Forty-eight hour access to primary care: practice factors predicting patients' perceptions

Background: The government has proposed a 48-hour target for GP availability. Although many practices are moving towards delivering that goal, recent national patient surveys have reported a deterioration in patients' reports of doctor availability. What practice factors contribute to patients' perceptions of doctor availability? Method: A cross sectional patient survey (11 000 patients from 54 inner London practices, 7247 (66%) respondents) using the General Practice Assessment Survey. We asked patients how soon they could be seen in their practice following non-urgent consultation requests and related their aggregated responses to the characteristics of their practice. Results: Three factors relating to practice administration and appointments systems operation independently predicted patients' reports of doctor availability. These were the proportion of patients asked to attend the surgery and wait to be seen, the proportion of patients seen using an emergency surgery arrangement, and the extent of practice computerization. Conclusion: Some practices may have difficulty in meeting the target for GP availability. Meeting the target will involve careful review of practice administrative procedures.

Perceptions of psychological content in the GP consultation - the role of practice, personal and prescribing attributes

Objective: The aim of the present study was to determine the relationship between the characteristics of general practices and the perceptions of the psychological content of consultations by GPs in those practices. Methods: A cross-sectional survey was conducted of all GPs (22 GPs based in nine practices) serving a discrete inner city community of 41 000 residents. GPs were asked to complete a log-diary over a period of five working days, rating their perception of the psychological content of each consultation on a 4-point Likert scale, ranging from 0 (no psychological content) to 3 (entirely psychological in content). The influence of GP and practice characteristics on psychological content scores was examined. Results: Data were available for every surgery-based consultation (n = 2206) conducted by all 22 participating GPs over the study period. The mean psychological content score was 0.58 (SD 0.33). Sixty-four percent of consultations were recorded as being without any psychological content; 6% were entirely psychological in content. Higher psychological content scores were significantly associated with younger GPs, training practices (n = 3), group practices (n = 4), the presence of on-site mental health workers (n = 5), higher antidepressant prescribing volumes and the achievement of vaccine and smear targets. Training status had the greatest predictive power, explaining 51% of the variation in psychological content. Neither practice consultation rates, GP list size, annual psychiatric referral rates nor volumes of benzodiazepine prescribing were related to psychological content scores. Conclusion: Increased awareness by GPs of the psychological dimension within a consultation may be a feature of the educational environment of training practices.

Ethnographic methodologies for construction research: knowing, practice and interventions

Ethnographic methodologies developed in social anthropology and sociology hold considerable promise for addressing practical, problem-based research concerned with the construction site. The extended researcher-engagement characteristic of ethnography reveals rich insights, yet is infrequently used to understand how workplace realities are lived out on construction sites. Moreover, studies that do employ these methods are rarely reported within construction research journals. This paper argues that recent innovations in ethnographic methodologies offer new routes to: posing questions; understanding workplace socialities (i.e. the qualities of the social relationships that develop on construction sites); learning about forms, uses and communication of knowledge on construction sites; and turning these into meaningful recommendations. This argument is supported by examples from an interdisciplinary ethnography concerning migrant workers and communications on UK construction sites. The presented research seeks to understand how construction workers communicate with managers and each other and how they stay safe on site, with the objective of informing site health-and-safety strategies and the production and evaluation of training and other materials.

Codification vs personalisation: A study of the information evaluation practice between aerospace and construction industries

In the emerging digital economy, the management of information in aerospace and construction organisations is facing a particular challenge due to the ever-increasing volume of information and the extensive use of information and communication technologies (ICTs). This paper addresses the problems of information overload and the value of information in both industries by providing some cross-disciplinary insights. In particular it identifies major issues and challenges in the current information evaluation practice in these two industries. Interviews were conducted to get a spectrum of industrial perspectives (director/strategic, project management and ICT/document management) on these issues in particular to information storage and retrieval strategies and the contrasting approaches to knowledge and information management of personalisation and codification. Industry feedback was collected by a follow-up workshop to strengthen the findings of the research. An information-handling agenda is outlined for the development of a future Information Evaluation Methodology (IEM) which could facilitate the practice of the codification of high-value information in order to support through-life knowledge and information management (K&IM) practice.

Knowledge and information evaluation practice: an exploratory study in a construction firm

There are a number of challenges associated with managing knowledge and information in construction organizations delivering major capital assets. These include the ever-increasing volumes of information, losing people because of retirement or competitors, the continuously changing nature of information, lack of methods on eliciting useful knowledge, development of new information technologies and changes in management and innovation practices. Existing tools and methodologies for valuing intangible assets in fields such as engineering, project management and financial, accounting, do not address fully the issues associated with the valuation of information and knowledge. Information is rarely recorded in a way that a document can be valued, when either produced or subsequently retrieved and re-used. In addition there is a wealth of tacit personal knowledge which, if codified into documentary information, may prove to be very valuable to operators of the finished asset or future designers. This paper addresses the problem of information overload and identifies the differences between data, information and knowledge. An exploratory study was conducted with a leading construction consultant examining three perspectives (business, project management and document management) by structured interviews and specifically how to value information in practical terms. Major challenges in information management are identified. An through-life Information Evaluation methodology (IEM) is presented to reduce information overload and to make the information more valuable in the future.