Mark Exworthy, Glenn Smith, Jonathan Gabe and Ian Rees Jones
In recent years, the clinical performance of named cardiac surgeons in England has been disclosed. This paper aims to explore the nature and impact of disclosure of clinical…
Abstract
Purpose
In recent years, the clinical performance of named cardiac surgeons in England has been disclosed. This paper aims to explore the nature and impact of disclosure of clinical performance.
Design/methodology/approach
The paper draws on literature from across the social sciences to assess the impact of disclosure, as a form of transparency, in improving clinical performance. Specifically, it employs the “programme theory” of disclosure.
Findings
The “programme theory” of disclosure involves identification, naming, public sanction and recipient response. Named individual (consultant) surgeons have been identified through disclosure but this masks the contribution of the clinical team, including junior surgeons. Mortality is the prime performance measure but given low mortality rates, there are problems interpreting this measure. The naming of surgeons has been achieved through disclosure on web sites, developed between the health‐care regulator and the surgical profession itself. However, participation remains voluntary. The intention of disclosure is that interested parties (especially patients) will shun poorly performing surgeons. However, these parties' willingness and ability to exercise this sanction appears limited. Surgeons' responses are emergent but about a quarter of surgeons are not participating currently. Fears that surgeons would avoid high‐risk patients seem to have been unrealised. While disclosure may have a small effect on individual reputations, the surgical profession as a whole has embraced disclosure.
Originality/value
While the aim of disclosure has been to create a transparent medical system and to improve clinical performance, disclosure may have the opposite effect, concealing some performance issues and possibly strengthening professional autonomy. Disclosure therefore represents greater transparency in health‐care but it is uncertain whether it will improve performance in the ways that the policy intends.
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Justin Waring, Mary Dixon‐Woods and Karen Yeung
This paper aims to outline and comment on the changes to medical regulation in the UK that provide the background to a special issue of the Journal of Health Organization and…
Abstract
Purpose
This paper aims to outline and comment on the changes to medical regulation in the UK that provide the background to a special issue of the Journal of Health Organization and Management on regulating doctors.
Design/methodology/approach
This paper takes the form of a review.
Findings
Although the UK medical profession enjoyed a remarkably stable regulatory structure for most of the first 150 years of its existence, it has undergone a striking transformation in the last decade. Its regulatory form has mutated from one of state‐sanctioned collegial self‐regulation to one of state‐directed bureaucratic regulation. The erosion of medical self‐regulation can be attributed to: the pressures of market liberalisation and new public management reforms; changing ideologies and public attitudes towards expertise and risk; and high profile public failures involving doctors. The “new” UK medical regulation converts the General Medical Council into a modern regulator charged with implementing policy, and alters the mechanisms for controlling and directing the conduct and performance of doctors. It establishes a new set of relationships between the medical profession and the state (including its agencies), the public, and patients.
Originality/value
This paper adds to the literature by identifying the main features of the reforms affecting the medical profession and offering an analysis of why they have taken place.
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This chapter considers how far political devolution has enabled the government in Wales to develop a distinctive approach to student funding. It examines in particular claims that…
Abstract
This chapter considers how far political devolution has enabled the government in Wales to develop a distinctive approach to student funding. It examines in particular claims that policy choices in Wales on student funding reflect a commitment to ‘progressive universalism’, a term sometimes used by policy-makers in Wales and elsewhere to describe combining means-tested and non-means-tested benefits. The chapter also explores the growing use of income-contingent loans, arguing that such loans complicate debates about targeting and universalism.
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Justin Rogers, Ian Thomas and Philip Mendes
This study explores the experiences of care-experienced people living in supported housing provided by the Rees Foundation in England. This study aims to understand the challenges…
Abstract
Purpose
This study explores the experiences of care-experienced people living in supported housing provided by the Rees Foundation in England. This study aims to understand the challenges faced by those over 25 who have aged out of statutory support and explores how the Rees Foundation’s services help address these challenges.
Design/methodology/approach
This study uses a qualitative approach, using semi-structured interviews with five tenants and five staff members from the housing project. Thematic analysis identified key themes related to homelessness, safety, stability and the importance of relationships with outreach workers.
Findings
The findings reveal that care leavers often face a “cliff edge” when statutory support ends, resulting in risks such as homelessness and social isolation. The Rees Foundation’s approach, which includes ongoing emotional and practical support, plays a crucial role in fostering safety, stability and hope among tenants.
Originality/value
This study offers original insights into the effectiveness of sustained support for care-experienced people beyond the age of 25, an age group that has been largely overlooked in existing research. By focusing on a population often neglected in care leaver studies, it highlights the need for extended support services to prevent long-term adverse outcomes, contributing to the broader understanding of post-care transitions.
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It has often been said that a great part of the strength of Aslib lies in the fact that it brings together those whose experience has been gained in many widely differing fields…
Abstract
It has often been said that a great part of the strength of Aslib lies in the fact that it brings together those whose experience has been gained in many widely differing fields but who have a common interest in the means by which information may be collected and disseminated to the greatest advantage. Lists of its members have, therefore, a more than ordinary value since they present, in miniature, a cross‐section of institutions and individuals who share this special interest.
Introduces a special issue on globalization and the welfare state. Asserts that economic globalization constrains national economic and social policy far more now than ever…
Abstract
Introduces a special issue on globalization and the welfare state. Asserts that economic globalization constrains national economic and social policy far more now than ever before, although the level of international trade has not increased that much compared to levels at the beginning of this century. Talks about the political consequences of economic globalization, particularly welfare state retrenchment in the advanced capitalist world. Outlines the papers included in this issue – comparing welfare system changes in Sweden, the UK and the USA; urban bias in state policy‐making in Mexico; and the developing of the Israeli welfare state. Concludes that economic globalization has a limited effect in shaping social welfare policy in advanced capitalist countries; nevertheless, recommends further research into which aspects of economic globalization shape social welfare policy.
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In the last four years, since Volume I of this Bibliography first appeared, there has been an explosion of literature in all the main functional areas of business. This wealth of…
Abstract
In the last four years, since Volume I of this Bibliography first appeared, there has been an explosion of literature in all the main functional areas of business. This wealth of material poses problems for the researcher in management studies — and, of course, for the librarian: uncovering what has been written in any one area is not an easy task. This volume aims to help the librarian and the researcher overcome some of the immediate problems of identification of material. It is an annotated bibliography of management, drawing on the wide variety of literature produced by MCB University Press. Over the last four years, MCB University Press has produced an extensive range of books and serial publications covering most of the established and many of the developing areas of management. This volume, in conjunction with Volume I, provides a guide to all the material published so far.