Integrating service user and practitioner expertise within a web-based system for collaborative mental-health risk and safety management

Objectives: To develop a decision support system (DSS), myGRaCE, that integrates service user (SU) and practitioner expertise about mental health and associated risks of suicide, self-harm, harm to others, self-neglect, and vulnerability. The intention is to help SUs assess and manage their own mental health collaboratively with practitioners. Methods: An iterative process involving interviews, focus groups, and agile software development with 115 SUs, to elicit and implement myGRaCE requirements. Results: Findings highlight shared understanding of mental health risk between SUs and practitioners that can be integrated within a single model. However, important differences were revealed in SUs' preferred process of assessing risks and safety, which are reflected in the distinctive interface, navigation, tool functionality and language developed for myGRaCE. A challenge was how to provide flexible access without overwhelming and confusing users. Conclusion: The methods show that practitioner expertise can be reformulated in a format that simultaneously captures SU expertise, to provide a tool highly valued by SUs. A stepped process adds necessary structure to the assessment, each step with its own feedback and guidance. Practice Implications: The GRiST web-based DSS (www.egrist.org) links and integrates myGRaCE self-assessments with GRiST practitioner assessments for supporting collaborative and self-managed healthcare.

Developing user involvement in a UK cancer network:professionals’ and users’ perspectives

This paper explores the results of a consensus development exercise that explored diverse perspectives and sought to identify key principles for the development of user involvement in a cancer network. The exercise took place within one of 34 UK cancer networks and was a collaboration between the NHS, two universities and two voluntary sector organizations. The paper explores professionals’ and users’ perspectives on user involvement with reference to the current sociopolitical context of user participation. British policy documents have placed increasing emphasis on issues of patient and public participation in the evaluation and development of health services, and the issue of lay participation represents an important aspect of a critical public health agenda. The project presented here shows that developing user involvement may be a complex task, with lack of consensus on key issues representing a significant barrier. Further, the data suggest that professional responses can partly be understood in relation to specific occupational standpoints and strategies that potentially allow professionals to define and limit users’ involvement. The implications of these findings and the impact of the consensus development process itself are discussed.

Revolution or evolution:the challenges of conceptualizing patient and public involvement in a consumerist world

Background Changing the relationship between citizens and the state is at the heart of current policy reforms. Across England and the developed world, from Oslo to Ontario, Newcastle to Newquay, giving the public a more direct say in shaping the organization and delivery of healthcare services is central to the current health reform agenda. Realigning public services around those they serve, based on evidence from service user's experiences, and designed with and by the people rather than simply on their behalf, is challenging the dominance of managerialism, marketization and bureaucratic expertise. Despite this attention there is limited conceptual and theoretical work to underpin policy and practice. Objective This article proposes a conceptual framework for patient and public involvement (PPI) and goes on to explore the different justifications for involvement and the implications of a rights-based rather than a regulatory approach. These issues are highlighted through exploring the particular evolution of English health policy in relation to PPI on the one hand and patient choice on the other before turning to similar patterns apparent in the United States and more broadly. Conclusions A framework for conceptualizing PPI is presented that differentiates between the different types and aims of involvement and their potential impact. Approaches to involvement are different in those countries that adopt a rights-based rather than a regulatory approach. I conclude with a discussion of the tension and interaction apparent in the globalization of both involvement and patient choice in both policy and practice. © 2009 Blackwell Publishing Ltd.

Development and psychometric evaluation of a new team effectiveness scale for all types of community adult mental health teams:a mixed-methods approach

Defining 'effectiveness' in the context of community mental health teams (CMHTs) has become increasingly difficult under the current pattern of provision required in National Health Service mental health services in England. The aim of this study was to establish the characteristics of multi-professional team working effectiveness in adult CMHTs to develop a new measure of CMHT effectiveness. The study was conducted between May and November 2010 and comprised two stages. Stage 1 used a formative evaluative approach based on the Productivity Measurement and Enhancement System to develop the scale with multiple stakeholder groups over a series of qualitative workshops held in various locations across England. Stage 2 analysed responses from a cross-sectional survey of 1500 members in 135 CMHTs from 11 Mental Health Trusts in England to determine the scale's psychometric properties. Based on an analysis of its structural validity and reliability, the resultant 20-item scale demonstrated good psychometric properties and captured one overall latent factor of CMHT effectiveness comprising seven dimensions: improved service user well-being, creative problem-solving, continuous care, inter-team working, respect between professionals, engagement with carers and therapeutic relationships with service users. The scale will be of significant value to CMHTs and healthcare commissioners both nationally and internationally for monitoring, evaluating and improving team functioning in practice.

Mental health pharmacists views on shared decision-making for antipsychotics in serious mental illness

Background People diagnosed with serious mental illnesses (SMIs) such as schizophrenia and bipolar affective disorder are frequently treated with antipsychotics. National guidance advises the use of shared decision-making (SDM) in antipsychotic prescribing. There is currently little data on the opinions of health professionals on the role of SDM. Objective To explore the views and experiences of UK mental health pharmacists regarding the use of SDM in antipsychotic prescribing in people diagnosed with SMI. Setting The study was conducted by interviewing secondary care mental health pharmacists in the UK to obtain qualitative data. Methods Semi-structured interviews were recorded. An inductive thematic analysis was conducted using the method of constant comparison. Main outcome measure Themes evolving from mental health pharmacists on SDM in relation to antipsychotic prescribing in people with SMI. Results Thirteen mental health pharmacists were interviewed. SDM was perceived to be linked to positive clinical outcomes including adherence, service user satisfaction and improved therapeutic relations. Despite more prescribers and service users supporting SDM, it was not seen as being practised as widely as it could be; this was attributed to a number of barriers, most predominantly issues surrounding service user’s lacking capacity to engage in SDM and time pressures on clinical staff. The need for greater effort to work around the issues, engage service users and adopt a more inter-professional approach was conveyed. Conclusion The mental health pharmacists support SDM for antipsychotic prescribing, believing that it improves outcomes. However, barriers are seen to limit implementation. More research is needed into overcoming the barriers and measuring the benefits of SDM, along with exploring a more inter-professional approach to SDM.

User involvement in UK cancer services:bridging the policy gap

Recent UK government initiatives aim to increase user involvement in the National Health Service (NHS) in two ways: by encouraging service users to take an active role in making decisions about their own care; and by establishing opportunities for wider public participation in service development. The purpose of this study was to examine how UK cancer service users understand and relate to the concept of user involvement. The data were collected through in-depth interviews, which were analysed for content according to the principles of grounded theory. The results highlight the role of information and communication in effective user involvement. Perhaps more importantly, this study suggests that the concept of user involvement is unclear to many cancer service users. This paper argues the need for increased awareness and understanding of what user involvement is and how it can work.

Divided care and the Third Way:user involvement in statutory and voluntary sector cancer services

In health care, as in much of the public sphere, the voluntary sector is playing an increasingly large role in the funding, provision and delivery of services and nowhere is this more apparent than in cancer care. Simultaneously the growth of privatisation, marketisation and consumerism has engendered a rise in the promotion of 'user involvement' in health care. These changes in the organisation and delivery of health care, in part inspired by the 'Third Way' and the promotion of public and citizen participation, are particularly apparent in the British National Health Service. This paper presents initial findings from a three-year study of user involvement in cancer services. Using both case study and survey data, we explore the variation in the definition, aims, usefulness and mechanisms for involving users in the evaluation and development of cancer services across three Health Authorities in South West England. The findings have important implications for understanding shifts in power, autonomy and responsibility between patients, carers, clinicians and health service managers. The absence of any common definition of user involvement or its purpose underlines the limited trust between the different actors in the system and highlights the potentially negative impact of a Third Way health service.

The digital divide and ICT learning in rural communities:examples of good practice service delivery

This article aims to gain a greater understanding of relevant and successful methods of stimulating an ICT culture and skills development in rural areas. The paper distils good practice activities, utilizing criteria derived from a review of the rural dimensions of ICT learning, from a range of relevant initiatives and programmes. These good practice activities cover: community resource centres providing opportunities for ‘tasting’ ICTs; video games and Internet Cafe´s as tools removing ‘entry barriers’; emphasis on ‘user management’ as a means of creating ownership; service delivery beyond fixed locations; use of ICT capacities in the delivery of general services; and selected use of financial support.

Does role clarity explain employee-perceived service quality? A study of antecedents and consequences in call centres

Purpose – Role clarity of frontline staff is critical to their perceptions of service quality in call centres. The purpose of this study is to examine the effects of role clarity and its antecedents and consequences on employee-perceived service quality. Design/methodology/approach – A conceptual model, based on the job characteristics model and cognitive theories, is proposed. Key antecedents of role clarity considered here are feedback, autonomy, participation, supervisory consideration, and team support; while key consequences are organizational commitment, job satisfaction and service quality. An internal marketing approach is adopted and all variables are measured from the frontline employee's perspective. A structural equation model is developed and tested on a sample of 342 call centre representatives of a major commercial bank in the UK. Findings – The research reveals that role clarity plays a critical role in explaining employee perceptions of service quality. Further, the research findings indicate that feedback, participation and team support significantly influence role clarity, which in turn influences job satisfaction and organizational commitment. Research limitations/implications – The research suggests that boundary personnel in service firms should strive for more clarity in perceived role for delivering better service quality. The limitations are in sample availability from in-house transaction call centres of a single bank. Originality/value – The contributions of this study are untangling the confusing research evidence on the effect of role clarity on service quality, using service quality as a performance variable as opposed to productivity estimates, adopting an internal marketing approach to understanding the phenomenon, and introducing teamwork along with job-design and supervisory factors as antecedent to role clarity.

INTAMAP: the design and implementation of an interoperable automated interpolation web service

INTAMAP is a Web Processing Service for the automatic spatial interpolation of measured point data. Requirements were (i) using open standards for spatial data such as developed in the context of the Open Geospatial Consortium (OGC), (ii) using a suitable environment for statistical modelling and computation, and (iii) producing an integrated, open source solution. The system couples an open-source Web Processing Service (developed by 52°North), accepting data in the form of standardised XML documents (conforming to the OGC Observations and Measurements standard) with a computing back-end realised in the R statistical environment. The probability distribution of interpolation errors is encoded with UncertML, a markup language designed to encode uncertain data. Automatic interpolation needs to be useful for a wide range of applications and the algorithms have been designed to cope with anisotropy, extreme values, and data with known error distributions. Besides a fully automatic mode, the system can be used with different levels of user control over the interpolation process.

eHabitat, a multi-purpose Web Processing Service for ecological modeling

The number of interoperable research infrastructures has increased significantly with the growing awareness of the efforts made by the Global Earth Observation System of Systems (GEOSS). One of the Societal Benefit Areas (SBA) that is benefiting most from GEOSS is biodiversity, given the costs of monitoring the environment and managing complex information, from space observations to species records including their genetic characteristics. But GEOSS goes beyond simple data sharing to encourage the publishing and combination of models, an approach which can ease the handling of complex multi-disciplinary questions. It is the purpose of this paper to illustrate these concepts by presenting eHabitat, a basic Web Processing Service (WPS) for computing the likelihood of finding ecosystems with equal properties to those specified by a user. When chained with other services providing data on climate change, eHabitat can be used for ecological forecasting and becomes a useful tool for decision-makers assessing different strategies when selecting new areas to protect. eHabitat can use virtually any kind of thematic data that can be considered as useful when defining ecosystems and their future persistence under different climatic or development scenarios. The paper will present the architecture and illustrate the concepts through case studies which forecast the impact of climate change on protected areas or on the ecological niche of an African bird.

Pragmatic development of service based real-time change data capture

This thesis makes a contribution to the Change Data Capture (CDC) field by providing an empirical evaluation on the performance of CDC architectures in the context of realtime data warehousing. CDC is a mechanism for providing data warehouse architectures with fresh data from Online Transaction Processing (OLTP) databases. There are two types of CDC architectures, pull architectures and push architectures. There is exiguous data on the performance of CDC architectures in a real-time environment. Performance data is required to determine the real-time viability of the two architectures. We propose that push CDC architectures are optimal for real-time CDC. However, push CDC architectures are seldom implemented because they are highly intrusive towards existing systems and arduous to maintain. As part of our contribution, we pragmatically develop a service based push CDC solution, which addresses the issues of intrusiveness and maintainability. Our solution uses Data Access Services (DAS) to decouple CDC logic from the applications. A requirement for the DAS is to place minimal overhead on a transaction in an OLTP environment. We synthesize DAS literature and pragmatically develop DAS that eciently execute transactions in an OLTP environment. Essentially we develop effeicient RESTful DAS, which expose Transactions As A Resource (TAAR). We evaluate the TAAR solution and three pull CDC mechanisms in a real-time environment, using the industry recognised TPC-C benchmark. The optimal CDC mechanism in a real-time environment, will capture change data with minimal latency and will have a negligible affect on the database's transactional throughput. Capture latency is the time it takes a CDC mechanism to capture a data change that has been applied to an OLTP database. A standard definition for capture latency and how to measure it does not exist in the field. We create this definition and extend the TPC-C benchmark to make the capture latency measurement. The results from our evaluation show that pull CDC is capable of real-time CDC at low levels of user concurrency. However, as the level of user concurrency scales upwards, pull CDC has a significant impact on the database's transaction rate, which affirms the theory that pull CDC architectures are not viable in a real-time architecture. TAAR CDC on the other hand is capable of real-time CDC, and places a minimal overhead on the transaction rate, although this performance is at the expense of CPU resources.

The snakes and ladders of user involvement:moving beyond Arnstein

For 35 years, Arnstein's ladder of citizen participation has been a touchstone for policy makers and practitioners promoting user involvement. This article critically assesses Arnstein's writing in relation to user involvement in health drawing on evidence from the United Kingdom, the Netherlands, Finland, Sweden and Canada. Arnstein's model, however, by solely emphasizing power, limits effective responses to the challenge of involving users in services and undermines the potential of the user involvement process. Such an emphasis on power assumes that it has a common basis for users, providers and policymakers and ignores the existence of different relevant forms of knowledge and expertise. It also fails to recognise that for some users, participation itself may be a goal. We propose a new model to replace the static image of a ladder and argue that for user involvement to improve health services it must acknowledge the value of the process and the diversity of knowledge and experience of both health professionals and lay people.

Online trendy topics detection in microblogs with selective user monitoring under cost constraints

As microblog services such as Twitter become a fast and convenient communication approach, identification of trendy topics in microblog services has great academic and business value. However detecting trendy topics is very challenging due to huge number of users and short-text posts in microblog diffusion networks. In this paper we introduce a trendy topics detection system under computation and communication resource constraints. In stark contrast to retrieving and processing the whole microblog contents, we develop an idea of selecting a small set of microblog users and processing their posts to achieve an overall acceptable trendy topic coverage, without exceeding resource budget for detection. We formulate the selection operation of these subset users as mixed-integer optimization problems, and develop heuristic algorithms to compute their approximate solutions. The proposed system is evaluated with real-time test data retrieved from Sina Weibo, the dominant microblog service provider in China. It's shown that by monitoring 500 out of 1.6 million microblog users and tracking their microposts (about 15,000 daily) with our system, nearly 65% trendy topics can be detected, while on average 5 hours earlier before they appear in Sina Weibo official trends.

Making energy service companies (ESCOS) future fit

Energy service companies (ESCOs) are faced with a range of challenges and opportunities associated with the rapidly changing and flexible requirements of energy customers (end users) and rapid improvements in technologies associated with energy and ICT. These opportunities for innovation include better prediction of energy demand, transparency of data to the end user, flexible and time dependent energy pricing and a range of novel finance models. The liberalisation of energy markets across the world has leads to a very small price differential between suppliers on the unit cost of energy. Energy companies are therefore looking to add additional layers of value using service models borrowed from the manufacturing industry. This opens a range of new product and service offerings to energy markets and consumers and has implications for the overall efficiency, utility and price of energy provision.