Robert Nash, Ramya Srinivasan, Bruno Kenway and James Quinn
The purpose of this paper is to assess whether clinicians have an accurate perception of the preventability of their patients’ mortality. Case note review estimates that…
Abstract
Purpose
The purpose of this paper is to assess whether clinicians have an accurate perception of the preventability of their patients’ mortality. Case note review estimates that approximately 5 percent of inpatient deaths are preventable.
Design/methodology/approach
The design involved in the study is a prospective audit of inpatient mortality in a single NHS hospital trust. The case study includes 979 inpatient mortalities. A number of outcome measures were recorded, including a Likert scale of the preventability of death- and NCEPOD-based grading of care quality.
Findings
Clinicians assessed only 1.4 percent of deaths as likely to be preventable. This is significantly lower than previously published values (p<0.0001). Clinicians were also more likely to rate the quality of care as “good,” and less likely to identify areas of substandard clinical or organizational management.
Research limitations/implications
The implications of objective assessment of the preventability of mortality are essential to drive quality improvement in this area.
Practical implications
There is a wide disparity between independent case note review and clinicians assessing the care of their own patients. This may be due to a “knowledge gap” between reviewers and treating clinicians, or an “objectivity gap” meaning clinicians may not recognize preventability of death of patients under their care.
Social implications
This study gives some insight into deficiencies in clinical governance processes.
Originality/value
No similar study has been performed. This has significant implications for the idea of the preventability of mortality.
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The emphasis of this survey is on motion picture reference material that has been published since 1982. This update does not, for the most part, include titles covered in a prior…
Abstract
The emphasis of this survey is on motion picture reference material that has been published since 1982. This update does not, for the most part, include titles covered in a prior RSR article (1:4; 1983), written by myself, or in an even earlier article by Leslie Kane (7:1; 1979). In those few instances where titles that have appeared in the earlier RSR film surveys are discussed, it is because they now have a new subject emphasis.
Robert J. Nash and Vanessa S. Eugenio
In this chapter on “Teaching About Religious and Spiritual Difference in a Global Society,” Robert J. Nash and Vanessa Santos Eugenio present a broad religio-spiritual overview of…
Abstract
In this chapter on “Teaching About Religious and Spiritual Difference in a Global Society,” Robert J. Nash and Vanessa Santos Eugenio present a broad religio-spiritual overview of the world, complete with current statistics of religious affiliation across all countries, ethnicities, cultures, and races. The authors’ claim is that a well-developed religio-spiritual literacy in each person is necessary in order to be a productive, pluralistic member of an interdependent global community. In order to become increasingly pluralistic in our worldviews, we must look at how educators at all levels of schooling facilitate conversations about religion. We must learn how to become “cosmopolites” – citizens of the world who are not only genuine sociocultural pluralists, but who are also literate, and understanding, regarding the core religio-spiritual differences that often divide, rather than unite, people. In their concluding section, the authors summarize their personal educational beliefs through two letters written to teachers. These letters provide a number of practical tips and tools for teaching about religion and spirituality in classrooms at all levels of education.
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Although typologies of violence have become more common, relatively little attention has been given to Donald Black’s (1983) distinction between moralistic and predatory violence…
Abstract
Although typologies of violence have become more common, relatively little attention has been given to Donald Black’s (1983) distinction between moralistic and predatory violence. Moralistic violence is rooted in conflict; predatory violence is rooted in exploitation. We elaborate Black’s typology and show how it is similar to, but distinct from, other typologies of violence. We also address the criteria by which typologies of any kind might be judged. Borrowing from the literatures on typologies and on standards of scientific theory, we argue that explanatory typologies should be evaluated according to four criteria: the degree to which they are powerful, theoretical, general, and parsimonious. Applying the criteria to Black’s typology, we argue that the distinction between moralistic and predatory violence is an important contribution to the arsenal of the student of violence.
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Russell Jaffe, Robert A. Nash, Richard Ash, Norm Schwartz, Robert Corish, Tammy Born, James P. Carter and Harold Lazarus
Healthcare is both the largest (17 + percent) and the most rapidly growing (three plus times the consumer product index (measure of inflation) and half a percent of gross domestic…
Abstract
Purpose
Healthcare is both the largest (17 + percent) and the most rapidly growing (three plus times the consumer product index (measure of inflation) and half a percent of gross domestic product each year) segment of the US economy. The purpose of this paper is to focus on outcome successes that illustrate application of a previously reported health equation. The health equation allows an organized and more transparent assessment of healthcare outcomes.
Design/methodology/approach
The approach includes “end use/least cost” techniques that identifies healthful care as a big unmet need (BUN) and equally attractive business opportunity in identifying health promotion that improves outcome at lower net costs.
Findings
Opportunity exists to reduce costs while also reducing adverse events, healthcare morbidity and morality. Transparency is essential to find what works more effectively to yield desired outcomes. Metrics and measures, particularly more precise tools to assess true outcome in promoting health or managing ill health, are given priority as they allow quantified and, often econometric, outcome opportunities in the midst of current uncertainties.
Practical implications
This paper is for consumers and businesses, managers and administrators, professionals and allied health professionals. The successes described herein illustrate fundamental opportunities driving change and innovation within healthcare and in our society.
Originality/value
Attention is called to opportunity areas that can fund out of savings the transition from the authors' current “sickness care” system to a healthful care, proactive prevention approach to delivering care. Novel application of transparency and end use/least cost can help guide choices to achieve healthier outcomes.
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Russell Jaffe, Robert A. Nash, Richard Ash, Norm Schwartz, Robert Corish, Tammy Born and Harold Lazarus
This article aims to present an equation of health to allow measurement and more precise comparison of what is more or less effective in promoting health or managing ill health…
Abstract
Purpose
This article aims to present an equation of health to allow measurement and more precise comparison of what is more or less effective in promoting health or managing ill health. It builds upon and extends a prior report (JMD, Volume 25 Number 10, 2006, pp. 981‐995).
Design/methodology/approach
Applying basic scientific methods and empiric observations, the equation proposed in this article is a state of the current science. Such an equation allows for more systematic and predictive comparison of health initiatives.
Findings
The pace of scientific progress is outstripping our institutional adaptive response mechanisms. An approach to the causes of ill health appears more promising than re‐configuration of current disease reactive, symptom treatment care. This paper starts from first principles and builds a model that results in an equation of health.
Research limitations/implications
Refinement of the model and replication by others are needed to fully determine the predictive value of this approach.
Practical implications
The opportunity to reduce costs while also reducing adverse events, healthcare morbidity and morality.
Originality/value
This article calls attention to areas of opportunity to fund out of savings the transition from our current “sick care” system to a health promotion/proactive prevention approach to caring.
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Russell Jaffe, Robert A. Nash, Richard Ash, Norman Schwartz, Robert Corish, Tammy Born, Harold Lazarus and ASIMP Working Group on Healthcare Transparency
Healthcare is an ever‐growing segment of the American economy. Transparency facilitates better decision‐making and better outcomes measures. The purpose of this paper is to…
Abstract
Purpose
Healthcare is an ever‐growing segment of the American economy. Transparency facilitates better decision‐making and better outcomes measures. The purpose of this paper is to present the human and economic results of increasing transparency.
Design/methodology/approach
The ASIMP Working Group on Healthcare Transparency represents a diverse yet conscilient group of practitioners, researchers, regulators, economists, and academics. Given the need for re‐envisioning healthcare to include more accountability, evidence of efficacy and transparency, this integrative medicine (ASIMP) working group is suitable to address the above purpose.
Findings
Substantial opportunity exists to reduce morbidity and mortality, suffering and excess death, unnecessary costs and risks. Greater transparency facilitates the transition to safer, more effective, more humane healthcare.
Research limitations/implications
This paper starts from a need to improve clinical outcomes and value for resources devoted. Best efforts of a national working group are presented. The implications of the report, when tested, will determine the enduring value of this work.
Practical implications
Consumers and business, administrators and practitioners can improve care at lower cost by increasing transparency. This will accelerate the diffusion of effective approaches that are not yet in widespread use despite replication of efficacy.
Originality/value
This is the first time an integrative approach has been compared with conventional healthcare models, particularly with regard to the role of transparency in healthcare management.
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Jasmine Koch, Andrew Martin and Robert Nash
The purpose of this paper is to consider how German wineries can successfully diversify into wine tourism, in an effort to support their primary business activity of producing and…
Abstract
Purpose
The purpose of this paper is to consider how German wineries can successfully diversify into wine tourism, in an effort to support their primary business activity of producing and selling high quality wine.
Design/methodology/approach
A survey questionnaire was created, collected and analysed using the software programme SurveyMonkey.
Findings
Results indicate that the implementation of wine tourism by German vintners will be a significant challenge as the respondents report a lack of marketing and tourism management skill and knowledge; most are small to medium‐sized enterprises (SMEs) – which means they have little time or manpower available to devote to developing wine tourism; and there is a low level of reported co‐operation amongst stakeholders.
Research limitations/implications
The research could have taken place over a longer period of time, in order to present more reliable data and also it could have included a more representative sample from other sectors of the industry, such as co‐operatives. The research is also limited in scope to Germany and further comparative studies could be carried out focusing on other wine tourism‐related countries, such as New Zealand, France or Italy.
Practical implications
Wine tourism is a crucial element of both the tourism industry as well as the sector of viniculture. Wine tourism marketing strategies fail to meet the expectations of either the vintners or the tourists. However, wine tourism is vitally important for vineyards as it helps to create brand loyalty and to establish customer relationships.
Social implications
There is a strong need to create marketing strategies which strike a balance between developing and promoting wine tourism and the core activity of the vineyards, which is to produce and sell wine.
Originality/value
The availability of literature in English on German wine tourism is scarce and this study is significant, especially because wine tourism in Germany is a relatively new phenomenon. The development of appropriate marketing strategies is therefore required to successfully improve wine tourism.
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Current issues of Publishers' Weekly are reporting serious shortages of paper, binders board, cloth, and other essential book manufacturing materials. Let us assure you these…
Abstract
Current issues of Publishers' Weekly are reporting serious shortages of paper, binders board, cloth, and other essential book manufacturing materials. Let us assure you these shortages are very real and quite severe.