintain a constant presence in the ever-changing state political arena, which individual physicians and other caregivers simply cannot do. It allows for the development of increased sophistication among its members, which likewise increases the ability to affect the political process. It should be done with a philosophical set of standards that preserves its integrity and focuses on its goals, which must be carefully delineated from the inception. Coalitions are an effective way to deal with public issues of maternal and child health.

Child↗

What is political leadership?

This article is about political leadership in nursing. It reports on the RCN's Political Leadership programme and outlines how nurses can develop and influence public policy. The author attempts to increase understanding of how nurses can improve public policy and outlines the role of the political leader in nursing. She concludes that nurses need to gain appropriate knowledge to enable them to influence policy and practise effectively.

Attitude of Health Personnel↗

[Current responsibilities of health care research and political counseling].

Health systems research aims to contribute to the progressive development of medicine and health services. To bridge the gap between the two logics of scientific and the political administrative agency, politics consultancy may be applied. However, the chances of transferring scientific knowledge into rational politics vary widely. Major issues of health system research include outcome oriented health targets, outcome oriented reimbursement, health technology assessment, new forms of provision, patient information and ageing in regard to healthcare. Physicians are advised to keep in touch with these developments--although some of them are still in an embryonic stage--because they have the potential to deeply influence the physician's practice routines in the future.

Forecasting↗

Positive politics.

The term "playing politics" usually brings to mind undesirable qualities such as manipulation, power abuse and overt self-interest. Yet politics is a constant in daily life and indeed is very necessary in gaining support for both personal and corporate projects. This article discusses how, through communication and leadership, political skills can be used to realize common goals in an organization.

Administrative Personnel↗

Positive politics: playing corporate games with personal integrity.

The desire for power is personal. Competence and political intelligence are the prerequisites for handling power in a healthy manner. Politics is not a nasty word or a set of behaviors that inevitably turns you into a shady character of whom your mother would be ashamed. You need never divorce your own morality from the situation. The choice to improve your political functioning is yours. You always retain the right to play, and you retain the right to decide when to play. But you are a better manager, a better professional, and a more educated person if you can identify what others are doing and how their behavior will impact you. It is not just for success, it is for survival--success and survival on your own terms.

Hospital Administrators↗

Politics and poker--two game plans shape up in AIDS-control strategy.

A line from the song 'Politics and Poker,' from the Broadway musical Fiorello, goes: 'Neither game's for children, either game is rough. Decisions, decisions, like who to pick, how to bet, how to play, how to call a bluff.' Events in recent months, leading up to and following the release of CCD's recommendations for preventing transmission of HIV to patients by health care workers, can be characterized as a nation playing both games in trying to deal with undefinable or unexplainable risks of AIDS transmission. The nation seems split between those who favor politically astute (though not necessarily logically or ethically sound) solutions, and those who believe that HIV-infected practitioners must make decisions on testing, disclosure, and changes in practice based on a rational assessment of each individual case--factoring in the odds of viral transmission, the chance of losing a career, the interpretation of risk, adherence to stringent infection control technique, timing, patient confidence, and peer support. Ether one is a gamble. This special issue of Hospital Ethics takes a look at the politics and poker of AIDS testing and disclosure, with special attention to the kinds of advice being offered to hospitals as they develop policies on infected health care workers.

AIDS Serodiagnosis↗

Healthcare reform's moral, spiritual issues. The problems are not just political.

Although President Clinton's proposals were defeated in 1994, healthcare reform is an issue that will not go away. But it is an especially complex issue because it is moral and spiritual as well as political. Catholic social teaching could help free us Americans from our confusion on the topic. For example, the Catholic ideas of justice, subsidiarity, and the common good could help us address the crux of the healthcare reform debate, which questions the fairness of forcing more fortunate people to provide healthcare for those who are sick and poor. Catholic social teaching tells us that our healthcare decisions must be made not only on the basis of what is good for me but what is good for us as a community. By the same token, we might find that several specifically spiritual ideas are helpful. Christianity says, for example, that sickness can be a gift because it is a window on immortality for us; that we should not prize life above all other values; and that friendship--including the civic friendship involved in healthcare--is a way we can enter full friendship with God. These moral and spiritual ideas lead us to certain political conclusions: Healthcare reform should be politically realistic, relatively simple. and inclusive. Because healthcare is a good like no other, it can be a powerful occasion for realizing God's own compassion, healing, and justice.

Attitude to Health↗

Organizational politics: did you hear?

How do you define organizational politics? The underground system of communication, the grapevine, what's really going on in the organization, rumors, knowing who really has the power? However you define it, all sources agree you'd better not ignore it. According to one physician executive: "Organizational politics is how things really get done, who really has the power, how decisions get made. Things are not always what they appear to be on the organizational chart." Presented here are some thoughts about organizational politics from physician executives and their stories of when it helped or hurt their careers or prevented them from accomplishing something in their organizations.

Decision Making, Organizational↗

The politics of implementing intersectoral policies for primary health care development: experience and lessons from Tanzania.

The paper reviews the initiatives made by the Government of Tanzania to develop intersectoral collaboration for the implementation of Primary Health Care(PHC). It explains why there has been little in those directions. A number of shortcomings were identified during the different phases of PHC implementation, these include: misconception of PHC by the MoH as PHC was paradoxically initiated in the MoH (national level) as a vertical programme alongside other vertical programmes which were not coordinated, formation of the PHC coordinating committees alongside development committees existing at village, district and regional levels gave rise to unnecessary multiplication of committees at these levels: a tendency by the MoH to refrain from implementing its past decisions such as dropping the formation of a National Health Council to guide the PHC-oriented policy formulation process at national level; weakening the national level coordinating mechanism by lack of political legitimacy it deserves; and inadequate legal mechanisms proposed in the 1983 PHC guidelines to back up PHC implementation which were made in reference to only the village level PHC committee. Experience of implementing PHC in Tanzania highlights the point that intersectoral collaboration is not simply a technical issue but as influenced by socio-political factors. This article has raised a number of issues which have to be noted in order to improve intersectoral collaboration in Tanzania. First, is the need to place PHC on Tanzania's political agenda. This may taken time but it is a necessary exercise to undertake. Second, effective mechanisms to foster policy coordination at national level should be developed. Third, intersectoral coordination processes at national level should guide similar processes at subnational levels. Fourth, is always to be aware of an counteract the problems presented by the medical model in health programmes implementation processes.

Health Plan Implementation↗

Political skills and the science of diplomacy.

Present NHS management structure involves relationships which are based more on political processes than authority. In the first of a two-part article Steve Harrison and Jack Hallas look at management as a political process and argue that politics are about redistribution of resources and cannot be taken out of health care management.

Administrative Personnel↗

The legal perspective: how hospitals can play politics.

A number of federal tax and election laws apply to political activity by charitable hospitals and trade associations, including the formation of political action committees. Trustees of charitable hospitals should approach political activity with an awareness of potential IRS hostility and with the advice of legal counsel.

Hospitals↗

Trustees: indispensable to hospitals' political thrust.

Because of trustees' unique role in the hospital and the community, they are a vital part of health care's political thrust. The American Hospital Association and the allied state and metropolitan hospital associations have responded to trustees' increased commitment to political action by stepping up their own commitment to trustee political involvement.

American Hospital Association↗