Disentangling patient and public involvement in healthcare decisions:why the difference matters

Patient and public involvement has become an integral aspect of many developed health systems and is judged to be an essential driver for reform. However, little attention has been paid to the distinctions between patients and the public, and the views of patients are often seen to encompass those of the general public. Using an ideal-type approach, we analyse crucial distinctions between patient involvement and public involvement using examples from Sweden and England. We highlight that patients have sectional interests as health service users in contrast to citizens who engage as a public policy agent reflecting societal interests. Patients draw on experiential knowledge and focus on output legitimacy and performance accountability, aim at typical representativeness, and a direct responsiveness to individual needs and preferences. In contrast, the public contributes with collective perspectives generated from diversity, centres on input legitimacy achieved through statistical representativeness, democratic accountability and indirect responsiveness to general citizen preferences. Thus, using patients as proxies for the public fails to achieve intended goals and benefits of involvement. We conclude that understanding and measuring the impact of patient and public involvement can only develop with the application of a clearer comprehension of the differences.

'Taking a sickie':Job satisfaction and job involvement as interactive predictors of absenteeism in a public organization

Correlations between absenteeism and work attitudes such as job satisfaction have often been found to be disappointingly weak. As prior work reveals, this might be due to ignoring interactive effects of attitudes with different attitude targets (e.g. job involvement and organizational commitment). Drawing on basic principles in personality research and insights about the situational variability of job satisfaction judgments, we proposed that similar interactions should be present also for attitudes with the same target. More specifically, it was predicted that job involvement affects absenteeism more if job satisfaction is low as this indicates a situation with weak constraints. Both attitudes were assessed in a sample of 436 employees working in a large civil service organization, and two indexes of absence data (frequency and time lost) were drawn from personnel records covering a 12-month period following the survey. Whereas simple correlations were not significant, a moderated regression documented that the hypothesized interaction was significant for both indicators of absence behaviour. As a range of controls (e.g. age, gender, job level) were accounted for, these findings lend strong support to the importance of this new, specific form of attitude interaction. Thus, we encourage researchers not only to consider interactions of attitudes with a different focus (e.g. job vs. organization) but also interactions between job involvement and job satisfaction as this will yield new insights into the complex function of attitudes in influencing absenteeism. © 2007 The British Psychological Society.

Attitudes towards advanced manufacturing technology (AMT):the role of AMT experience, skill level and job involvement

Studied the attitudes of shopfloor employees toward AMT as a function of experience with working with AMT, skill level, and job involvement. Survey data were collected from 115 employees of a large microelectronics company in England. Four job types were identified, which differed in terms of mode of work (manual/AMT) and skill level (low/high). Results show that those who worked with computers had more favorable attitudes toward AMT than those who did not. Results support A. Rafaeli's (see record 1986-20891-001) finding that the most favorable attitudes toward AMT were held by those who worked with computers and had high job involvement. Skill level had no significant effects on Ss' attitudes.

Undermining patient and public engagement and limiting its impact:the consequences of the Health and Social Care Act 2012 on collective patient and public involvement

Patient and public involvement has been at the heart of UK health policy for more than two decades. This commitment to putting patients at the heart of the British National Health Service (NHS) has become a central principle helping to ensure equity, patient safety and effectiveness in the health system. The recent Health and Social Care Act 2012 is the most significant reform of the NHS since its foundation in 1948. More radically, this legislation undermines the principle of patient and public involvement, public accountability and returns the power for prioritisation of health services to an unaccountable medical elite. This legislation marks a sea-change in the approach to patient and public involvement in the UK and signals a shift in the commitment of the UK government to patient-centred care. © 2013 John Wiley & Sons Ltd.

Bridging divides:patient and public involvement on both sides of the Atlantic

Guest editorial

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.

Health inequalities and user involvement?

This chapter examines the theory and practice of user involvement and evaluates its impact on health inequalities in Great Britain. It describes different types of user involvement and highlights the problems in trying to define ‘hard to reach’ groups and the importance of user involvement for such groups. It concludes that user involvement is everyone's business that requires radical shifts in both theory and practice to succeed. It also suggests that creating and promoting greater exchange between those who provide and manage health services and communities and individuals who seek and receive services will create better tailoring of services to demand.

The development and diffusion of industrial robots

This thesis describes the history of robots and explains the reasons for the international differences in robot diffusion, and the differences in the diffusion of various robot applications with reference to the UK. As opposed to most of the literature, diffusion is examined with an integrated and interdisciplinary perspective. Robot technology evolves from the interaction of development, supply and manufacture, adoption, and promotion. activities. Emphasis is given to the analysis of adoption, at present the most important limiting factor of robot advancement in the UK. Technical development is inferred from a comparison of surveys on equipment, and from the topics of ten years of symposia papers. This classification of papers is also used to highlight the international and institutional differences in robot development. Analysis of the growth in robot supply, manufacture, and use is made from statistics compiled. A series of interviews with users and potential users serves to illustrate the factors and implications of the adoption of different robot systems in the UK. Adoption pioneering takes place when several conditions exist: when the technology is compatible with the firm, when its advantages outweigh its disadvantages, and particularly when a climate exists which encourages the managerial involvement and the labour acceptance. The degree of compatibility (technical, methodological, organisational, and economic) and the consequences (profitability, labour impacts, and managerial effects) of different robot systems (transfer, manipulative, processing, and assembly) are determined by various aspects of manufacturing operations (complexity, automation, integration, labour tasks, and working conditions). The climate for adoption pioneering is basically determined by the performance of firms. The firms' policies on capital investment have as decisive a role in determining the profitability of robots as their total labour costs. The performance of the motor car industry and its machine builders explains, more than any other factor, the present state of robot advancement in the UK.

Event related potential (ERP) evidence for selective impairment of verbal recollection in abstinent recreational methylenedioxymethamphetamine (“Ecstasy”)/polydrug users

Objectives Ecstasy is a recreational drug whose active ingredient, 3,4-methylenedioxymethamphetamine (MDMA), acts predominantly on the serotonergic system. Although MDMA is known to be neurotoxic in animals, the long-term effects of recreational Ecstasy use in humans remain controversial but one commonly reported consequence is mild cognitive impairment particularly affecting verbal episodic memory. Although event-related potentials (ERPs) have made significant contributions to our understanding of human memory processes, until now they have not been applied to study the long-term effects of Ecstasy. The aim of this study was to examine the effects of past Ecstasy use on recognition memory for both verbal and non-verbal stimuli using ERPs. Methods We compared the ERPs of 15 Ecstasy/polydrug users with those of 14 cannabis users and 13 non-illicit drug users as controls. Results Despite equivalent memory performance, Ecstasy/polydrug users showed an attenuated late positivity over left parietal scalp sites, a component associated with the specific memory process of recollection. Conlusions This effect was only found in the word recognition task which is consistent with evidence that left hemisphere cognitive functions are disproportionately affected by Ecstasy, probably because the serotonergic system is laterally asymmetrical. Experimentally, decreasing central serotonergic activity through acute tryptophan depletion also selectively impairs recollection, and this too suggests the importance of the serotonergic system. Overall, our results suggest that Ecstasy users, who also use a wide range of other drugs, show a durable abnormality in a specific ERP component thought to be associated with recollection.

Introduction: improving manufacturing performance through technology diffusion, implementation and management

The role of technology management in achieving improved manufacturing performance has been receiving increased attention as enterprises are becoming more exposed to competition from around the world. In the modern market for manufactured goods the demand is now for more product variety, better quality, shorter delivery and greater flexibility, while the financial and environmental cost of resources has become an urgent concern to manufacturing managers. This issue of the International Journal of Technology Management addresses the question of how the diffusion, implementation and management of technology can improve the performance of manufacturing industries. The authors come from a large number of different countries and their contributions cover a wide range of topics within this general theme. Some papers are conceptual, others report on research carried out in a range of different industries including steel production, iron founding, electronics, robotics, machinery, precision engineering, metal working and motor manufacture. In some cases they describe situations in specific countries. Several are based on presentations made at the UK Operations Management Association's Sixth International Conference held at Aston University at which the conference theme was 'Achieving Competitive Edge: Getting Ahead Through Technology and People'. The first two papers deal with questions of advanced manufacturing technology implementation and management. Firstly Beatty describes a three year longitudinal field study carried out in ten Canadian manufacturing companies using CADICAM and CIM systems. Her findings relate to speed of implementation, choice of system type, the role of individuals in implementation, organization and job design. This is followed by a paper by Bessant in which he argues that a more a strategic approach should be taken towards the management of technology in the 1990s and beyond. Also considered in this paper are the capabilities necessary in order to deploy advanced manufacturing technology as a strategic resource and the way such capabilities might be developed within the firm. These two papers, which deal largely with the implementation of hardware, are supplemented by Samson and Sohal's contribution in which they argue that a much wider perspective should be adopted based on a new approach to manufacturing strategy formulation. Technology transfer is the topic of the following two papers. Pohlen again takes the case of advanced manufacturing technology and reports on his research which considers the factors contributing to successful realisation of AMT transfer. The paper by Lee then provides a more detailed account of technology transfer in the foundry industry. Using a case study based on a firm which has implemented a number of transferred innovations a model is illustrated in which the 'performance gap' can be identified and closed. The diffusion of technology is addressed in the next two papers. In the first of these, by Lowe and Sim, the managerial technologies of 'Just in Time' and 'Manufacturing Resource Planning' (or MRP 11) are examined. A study is described from which a number of factors are found to influence the adoption process including, rate of diffusion and size. Dahlin then considers the case of a specific item of hardware technology, the industrial robot. Her paper reviews the history of robot diffusion since the early 1960s and then tries to predict how the industry will develop in the future. The following two papers deal with the future of manufacturing in a more general sense. The future implementation of advanced manufacturing technology is the subject explored by de Haan and Peters who describe the results of their Dutch Delphi forecasting study conducted among a panel of experts including scientists, consultants, users and suppliers of AMT. Busby and Fan then consider a type of organisational model, 'the extended manufacturing enterprise', which would represent a distinct alternative pure market-led and command structures by exploiting the shared knowledge of suppliers and customers. The three country-based papers consider some strategic issues relating manufacturing technology. In a paper based on investigations conducted in China He, Liff and Steward report their findings from strategy analyses carried out in the steel and watch industries with a view to assessing technology needs and organizational change requirements. This is followed by Tang and Nam's paper which examines the case of machinery industry in Korea and its emerging importance as a key sector in the Korean economy. In his paper which focuses on Venezuela, Ernst then considers the particular problem of how this country can address the problem of falling oil revenues. He sees manufacturing as being an important contributor to Venezuela's future economy and proposes a means whereby government and private enterprise can co-operate in development of the manufacturing sector. The last six papers all deal with specific topics relating to the management manufacturing. Firstly Youssef looks at the question of manufacturing flexibility, introducing and testing a conceptual model that relates computer based technologies flexibility. Dangerfield's paper which follows is based on research conducted in the steel industry. He considers the question of scale and proposes a modelling approach determining the plant configuration necessary to meet market demand. Engstrom presents the results of a detailed investigation into the need for reorganising material flow where group assembly of products has been adopted. Sherwood, Guerrier and Dale then report the findings of a study into the effectiveness of Quality Circle implementation. Stillwagon and Burns, consider how manufacturing competitiveness can be improved individual firms by describing how the application of 'human performance engineering' can be used to motivate individual performance as well as to integrate organizational goals. Finally Sohal, Lewis and Samson describe, using a case study example, how just-in-time control can be applied within the context of computer numerically controlled flexible machining lines. The papers in this issue of the International Journal of Technology Management cover a wide range of topics relating to the general question of improving manufacturing performance through the dissemination, implementation and management of technology. Although they differ markedly in content and approach, they have the collective aim addressing the concepts, principles and practices which provide a better understanding the technology of manufacturing and assist in achieving and maintaining a competitive edge.

The use of anticholinergic agents to treat excessive oropharyngeal and tracheal secretions in palliative care

Palliative care involves a multi-professional team approach to the provision of active, holistic care for patients and their families when the patient's disease is no longer responsive to curative treatment. Patient care encompasses medical and pharmacological intervention for symptom control, together with psychological, spiritual and social support for patients and families. Care is provided by teams in hospice, hospital or community environments. Although traditionally associated with providing care for cancer patients, palliative care services are increasingly providing for patients with non-malignant disease. Symptoms commonly associated with terminal phase of disease include pain, nausea, agitation, respiratory symptoms and general fatigue. During the last few days of life, patients may become weak, resulting in difficulty taking oral medication and have periods of unconsciousness. Some patients may require drug administration via subcutaneous infusion. A proportion of patients may develop difficulty clearing respiratory secretions causing a characteristic ‘death rattle’, which although not generally considered to be distressing for the patient, is often treated with a variety of anticholinergic drugs in an attempt to reduce the ‘noisy breathing’ for the benefit of relatives and others who may be closely associated with the patient.This study examined treatment of death rattle in two Hospices focusing on objective and subjective outcome measures in order to determine the efficacy of anticholinergic regimens in current use. Qualitative methods were employed to elicit attitudes of professionals and carers working closely with the patient. The number of patients recruited and monitored were small, many confounding factors were identified which questioned firstly the clinical rationale for administering anticholinergic drugs routinely to treat death rattle and secondly, the ethics of administering drug regimens to patients to treat death rattle with the primary aim of relieving distress for others. Ethnical issues, including those of consent are discussed in relation to their impact on the methodology of end of life studies in medicines management in palliative care.

Professionalisation and ophthalmic optics

This thesis is a sociological study of the ophthalmic optical profession in Britain. It includes a survey of the development of ophthalmic optics as an occupation and three questionnaire, surveys, one each of first and final year ophthalmic optics students, and one of practising opticians. The developmental survey showed that four themes have been important in the occupation's process of professionalisation - the actions of the opticians' leaders, the gradual unification of the bodies, representing segments of the profession, the struggle with medicine and the involvement of ophthalmic opticians in state-organised optical welfare schemes. The student surveys showed that the profession is now recruiting largely from middle class, state educated groups, and increasingly from women, who hold significantly different attitudes to income, independence and career commitment. In general, both first and final year students considered service to be rather more important than furthering knowledge. Practising opticians have been recruited increasingly, from middle class backgrounds, mostly from state selective secondary schools, but with a large minority from non-state schools. The self-recruitment rate of the profession (18.9%) is very similar to that for British medical students. Significant differences in concepts of professionalism were found among ophthalmic opticians of different ages, sexes and types of practice but few among those in different areas of practice. In general, ophthalmic opticians seemed to stress service more·than furthering knowledge. It is suggested that the leaders of the profession have 'negotiated' considerable autonomy for its members and that the possibilities for commercialism within the ophthalmic optician's professional role are intrinsically no greater than those in more 'established' professions.

A critical evaluation of contrast susceptibility as a predictor of driving accident involvement

Contrast susceptibility is defined as the difference in visual acuity recorded for high and low contrast optotypes. Other researchers refer to this parameter as "normalised low contrast acuity". Pilot surveys have revealed that contrast susceptibility deficits are more strongly related to driving accident involvement than are deficits in high contrast visual acuity. It has been hypothesised that driving situation avoidance is purely based upon high contrast visual acuity. Hence, the relationship between high contrast visual acuity and accidents is masked by situation avoidance whilst drivers with contrast susceptibility deficits remain prone to accidents in poor visibility conditions. A national survey carried out to test this hypothesis provided no support for either the link between contrast susceptibility deficits and accidents involvement or the proposed hypothesis. Further, systematically worse contrast susceptibility scores emerged from vision screeners compared to wall mounted test charts. This discrepancy was not due to variations in test luminance or instrument myopia. Instead, optical imperfections inherent in vision screeners were considered to be responsible. Although contrast susceptibility is unlikely to provide a useful means of screening drivers' vision, previous research does provide support for its ability to detect visual deficits that may influence everyday tasks. In this respect, individual contrast susceptibility variations were found to reflect variations in the contrast sensitivity function - a parameter that provides a global estimate of human contrast sensitivity.