WASOP, a qualitative methodology for waste minimization: systems thinking, HAZOP principles and nuclear waste

Purpose – The international nuclear community continues to face the challenge of managing both the legacy waste and the new wastes that emerge from ongoing energy production. The UK is in the early stages of proposing a new convention for its nuclear industry, that is: waste minimisation through closely managing the radioactive source which creates the waste. This paper proposes a new technique (called waste and source material operability study (WASOP)) to qualitatively analyse a complex, waste-producing system to minimise avoidable waste and thus increase the protection to the public and the environment. Design/methodology/approach – WASOP critically considers the systemic impact of up and downstream facilities on the minimisation of nuclear waste in a facility. Based on the principles of HAZOP, the technique structures managers' thinking on the impact of mal-operations in interlinking facilities in order to identify preventative actions to reduce the impact on waste production of those mal-operations.' Findings – WASOP was tested with a small group of experienced nuclear regulators and was found to support their qualitative examination of waste minimisation and help them to work towards developing a plan of action. Originality/value – Given the newness of this convention, the wider methodology in which WASOP sits is still in development. However, this paper communicates the latest thinking from nuclear regulators on decision-making methodology for supporting waste minimisation and is hoped to form part of future regulatory guidance. WASOP is believed to have widespread potential application to the minimisation of many other forms of waste, including that from other energy sectors and household/general waste.

Help-seeking for medically unexplained hearing difficulties:a qualitative study

Aims - Up to 10% of audiology patients report diffi culties hearing speech in noise even though clinical investigation reveals normal hearing thresholds, in other words, no evidence of physical pathology. The diagnostic category applied to these patients is known as King-Kopetzky Syndrome (KKS). This study aimed to gather descriptions of patients' experiences of the clinical encounter involving their KKS diagnosis and analyse the themes of help-seeking, as part of a larger study into the process of coping with medically unexplained hearing diffi culties. Method - A qualitative approach was employed, comprising unstructured interviews in the homes of 25 patients who had attended audiology services (and received a diagnosis of KKS) in Bath and Cardiff. Thematic analysis of transcripts was undertaken, infl uenced by grounded theory techniques. Findings - Informants characterized the clinical encounter as either negative or positive. Negative consultations were those in which patients' illness claims were dismissed and as such not validated. Positive encounters were typifi ed by the provision of meaningful information that reconciled clinical information with the patients' experiences of hearing loss. Conclusion - Successful management of medically unexplained illnesses requires the adoption of a patient-centred approach, rather than focusing on the absence of observable pathology

GPs' perspectives on managing the NHS Health Check in primary care:a qualitative evaluation of implementation in one area of England

OBJECTIVES: To evaluate the implementation of the National Health Service (NHS) Health Check programme in one area of England from the perspective of general practitioners (GPs). DESIGN: A qualitative exploratory study was conducted with GPs and other healthcare professionals involved in delivering the NHS Health Check and with patients. This paper reports the experience of GPs and focuses on the management of the Heath Check programme in primary care. SETTING: Primary care surgeries in the Heart of Birmingham region (now under the auspices of the Birmingham Cross City Clinical Commissioning Group) were invited to take part in the larger scale evaluation. This study focuses on a subset of those surgeries whose GPs were willing to participate. PARTICIPANTS: 9 GPs from different practices volunteered. GPs served an ethnically diverse region with areas of socioeconomic deprivation. Ethnicities of participant GPs included South Asian, South Asian British, white, black British and Chinese. METHODS: Individual semistructured interviews were conducted with GPs face to face or via telephone. Thematic analysis was used to analyse verbatim transcripts. RESULTS: Themes were generated which represent GPs' experiences of managing the NHS Health Check: primary care as a commercial enterprise; 'buy in' to concordance in preventive healthcare; following protocol and support provision. These themes represent the key issues raised by GPs. They reveal variability in the implementation of NHS Health Checks. GPs also need support in allocating resources to the Health Check including training on how to conduct checks in a concordant (or collaborative) way. CONCLUSIONS: The variability observed in this small-scale evaluation corroborates existing findings suggesting a need for more standardisation. Further large-scale research is needed to determine how that could be achieved. Work needs to be done to further develop a concordant approach to lifestyle advice which involves tailored individual goal setting rather than a paternalistic advice-giving model.