Innovation care pathways and the healthcare built environment: An explanatory framework and research agenda

The built environment in which health and social care is delivered can have an impact on the efficiency and outcomes of care processes. The health-care estate is large and growing and is expensive to build, adapt and maintain. The design of these buildings is a complex, difficult and political process. Better use of care pathways as an input to the design and use of the built environment has the potential to deliver significant benefits. A number of variations on the idea of care pathways are already used in designing health-care buildings but this is under-researched. This paper provides a framework for thinking about care pathways and the health-care built environment. The framework distinguishes between five different pathway ‘types’ defined for the purpose of understanding the relationship between pathways and infrastructure. The five types are: ‘care pathways’, ‘integrated care pathways’, ‘patient pathways’, ‘patient journeys’ and ‘patient flows’. The built environment implications of each type are discussed and recommendations made for those involved in either building development or care pathway projects.

Care pathways and designing the healthcare built environment: an explanatory framework

The built environment in which health and social care is delivered can have an impact on the efficiency and outcomes of care processes. The health-care estate is large and growing and is expensive to build, adapt and maintain. The design of these buildings is a complex, difficult and political process. Better use of care pathways as an input to the design and use of the built environment has the potential to deliver significant benefits. A number of variations on the idea of care pathways are already used in designing health-care buildings but this is under-researched. This paper provides a framework for thinking about care pathways and the health-care built environment. The framework distinguishes between five different pathway ‘types’ defined for the purpose of understanding the relationship between pathways and infrastructure. The five types are: ‘care pathways’, ‘integrated care pathways’, ‘patient pathways’, ‘patient journeys’ and ‘patient flows’. The built environment implications of each type are discussed and recommendations made for those involved in either building development or care pathway projects.

A climate of control: flooding, displacement and planned resettlement in the Lower Zambezi River valley, Mozambique

In recent years, the potential role of planned, internal resettlement as a climate change adaptation measure has been highlighted by national governments and the international policy community. However, in many developing countries, resettlement is a deeply political process that often results in an unequal distribution of costs and benefits amongst relocated persons. This paper examines these tensions in Mozambique, drawing on a case study of flood-affected communities in the Lower Zambezi River valley. It takes a political ecology approach – focusing on discourses of human-environment interaction, as well as the power relationships that are supported by such discourses – to show how a dominant narrative of climate change-induced hazards for small-scale farmers is contributing to their involuntary resettlement to higher-altitude, less fertile areas of land. These forced relocations are buttressed by a series of wider economic and political interests in the Lower Zambezi River region, such dam construction for hydroelectric power generation and the extension of control over rural populations, from which resettled people derive little direct benefit. Rather than engaging with these challenging issues, most international donors present in the country accept the ‘inevitability’ of extreme weather impacts and view resettlement as an unfortunate and, in some cases, necessary step to increase people’s ‘resilience’, thus rationalising the top-down imposition of unpopular social policies. The findings add weight to the argument that a depoliticised interpretation of climate change can deflect attention away from underlying drivers of vulnerability and poverty, as well as obscure the interests of governments that are intent on reordering poor and vulnerable populations.

Public values and community energy: lessons from the US and UK

This paper examines some of the normative aspects of community energy programmes — defined here as decentralized forms of energy production and distributed energy technologies where production decisions are made as close as possible to sources of consumption. Such projects might also display a degree of separation from the formal political process. The development of a community energy system often generates a great deal of debate about both the degree of public support for such programmes and the values around which programmes ought to be organized. Community energy programmes also raise important issues regarding the energy choice problem, including questions of process, that is, by whom a project is developed and the influence of both community and exogenous actors, as well as certain outcome issues regarding the spatial and social distribution of energy. The case studies, drawn from community energy programmes in both the United States and the United Kingdom, allow for a careful examination of all of these factors, considering in particular the complex interplay and juxtaposition between the ideas of 'public value' and 'public values'.

Devolution and the political representation of business interests in the UK

The devolution of political power in Scotland, Wales and Northern Ireland and the developing regional agenda in England are widely read as a significant reconfiguration of the institutions and scales of economic governance. The process is furthest developed in Scotland while Wales and Northern Ireland, in their own distinct ways, provide intermediate cases. Devolution is least developed in England where regional political identities are generally weak and the historical legacy of regional institutions is limited. Within the overall context of devolution government policy has continued to emphasize partnership forms of. governance. Accordingly, the political representation of business interests has a particular salience in the new arrangements. This paper reports on findings from a study designed to examine the relationship between devolution and changes in the political representation of business interests in the territories and regions of the UK. It highlights a number of changes in the nature and extent of business representation. While some of these are significant the evidence suggests that they fail to mark a fundamental shift in the institutional foundation for sub-national business interest representation in the UK. Indeed the political geography of business representation remains dominated by an overarching centralism that is likely to provide a significant check on the further devolution of political power and democratic authority. (c) 2004 Elsevier Ltd. All rights reserved.

Devolution and the political representation of business interests in the UK

The devolution of political power in Scotland, Wales and Northern Ireland and the developing regional agenda in England are widely read as a significant reconfiguration of the institutions and scales of economic governance. The process is furthest developed in Scotland while Wales and Northern Ireland, in their own distinct ways, provide intermediate cases. Devolution is least developed in England where regional political identities are generally weak and the historical legacy of regional institutions is limited. Within the overall context of devolution government policy has continued to emphasize partnership forms of. governance. Accordingly, the political representation of business interests has a particular salience in the new arrangements. This paper reports on findings from a study designed to examine the relationship between devolution and changes in the political representation of business interests in the territories and regions of the UK. It highlights a number of changes in the nature and extent of business representation. While some of these are significant the evidence suggests that they fail to mark a fundamental shift in the institutional foundation for sub-national business interest representation in the UK. Indeed the political geography of business representation remains dominated by an overarching centralism that is likely to provide a significant check on the further devolution of political power and democratic authority. (c) 2004 Elsevier Ltd. All rights reserved.

Theorizing Literacy, Politics and Social Process: revisiting Maktab literacy in Rian in search of a paradigm

Literacy as a social practice is integrally linked with social, economic and political institutions and processes. As such, it has a material base which is fundamentally constituted in power relations. Literacy is therefore interwoven with the text and context of everyday living in which multi-levelled meanings are organically produced at both individual and societal level. This paper argues that if language thus mediates social reality, then it follows that literacy defined as a social practice cannot really be addressed as a reified, neutral activity but that it should take account of the social, cultural and political processes in which literacy practices are embedded. Drawing on the work of key writers within the field, the paper foregrounds the primary role of the state in defining the forms and levels of literacy required and made available at particular moments within society. In a case-study of the social construction of literacy meanings in pre-revolutionary Iran, it explores the view that the discourse about societal literacy levels has historically constituted a key terrain in which the struggle for control over meaning has taken place. This struggle, it is argued, sets the interests of the state to maintain ideological and political control over the production of knowledge within the culture and society over and against the needs identified by the individual for personal development, empowerment and liberation. In an overall sense, the paper examines existing theoretical perspectives on societal literacy programmes in terms of the scope that they provide for analyses that encompass the multi-levelled power relations that shape and influence dominant discourses on the relative value of literacy for both the individual and society

Transitions towards co-management: the process of marine resource management devolution in three east African countries

Communities are increasingly empowered with the ability and responsibility of working with national governments to make decisions about marine resources in decentralized co-management arrangements. This transition toward decentralized management represents a changing governance landscape. This paper explores the transition to decentralisation in marine resource management systems in three East African countries. The paper draws upon expert opinion and literature from both political science and linked social-ecological systems fields to guide exploration of five key governance transition concepts in each country: (1) drivers of change; (2) institutional arrangments; (3 institutional fit; (4) actor interactions; and (5) adaptive management. Key findings are that decentralized management in the region was largely donor-driven and only partly tranferred power to local stakeholders. However, increased accountability created a degree of democracy in regards to natural resource governance that was not previously present. Additionally, increased local-level adaptive management has emerged in most systems and, to date, this experimental management has helped to change resource user's views from metaphysical to more scientific cause-and-effect attribution of changes to resource conditions.

The Masters in Teaching and Learning (MTL): a retrospective, intrinsic case study of the process of policy into practice and its impact on teacher participants

The research reported here is a retrospective case study of the recent (2010) introduction of the Masters in Teaching and Learning (MTL) as a post-graduate level programme of professional development for teachers. It contributes to the debate and research over the past two decades about the impact of post-graduate professional development and appropriate ways of delivering it. The study is located within an extensive body of literature dealing with the importance of the teaching profession with regard to the success of schools and pupils and the impact of professional development on teaching quality and of teaching quality on attainment. A further relevant context is the ongoing tension between the teaching profession and academics on the one hand and government and political actors on the other, in respect of the approaches to professional development and to the control of educational processes. The research questions which inform the study deal with the perspectives of various participants – policy makers, programme directors, coaches and teachers studying for the MTL – on the extent to which the MTL is likely to have an ameliorative effect on teaching and pupil attainment, their experiences of the process of policy development and their experiences as course participants. The study adopts a case study approach which involves elite interviews with those responsible for the development and implementation of the MTL, questionnaires completed by MTL course participants and a comparison group taking a conventional MA and in depth interviews with participants and coaches. The results revealed tensions and difficulties associated with the development of the MTL including uneasy relationships between HE institutions and government agencies, ideas about ‘producer capture’, the relevance of the MBA model and concern over the role of coaches. However, while acknowledging various difficulties and some misconceived expectations they viewed its potential to meet its expressed aims positively, given time. Course participants were positive about their experience of the MTL and felt that it had contributed to many aspects of their professional development. Most saw it as a positive experience despite the variable quality of support from their schools, particularly in the form of the school-based coach the concept of which had been heralded as the bellwether of the MTL. It was striking that the responses of the MTL participants were very similar to those of teachers taking a conventional MA. A finding which would repay further investigation is that while the great majority of course participants felt that the MTL (and the MA) had contributed to their becoming more effective teachers they were much less confident that it had contributed to increased pupil attainment.