bluuebunny/crossref_metadata_2025 huggingface dataset:
Management Training for Consultants: A Personal Experience
Authors: Patterson Linda
Published: September 2004

Describes the Open University Course “Managing Health
Services” and its relevance to managerial training of consultants.
Beyond the Annual Report
Authors: Thunhurst Colin
Published: September 2004

Reflects on three years′ experience of Annual Reports on the Public
Health. Argues that the material benefits do not warrant an overly
substantial amount of dedicated time – a five‐year strategic
public health programme, supported by a periodic cross‐sectional
analysis, is more appropriate and would exploit much wider sources of
data than those generally appearing in Annual Reports, Considers the
value of the Decennial Census of Population, as a data source. Suggests
that it must be used in conjunction with other sources of
“hard” data. Also argues that methods for collecting and
incorporating qualitative data must be developed, together with a
framework for informed policy analysis, which would facilitate a
participative dialogue compatible with the aims of the “new”
public health.
Ethics and Health Care Rationing – New Challenges for the New Public Sector Manager
Authors: Smith Iain J.
Published: September 2004

The new public sector health managers are now being asked to make difficult choices regarding the rationing of health care. This is a new experience for many and exposes the ethical base from which many operate. Initiates the debate concerning which morality is currently being employed and whether sharing of these fundamental views can be achieved.
Managing Mr Kipling′s Way
Authors: Evans Jon
Published: September 2004

Discusses medical and management tasks and their relation within
the NHS context. Stresses the importance of doctors in effective
management of the service in relation to leadership, policy and strategy
making and in contributing to the wider debates on quality, efficiency,
effectiveness and efficiency of outcome. Emphasizes the need for doctors
to intervene in terms of setting medical priorities for the health
authority and to contribute fully to this process.
Consultants in Management Training: Learning and Doing
Authors: Smith Peter
Published: September 2004

Reports research by interview into the effectiveness of management
training for 40 medical consultants in two business schools which
indicates that while learning during the business schools′ programmes
was mostly approved of, subsequent application of that learning has been
more limited. Training can be made more effective by preparation before
a programme, high key management of the stages and progress of training,
an effective partnership between purchasers and providers of programmes,
and clear support and expectations from managers.
Performance Measurement: Focusing on the Key Issue
Authors: Brookfield David
Published: September 2004

Examines the nature of performance measurement in the NHS in its
relation to the principal objectives of a public health service. Argues
that existing measures (bed and theatre utilization, budget deficits,
and so on) can give rise to situations which are in conflict with such
objectives. Suggests performance measures should reflect the purpose of
a public health services. One way this may be achieved is by use of an
adjusted or weighted throughout measure which provides an indication of
the level of utilization of (largely) fixed resources. Once adopted as a
performance measure, throughput efficiency, established in the context
of clinical objectives and available resources at unit level gives rise
to quite different conclusions as to the effectiveness of existing
health care delivery than has traditionally been the case.
Gender Bias and the Process of Care
Authors: Dreachslin Janice L.
Published: September 2004

Reviews available literature on gender bias and the process of
medical care. Current findings point to possible gender bias in
treatment protocols for kidney and cardiac patients. Other clinical
conditions have not been studied. Identifies methodological challenges
to such research and discusses the need for further research.
An Analysis of Health Services Using Disease Staging: A Pilot Study in the Emilia‐Romagna Region of Italy
Authors: Taroni Francesco , Louis Daniel Z. , Yuen Elaine J.
Published: September 2004

The European Community is currently experimenting with the use of
Diagnosis Related Groups (DRGs) and other patient classification
systems. Disease Staging is a clinically based classification system
which focuses on the dimensions of severity of illness and can be
implemented using the same data required for the DRGs. Reports a pilot
study in the Emilia‐Romagna region of Italy, where data were analysed
from three hospitals for patients hospitalized in 1988 with four
diseases: coronary artery disease/acute myocardial infarction,
cholecystitis, appendicitis, and diabetes mellitus. The same patients
were classified using DRGs and Disease Staging, and the Disease Staging
methodology was used to analyse issues of timeliness of hospital
admission, length of stay patterns, and in‐hospital mortality rates.
Making “Peckham” Work for Managers
Authors: St Leger Selwyn
Published: September 2004

The “Peckham” initiative is introducing a coherent
framework for research and development (R&D) in the UK National
Health Service (NHS). This entails close collaboration between the
universities and the health service. However, there are inherent
weaknesses in the current ethos of research and academic which suggest
that there may be little understanding of the needs of NHS decision
makers. There is a danger if health service managers do not take control
of the agenda for R&D that it will be subverted to serve narrow
academic interests. Explores means by which this can be averted.
Suggests that managers should control the strategy of R&D and
through the use of checklists determine broadly the content of study
protocols.
The Potential of Cognitive Mapping in Planning Health Provision
Authors: Blackham R.B. , Corless R.
Published: September 2004

The World Health Organization′s project “Health for All in
2000” sets levels for future health care and provision for member
states. In the UK a Healthy Cities Network has been established and many
towns and cities are actively considering ways of working towards
attaining these levels. This involves a number of different
organizations and agencies working together to build models showing all
the factors and relationships which affect the health of a community.
The study aims to assess the potential of cognitive mapping techniques
in providing not only a consensus view, but also a better understanding of
those factors and relationships.
Audit and a Sense of Direction
Authors: Bull Adrian
Published: September 2004

Audit activity is now widespread. There are a range of views about
its prime purpose. Unless the audit programme has a clear purpose and
direction, it will falter. As commissioning develops, there will be more
explicit considerations of standards of care. Those standards will address
both the processes of outcomes of care, focusing on effectiveness and
appropriateness. They will best be generated by local agreement between
purchasers, providers and clinicians, based on the knowledge available
through research. Audit can provide a systematic appraisal of practice
against such standards, while ensuring confidentiality for individual
patients and clinicians. Property resourced, audit can play a valuable role
directly linked to the commissioning process, which will ensure that the
medical profession is fully engaged in the new dynamics of the NHS.
Clinicians′ Resistance to Consumer Satisfaction Surveys: What They Never Tell You
Authors: McAuliffe Eilish , MacLachlan Malcolm
Published: September 2004

The advent of “consumerism” in the NHS puts an increased
importance on finding out what consumers of health services think about
the treatment which they receive. Describes a consumer satisfaction
survey of mental health services. The focus is not on the outcome of the
survey but on the difficulties encountered whilst conducting it. Because
of the strategic value of consumer satisfaction information, only a
small proportion of surveys undertaken are published and hence the
difficulties of this kind of research are rarely discussed. Pays
particular attention to the effect which clinicians′ resistance to the survey
had on data collection. It is important for health service managers to
be aware of the process of consumer satisfaction surveys, so that they
may better judge the value of their outcome.
To Whom Do GPs Refer? A Study of the Development and Change of Referral Networks of General Practitioners in The Netherlands
Authors: Boonekamp L.C.M. , de Roo A.A.
Published: September 2004

One of the major goals of the recent NHS reforms has been to make
the NHS more responsive to the needs of patients by offering more
choice. DHAs and budget‐holding GP practices have been given an
incentive to obtain better value for money in purchasing health care
services. In doing so they will have to take account of the existing GP
referral patterns for as “key advisers” GPs can have major
influence on patients′ choice of hospitals and consultants. Until now
not much has been known about the structure, development and change of
referral patterns and the factors responsible for changes. A study
concerning these issues, conducted in The Netherlands, provides relevant
information for the British situation. The results (non‐specificity of
referrals, the role of tradition and distance in building up referred
relationships and patients′ influence on breaking up relationships)
suggest that GPs′ decisions in building up and changing referral
networks take place implicitly. Concludes that GPs need more information
in order to choose the best option. Information exchange within GP
practices or local/regional GP groups is a means of improving the basis
for decision making. At the same time there is a growing need for
research into cost/quality ratios of care offered by health care
providers. In Britain, DHAs could play an important role in initiating
and intensifying this research.
Evaluating Mergers as a Strategic Option: The Case of Hospitals
Authors: Chan Peng S. , Wayland Gay
Published: September 2004

During the 1980s, hospital merger activity was growing steadily due to fundamental changes in the provision of health care. Recently, however, the US Government has escalated its anti‐trust scrutiny of hospital mergers. Provides an indepth analysis of two recent hospital mergers, one of which was successful and the other was not. Any hospital considering a merger can benefit from analysing the strategies that were used to combat the anti‐trust challenge in both cases.
Management Information for Primary Care Prescribing
Authors: Frost Brian , Sillince John
Published: September 2004

Appraises existing management information for primary care
prescribing within the NHS. Examines the two most important management
problems facing primary care prescribing: budegtary control and quality
assurance. Reviews management information needs and evaluates existing
prescribing information systems. Identifies the four main factors
contributing to current problems: professional pressures, payment
imperatives, reactive administration, managerial deadlock. Discusses
future prospects for management information in primary care prescribing
reaching the conclusion that budgetary control is close to being
achieved, while quality assurance is still subject to a managerial
deadlock.
Perceptions of Quality: The Rural Dimension
Authors: Watt Ian S.
Published: September 2004

Rural populations have traditionally received less attention in
Britain than their urban counterparts, and little research into their
problems has been undertaken. Identifies and discusses potential
problems in the provision of quality health care in rural areas, based
on interviews with five senior NHS managers and supported by information
from relevant published literature. Identifies trade‐offs between the
various dimensions of quality which can occur in rural areas, and argues
that they should be based on objective information and be undertaken
explicitly.
HIV/AIDS: Some Organizational and Managerial Issues
Authors: Bennett Chris
Published: September 2004

Discusses factors emerging from research into the management and
organizational processes involved in developing services for HIV/AIDS
which affected the speed and character of the response made by health
authorities. An early response was promoted by perceived high local
prevalence, an existing service infrastructure, and high status
individuals “championing” the issue and helping to foster a
mobilizing sense of crisis. Responses were shaped by the diverse
interests and perspectives of those developing services; the lack of
established guidelines for treatment and service delivery, and
ring‐fenced funding. The idiosyncratic nature of initial service
development has sometimes made later strategic choices difficult. If the
momentum of service development is to be sustained, HIV/AIDS needs to be
integrated into mainstream service provision and managers need improved
information about local prevalence and evaluation of service
initiatives.
Survey of NHS Staff Health‐related Behaviours
Authors: Walsworth‐Bell J.P. , Theaker T. , Amir Z.
Published: September 2004

Reports a postal survey of NHS staff in six Districts in the North
Western Region. There were 3,525 replies, from staff in five main
occupational groups, with clear social gradients in respect of health
status, smoking and exercise, but a more complex picture in respect of
diet, stress and uptake of preventative services. There were no
significant differences in respect of alchohol consumption. Previous
research showed social class differences in mortality of NHS staff; this
study documents aspects of lifestyle consistent with that. Although the
importance of socio‐economic circumstances and social support should not
be disregarded, the survey results emphasize the need for NHS managers
to reduce the inequality in health experienced by NHS staff, working
with ancillary staff as a priority.
Operational Research: A Role in Strengthening Community
Participation?
Authors: Thunhurst Colin
Published: September 2004

Considers the potential use of operational research for
strengthening community participation – terms that have formerly
been employed ambiguously or with a variety of meanings. Begins by
providing some explanation of “operational research”,
identifying specifically those factors which have prompted the
development of a “new paradigm” operational research. Of
these, considers the need for new practices and particularly the value
of operational research adopting practices derivative from participatory
research. Outlines development of community operational research as an
example of new paradigm operational research; some of the work of the
Community Operational Research Unit in the UK is illustrated. Concludes
by examining the value of community operational research as a potential
tool for strengthening community participation.
Improving Health and Social Care in Mental Illness Services: A Survey of Health Service Managers in One Region of the UK
Authors: Huxley Peter
Published: September 2004

National directives in the UK aim to enhance community provision
for mentally ill people. One of these initiatives, the Care Programme
Approach (CPA) requires health and social services to develop a
needs‐led approach; care plans for discharged patients; co‐ordinated
“packages” of health and social care and information
systems. A survey conducted in the North Western Regional Health
Authority area confirms many of the findings of recent work and raises
other issues for health and social services managers. These include the
need to: recognize and alter bad clinical‐organizational practices;
develop assessment and priority rating systems which combine health and
social care variables; implement relevant and accessible information
systems; and develop adequate, standardized outcome measures for mental
health services.
How to Choose a Usable System for General Practice
Authors: Bakewell Catherine J.
Published: September 2004

Explores the issue of choosing a computer system for general
practice and provides a set of guidelines for effectively accomplishing
this daunting task. The author notes that to be usable a system must
fill the four criteria of effectiveness, learnability, flexibility and
attitude of user. Covers choosing an appropriate interface style,
whether to opt for colour, the issue of cursor or mouse, documentation,
training and speed. Notes that the guidelines are not exhaustive but are
a straightforward attempt to lead the uninitiated general practitioner
through the computer maze.
Reducing the Cost of Post‐operative Deep Venous Thrombosis
Authors: McNally M.A. , Mollan R.A.B. , Buxton M.J.
Published: September 2004

Concern has been expressed that the introduction of a non‐invasive
test as a further step in the diagnostic pathway for deep venous
thrombosis (DVT) can only increase the expense of detection in this
difficult condition. Presents a study and cost analysis of strain gauge
plethysmography in the diagnosis of DVT in 119 symptomatic patients.
Shows that non‐invasive screening is highly cost‐effective and does not
result in reduced efficacy. Examined and costed a number of diagnostic
algorithms and found a single strain gauge test to be the most sensitive
and cost‐effective selection procedure for venography. The cost of
diagnosing a single DVT can be reduced from £691 to £266 by
the use of this technique.
The Strategic Restructuring of US Hospitals
Authors: Chan Peng S.
Published: September 2004

The US health care industry has experienced dramatic economic,
social and technological changes since the late 1970s. These changes
have reshaped the structure and function of inpatient hospitals and
continue to drive their evolution into the 1990s. Examines the causes
and effects of these changes on major for‐profit hospital firms, and
suggests viable strategies for them to compete in the future.
Choice of GP: Fact or Fiction
Authors: Gabbott Mark , Hogg Gillian
Published: September 2004

The White Paper, Working for Patients, and the 1990 GP
Contract are designed to promote competition between general
practitioners and to encourage greater choice for consumers of primary
care. Considers the reforms in the light of established consumer
behaviour literature in other services and suggests that there are
likely to be particular problems for patients in making informed choices
about GPs. As a result, patients are unlikely to make decisions unless
circumstances force them to do so; which has implications for the way in
which GPs are remunerated.
Continuing Medical Education and Its Management
Authors: Vartanian Felix
Published: September 2004

Discusses the importance of continuing medical education (CME) as a
key means of improving the effectiveness of health care. Notes that CME
must be integral to the health system and be centrally placed within
that system if it is to have the required impact. CME methodology needs
to be examined and to have the appropriate effect CME activities should
be related to the problems experienced within the health system.
Stresses that to date there is little hard evidence to show that CME
equates with effective health care but that it is an act of faith to
which sensible health managers and professionals have no hesitation in
subscribing.
Medical Audit: The Views of Junior Doctors
Authors: Black N.A. , Thompson E.M.
Published: September 2004

Reports exploratory research into the reasons why many junior
doctors are critical of medical audit; the extent to which consultants
are aware of juniors′ views; and what might be done to make audit more
acceptable to juniors – using structured interviews amongst staff
(28 consultants and 34 juniors) in four district general hospitals in
South‐East England. Junior doctors were critical of audit for five main
reasons: the additional work involved; the audit cycle being longer than
their job contracts; the topics reflecting their consultants′ interests
and not theirs; doubt about the effectiveness of audit; and audit
meetings being boring, intimidating and even incriminatory. Some
consultants were well aware of these problems, but others were not. To
increase the support of juniors, audit needs to: involve them more and
be more participatory; be organized better; be less of a trial and more
supportive; recognize the extra demands on juniors′ time. Offers
suggestions for the successful implementation of medical audit.
Professional Autonomy in the Medical Field
Authors: Kennerley J.A.
Published: September 2004

Professionals subscribe to a given set of shared core values which
define their profession. In medicine they relate to the saving of life
and healing of the sick. Autonomy is concerned with the extent to which
the professional body can set its own rules and standards which
illustrate the ethos of the profession and define its character. It is
the professionals collectively who monitor the profession in terms of
procedures, practice, entry requirements and licences. Society′s role is
to determine what is appropriate or acceptable behaviour by
professionals and it is increasingly asking about medical activities
from a standpoint of priorities of need, appropriateness and value for
money. There have traditionally been two types of professional group,
random and clustered but we are now beginning to see the emergence of a
third type, the managed group. The management of clustered professional
groups is extremely difficult. Professional and academic freedoms are
jealously guarded while organizational goals are relegated in
comparison. The task facing managers in health care is daunting but
there are signs of progress. We are beginning to see the emergence of a
new partnership between clinicians and managers with agreement on
collective interpretation of clinical values leading to the development
of an enhanced ethos of health care which is better suited to the needs
of the patients.
An Initial Evaluation of Effective Health Care Bulletins as Instruments of Effective Dissemination
Authors: Ibbotson S.L. , Long A.F. , Sheldon T.A. , Mason J.
Published: September 2004

Reports a postal survey of 175 senior district health authority
managers to determine the extent to which the Effective Health Care
(EHC) bulletin No. 1 has effectively disseminated the results of a
systematic review of the effectiveness of population‐based bone density
screening for osteoporosis to health care commissioners in district
health authorities; and a supplement outlining the process of critical
appraisal. The information in the bulletin was perceived by a large
majority as “correct”. A positive correlation was found
between confidence to act and having read about the process of critical
appraisal. Confidence to act was strongly correlated with a stated
intention to use the bulletin in situations relating to the purchase of
bone density screening for osteoporosis and also with the view that the
bulletin would be influential in local discussions. Further research is
needed to assess the impact on decision making.
Decentralization and Primary Health Care in Developing Countries: Ten Key Questions
Authors: Collins Charles , Green Andrew
Published: September 2004

Decentralization is an important element in the policy formulation
and implementation of Primary Health Care (PHC) in developing countries.
While this may well be the case, certain forms of
“decentralization” policies can have negative implications
for the development of PHC. It can be associated with a reduced role of
the public sector, weaken the central Ministry of Health, be
instrumental in producing inequity and facilitate political domination.
It is necessary to examine decentralization with a view to securing its
effective formulation and implementation. A set of ten questions and
related issues is set out to facilitate this examination.
Managing the Fundholding Practice: Who Does What?
Authors: Newton John , Fraser Michelle , Wainwright Dave , Robinson John
Published: September 2004

Reports a study of fundholding in general practice in the Northern
Region and notes that although fundholding may have changed the role of
practice managers and some general practitioners, the structure of
authority remains unaltered. It appears that decision making remains the
prerogative of the clinical partners and reliant on the establishment of
consensus as the decision‐making approach. Notes that a key feature of
fundholding was to enable general practices to develop as small
businesses, formulating business plans and setting up management systems
supported by computer technology. However, the practices explored within
this particular study appear to be working well within the new system
despite the continuation of traditional approaches. The outcome in the
long term remains to be seen.
The Internal Market of the National Health Service: Some Early Observations from the Freeman Hospital, Newcastle upon Tyne
Authors: Craven B.M. , Smith C.J.
Published: September 2004

Deals first, with the theoretical framework within which the
Internal Market (NHSIM) is expected to operate and the particular
problems which occur when a service is provided to a consumer free at
the point of consumption (i.e. non‐marketed). Second, deals with some
costing procedures and stresses the importance of considering costs of
an episode jointly with other benefits. Both of these activities are at
a relatively early stage in the NHS in general. Third and fourth, deals
with two examples (internal medicine and cardiothoracic surgery) of how
the NHSIM has fared during the first year at the Freeman Hospital,
Newcastle upon Tyne. Shows how principles of the theory of finance may
be applied to contracting for Coronary Artery Bypass Graftings.
The Employment of Civilian Dentists in the Israel Defence Forces: A Public‐Private Mix Case Study
Authors: Levy Rachela , Wiener Michael , Rosen Bruce , Gabbay Benjamin
Published: September 2004

Documents how the Dental Service of the Israel Defence Forces (IDF)
successfully implemented private sector approaches to reimbursement and
staffing in a special project designed to improve prosthodontic care for
career military personnel. The innovative public‐private synthesis
enabled the IDF to relieve bottlenecks and increase productivity while
securing high levels of employee and patient satisfaction. The success
of the innovation can be attributed, in part, to specific measures taken
to adapt private sector practices to the culture and norms of
the public sector and to integrate the new program into the
broader organizational framework of the IDF Medical Corps. The
recruitment of managers appropriate to the various stages of the
organizational change cycle also played an important role in the
project′s success. The study is based on in‐depth interviews of senior
managers within the IDF medical corps, interviews of the managers
directly involved in implementing the change, IDF budget reports and
productivity analyses, and a survey of front‐line dentists. The analysis
will be of interest to managers of public health care systems from
around the world, who are looking to the private sector for innovative
ideas on how to improve the efficiency of public programmes.
How Do Clinicians Decide to Discharge Someone from Their Out‐patient Clinic?
Authors: Sullivan F.M.
Published: September 2004

The objective of this study was to describe the information
requirements and beliefs of hospital doctors working in out‐patient
departments at the point where a decision to discharge or retain a
patient is made. A preliminary assessment of clinical vignettes was
followed by discussions using a nominal group technique with doctors
working within out‐patient clinics. Nine consultant rheumatologists,
seven consultant vascular surgeons and seven senior house officers, on a
rotational training scheme in general medicine, took part. Their ranked
opinions were the principal outcome measures. In each of the three
settings, hospital clinicians affirmed that clinical considerations were
the overriding factors involved in the decision to discharge or retain
patients. These were mainly expressed as beliefs that the patient should
be fully investigated or that the clinical management required skills
only available within the speciality out‐patient clinic setting. The
senior house officers believed that informal guidelines existed in each
of their clinics. Guidelines were usually transmitted by more senior
doctors working in the clinic but were, at times, inconsistent so that
uncertainty existed for individual discharge decisions. The information
requirements and beliefs of senior house officers did not change during
the six months between assessments. Consultants working in out‐patient
clinics are consistent in their information‐gathering and belief
systems. That is to say, consultants in the specialties studied agreed
with one another in the discussion groups. They may fail to communicate
this fully to their junior staff. Explicit guidelines for junior staff
based on diagnostic and disease severity data would be of value in
making discharge decisions more consistent.
Health Gain: From Rhetoric to Reality
Authors: Hotchkiss Julie , Watson Paul , Boydell Leslie
Published: September 2004

The concept of health gain is increasingly being used as a
philosophical basis for the activities of health authorities, following
the 1991 NHS reforms. A series of three multidisciplinary conferences
were held to explore three health topics (coronary heart disease,
antenatal screening for congenital malformations, and teenage planned
parenthood) with respect to the management of health gain. A number of
general issues are described which can be applied to any health problem.
Particular issues include the importance of quantifying the problem
using modelling techniques to identify nodal intervention points where
an assessment of need for intervention can be made, problems in ensuring
effective interventions are used, the necessity for intersectoral
collaboration and the need to incorporate political reality into health
gain management.
Consultant Attitudes on the Impact of Computers: Users Compared with Non‐Users
Authors: Munday Stephen , Young David W.
Published: September 2004

The attitudes of doctors towards Computer‐Based Information Systems
(CBIS) are crucial to the successful implementation of medical audit,
resource management and clinical protocols. We present the results of a
postal questionnaire survey of 846 consultants (471 replies) on their
attitudes towards computers. The survey revealed doctors′ requirements
(demands) of CBISs and also their concerns (expectations) about the
likely impact of these systems. Clear differences are found between the
concerns of doctors who are computer users and those who are not. The
latter displaying more negative attitudes. It is assumed that if the
attitudes of the non‐users become like those of the user′s
implementation of CBISs will be more successful. Requirements for CBISs
were very similar between the two groups, suggesting that changes in
attitudes are not required, but that systems should display the features
listed in the demand section of the questionnaire. A strategy for the
implementation of CBISs should have two strands. It should meet the
demands and reduce the concerns of non‐users over computer systems. The
findings of this survey present for the first time an empirical basis
for the development of such a strategy.
Researching the Doctor Manager – Choosing Valid Methodologies
Authors: Mark Annabelle
Published: September 2004

In a recent research study of the effects of management training
for doctors working in the UK National Health Service, it has become
apparent that identifying the transition from doctor to manager does not
involve just a change in skills, knowledge and attitudes to the
differing roles of doctors and managers. Added validity is given to this
change by an acceptance, on the part of the participating doctors, of
the different research techniques required of management research,
compared with the standard techniques used in the practice of medicine.
Positivist versus phenomenological perspectives are compared in relation
to the research process itself focusing on the triangulation of methods
employed and their differing outcomes. The effectiveness of the various
methods are then compared in relation to the research outcomes and the
changes observed.
The Future of Waiting Lists
Authors: Mullen Penelope M.
Published: September 2004

Waiting lists have been a cause of concern since the inception of
the NHS. Many theories have been put forward to explain their existence
and there have been many proposals to reduce their length. With the
current changes in the NHS and the introduction of the Patient′s Charter
has come a renewed emphasis on reducing waiting lists and waiting times.
However, analysis of incentives within the new system suggests that
waiting lists may be reduced by limiting access rather than by
increasing treatment rate. Further, not only GP Fundholding, but also
the contractual relationships between District Health Authorities and
hospitals may lead to two‐tier systems, with admission priorities based
on source of funding rather than clinical urgency. Overall, it is
concluded that the NHS Review may result in fewer people obtaining
treatment, but with shorter waits for those who do receive treatment.
Good Health for All: A Challenge for the 1990s
Authors: Kells Janet
Published: September 2004

Notes the challenges currently faced by the NHS and specifically
the health goals outlined in Health of the Nation. Stresses the
importance of national policy and strategy development as a means of
recognizing the inter‐connectedness of services and policies. Cites a
number of examples exemplifying the way in which a wide variety of
agencies and organizations are related and impinge on health and health
care. These examples include transport, child benefit and homelessness
among others. Stresses the importance of stabilizing a system exposed to
substantial and continuous change.
Whither Nursing in the 1990s?
Authors: Hancock Christine
Published: September 2004

Discusses the way forward for the nursing professions in the last
decade of the twentieth century. Notes that Government health policy has
stated the need for more nursing resources in the future in the
community, together with extended nursing roles for those in a hospital
environment. Explores the changing focus of nursing and comments on the
recognition that nursing′s valuable and unique contribution to health is
reflected in the Government′s health strategies. Discusses the place of
Project 2000 as well as the role of nursing within the framework of the
Patient′s Charter.
Providing Primary Care Which Meets the Needs of Women
Authors: Yen Laurann
Published: September 2004

Outlines the key issues which determine primary care services as
appropriate to meet the needs of women users. These issues include
taking a particular interest in women and their health; recognizing the
importance of talking through health issues; not making their decisions
for them; working with women to improve their health and recognizing the
role of women as carers. Ends by noting the importance of primary care
providing a diverse range of professional services, not just those
identified as medical, and stresses again the importance of finding out
what women want as the key prerequisite in the provision of an
appropriate and relevant service.
Management Education for Clinical Directors: An Evaluation
Authors: Newman Karin , Cowling Alan
Published: September 2004

Based on a national evaluation of a £2 million
Government‐sponsored programme to send some 260 consultants from the 14
Regional Health Authorities in England to attend Business School
management programmes during 1992‐3. Reports on a 20‐month tracking
study to assess changes in the level and breadth of knowledge, attitudes
and behaviour as acknowledged by course participants, their UGMs, line
managers and where possible their chief executives. Over 2,000 course
participants were interviewed and some 106 completed both pre‐ and
post‐course attendance “self‐efficacy” questionnaires. Most
consultants emerged from the courses feeling more confident to handle
their current and prospective management roles and the tangible returns
to the organization suggest that advanced management development should
continue for consultants being appointed to senior management roles such
as clinical and medical directors.
Demotivating the Doctors: The Double Demotivation Hypothesis in the Health Services of Less‐developed Countries
Authors: MacLachlan Malcolm , Carr Stuart
Published: September 2004

The health services of many less‐developed countries continue to
struggle. Donors also continue to contribute money, equipment and
personnel in the hope of producing sustainable improvements in these
health services. Despite this cumulative effort over many years, some
health services in Africa have failed to make significant gains.
Suggests that the giving of aid, through the provision of medical and
other personnel, produces a potentially damaging double standard. In
particular, the dramatic dichotomy in the renumerations of local and
foreign doctors may have the unintended, but damaging, effect of
demotivating local staff. In addition, reviews research which supports
the notion that the higher‐paid foreign doctors may also experience a
demotivation, through being focused on extrinsic rather than intrinsic
aspects of their work. Discusses implications of this double
demotivation – in local as well as foreign doctors – for the
provision of medical personnel in less‐developed countries.
Clinic Decentralization: An Israeli Model and Evaluation Strategy
Authors: Gross Revital , Elhayany Asher , Zmora Irit
Published: September 2004

Presents a model for clinic decentralization, implemented by
Israel′s largest health insurance fund, Kupat Holim Clalit (KHC). The
main elements of the model are: allocation of a fixed budget; delegation
of authority for budget utilization and service delivery; provision of
incentives for fiscal responsibility; and establishment of an internal
information system. Explores expected outcomes of decentralization on
the basis of an extensive literature review. Emphasizes the importance
of evaluating such an organizational change, and outlines an evaluation
strategy. A major concern in this strategy is to control for the effects
of changes taking place at the same time‐as decentralization, and the
effects of background variables such as demographic characteristics,
health status, etc. For this purpose, a quasi‐experimental design was
developed, based on the comparison of an experimental and control
clinic, both before and after decentralization.
Supporting New Graduates in the Health Service: The Experiences of Entrants to the Speech and Language Therapy Profession
Authors: McCartney Elspeth , Kerr Jane , Cannon Linda , Martin Peter J.
Published: September 2004

Reports a survey of 1990 and 1991 graduates entering the speech and
language therapy profession in the UK. Questions focused on the
induction and support measures received from managers. Also investigates
the experiences of six new therapists in one “good practice”
area, Ayrshire and Arran Health Board, with a package of support
measures implemented. Results showed that new therapists were given a
great deal of help and support, and valued it highly. They welcomed
information on policies and practices, and there is a need for even more
written information. They made successful personal adaptations to the
work environment, and managers felt that they were effective overall.
The study serves as a benchmark for small professions entering the NHS
before reforms alter employment context. Suggests that good professional
managerial practices will have to be carefully maintained.
Making Sense of Purchasing, Audit, Guidelines and Research
Authors: Bull Adrian R.
Published: September 2004

Explores purchasing in relation to audit, guidelines and research.
Notes that the purchasing function is still embryonic, as the NHS
struggles to integrate the new reforms. Notes that the different threads
need to be woven into a coherent pattern if the full potential of the
NHS reforms is to be realized.
PCB‐design follows IC‐packaging
Authors: Kloeser J. , Scheel W.
Published: September 2004

The evolution of IC manufacturing technology has led to a decrease in feature size on the silicon die from around 2μm nowadays down to 0.18μm, and in the near future down to 0.13μm. This implies a simultaneous decrease in the distance of the individual contact pads (pitch), decreasing from a moderate 0.5mm to nowadays 0.1mm or even 0.07mm for leading edge ICs. The near future will not allow this trend to continue. Instead of peripheral contacts, several rows of contacts or even use of the entire die area to accommodate the contacts will allow the numbers of IOs to increase to the required value. Following the roadmap of electronic devices the PCB has its design continuously changed. Accordingly we need today PCBs with high density interconnects, realized by sequential build‐up technology (SBU) including microvias. We see at the end of the next decade that the semiconductor technology will be introduced at the PCB level. At this time we are also able to transfer the chip design into the PCB directly. This dependence of the development from chip‐ and PCB‐technology is the subject of the paper.
Immersion tin as a high performance solderable finish for fine pitch PWBs
Authors: Ormerod David H.
Published: September 2004

A new high performance immersion tin incorporating a co‐deposited organic provides a highly solderable PWB surface finish. The process is described and includes solderability data after accelerated aging and extended processing. Studies of SIR, metallic dendritic growth and ionic contamination are included. A final section shows the benefits for fine pitch assembly, including the yield improvements seen at reflow, ICT and final inspection. The reliability questions are answered and conclude that the flat solderable tin process provides a cost‐effective and yield‐enhancing planar alternative to Nickel‐Gold, HASL and OSPs.
Environmental best practice in the PCB industry
Authors: Goosey Martin
Published: September 2004

The need for the printed circuit board (PCB) industry to minimise its environmental impact is increasingly important, not only because of public lobbying but also because of the potential negative financial implications. For the industry to be competitive and to reduce its costs, it must therefore maximise the benefits of available environmental best practices. Since PCB manufacturing uses many processes that are potentially harmful to the environment, their negative impact can be significant. This also means, however, that there are major opportunities available through the adoption of waste minimisation and environmental best practices. This article outlines the advantages of adopting such practices within PCB manufacturing and details specific examples of where real improvements and savings can be made. Sources of further information are given and specific reference is made to the PCIF’s new PCB Industry Environmental Best Practice Guide.
The logic of collective consuming
Authors: Dolfsma Wilfred
Published: September 2004

In this article, contrary to popular belief, it is argued on the basis of transaction cost economics that consumers will become subcontractors on electronic markets. The effects of this tendency counter the benefits that might accrue to them as a result of product differentiation and price discrimination by firms, and is in actual fact an inescapable part of electronic markets, given the nature of the products and market mechanisms one should expect. Consumers invest time and effort building up a relation with an e‐tailer; an investment that is idiosyncratic. The e‐tailer only needs to invest in generic assets that enable him to automate the process of collecting and processing customer information needed in order to differentiate between products and discriminate between prices. The consumer becomes a dependent subcontractor.
The bureaucracy of murder: empirical evidence
Authors: Mixon Franklin G. , Sawyer W. Charles , Treviño Len J.
Published: September 2004

In detailing the crimes against humanity committed by the Nazi regime before and during the Second World War, Breton and Wintrobe (1986) Breton and Wintrobe describe the Nazi bureaucracy as a flexible microstructure that zealously carried out the “Final Solution” to the “Jewish question”. In this model of bureaucracy, superiors accomplish their aims not by dictating rigid top‐down orders to passive subordinates, but by allowing competition among parts of the bureaucracy and trading “informal services” for “informal payments” over time. The present research adds to the Breton‐Wintrobe argument by presenting anecdotal/empirical evidence showing how the murder of 6 million Jews was carried out in a flexible organization, wherein subordinates devised creative solutions to the “Jewish question”. Also provides evidence detailing how the quid pro quo operation resulted in dramatic payoffs for those subordinates proffering the most creative and/or efficient solutions.
Social economy as political practice
Authors: McMurtry J.J.
Published: September 2004

Within the current climate of rapacious neo‐liberal economic expansion and increasingly globalized public protest, the social economy tradition has again emerged as an important nodal point for practical and theoretical socio‐economic debate and action. However, as recent scholarship makes clear, there is no clear consensus on what this phrase means or the social and political role that this sector of society should play, given current conditions. This paper suggests an answer to both of these questions by focusing on and reworking the “radical/Utopian” stream of theorizing within the social economy discourse. It concludes that, unless the social economy movement recognizes the importance of reintegrating a “life‐world” politics into its economic vision, it will increasingly be used by government as the low‐ or no‐cost alternative to state‐funded social welfare. If this is allowed to happen the social economy will be relegated to an unofficial support/monitoring branch of government/neo‐liberal economic restructuring and, consequently, it will perpetuate the conditions which it has always been envisioned to challenge.
The persistence of weeds and their social impact
Authors: Auld Bruce A.
Published: September 2004

States that weeds appear in all types of agriculture, as well as in areas used for recreation and in natural ecosystems and cause huge economic loss in developed and developing countries despite technological advances. Explores the reasons for their persistence and their social impact. Concludes that weed occurrence is inevitable and has no simple remedy, and that weeds can only be managed and not eradicated.
Distributional implications of contemporary Judeo‐Christian economics
Authors: Beed Clive , Beed Cara
Published: September 2004

Distributional issues have re‐emerged as an important issue in economics, social science, and philosophy in the last few decades. In the same period, the relevance of derivative Judeo‐Christian socio‐economic principles to the contemporary world has been (re)asserted, developing an incipient Judeo‐Christian economics. Methodologically, this undertaking is comparable to that underlying the evolution of Islamic and other forms of religious economics. The methodology employed in the Judeo‐Christian undertaking is described via a worked example. The example shows how normative principles can be derived from Judeo‐Christian thought allegedly relevant to shaping the contemporary distribution of wealth and income. The principles are deduced from a particular sub‐set of Judeo‐Christian source material, and have the effect of generating greater equity in economic distribution. The deductions are compared with selected ideas canvassed in recent economics' discussion about inequitable distribution concerning appropriate criteria for guiding redistributional policy, ideas of “equal opportunity” vs “equal outcomes”, and the relation between distribution and economic growth.