A conceptual framework of patient satisfaction with a pharmacy adherence service

Background Patients do not adhere to their medicines for a host of reasons which can include their underlying beliefs as well as the quality of their interactions with healthcare professionals. One way of measuring the outcome of pharmacy adherence services is to assess patient satisfaction but no questionnaire exists that truly captures patients' experiences with these relatively new services. Objective Our objective was to develop a conceptual framework specific to patient satisfaction with a community pharmacy adherence service based on criteria used by patients themselves. Setting The study was based in community pharmacies in one large geographical area of the UK (Surrey). All the work was conducted between October 2008 and September 2010. Methods This study involved qualitative non-participant observation and semi-structured interviewing. We observed the recruitment of patients to the Medicines Use Review (MUR) service and also actual MUR consultations (7). We also interviewed patients (15). Data collection continued until no new themes were identified during analysis. We analysed interviews to firstly create a comprehensive account of themes which had significance within the transcripts, then created sub-themes within super-ordinate categories. We used a structure-process-outcome approach to develop a conceptual framework relating to patient satisfaction with the MUR. Favourable ethical opinion for this study was received from the NHS Surrey Research Ethics Committee on 2nd June 2008. Results Five super-ordinate themes linked to patient satisfaction with the MUR service were identified, including relationships with healthcare providers; attitudes towards healthcare providers; patients' experience of health, healthcare and medicines; patients' views of the MUR service; the logistics of the MUR service. In the conceptual framework, structure was conceptualised as existing relationships, environment, and time; process was conceptualised as related to recruitment and consultation stages; and outcome as two concepts of immediate patient outcomes and satisfaction on reflection. Conclusion We identified and highlighted factors that can influence patient satisfaction with the MUR service and this led to the development of a conceptual framework of patient satisfaction with the MUR service. This can form the basis for developing a questionnaire for measuring patient satisfaction with this and similar pharmacy adherence services. Impact of findings on practice * Pharmacists and researchers can access the relevant ideas presented here in relation to patient satisfaction with pharmacy adherence services. * Researcher can use the conceptual framework as a basis for measuring the quality of pharmacy adherence services. * Community pharmacists can improve the quality of healthcare they provide by realizing concepts relevant to patient satisfaction with adherence services.

In whose interests? The best interests principle under ethical scrutiny

This paper critically examines the best interests principle and its role in making decisions about intensive care treatment. In current practice the best interests principle is sometimes relied upon to guide decision making in circumstances when the patient is incompetent, although it is intrinsically linked to inconsistent assumptions about what is meant by quality of life. This situation means that there is potential that moral errors will be made that may result in an unwanted extension of life for some individuals or the premature death of others.

It is difficult to justify such decision making on ethical grounds. A greater understanding of the best interests principle, and consequently the concept of quality of life, is needed in order to ensure that decision making about intensive care is ethically defensible. It is argued that an ideal theory of quality of life provides an appropriate framework for best interests decisions, and that the decision making process ought to, whenever possible, involve the patient's close family.

Ethical behaviour: the means for creating and maintaining better reputations in arts organisations

Arts organisations, unsure of the level of continued government funding available and confronted with the need ever to improve, are seeking new ideas upon which they can focus. At a time when leadership and governance in arts organisations have changed in line with cultural expectations, how is their ethical stance assessed? How does their ethical stance impact on reputation? The challenge to build a good reputation starts at the top of the organisation; however, traditionally, one type of arts organisation, art museums, has focused on the activities level. In an age of globalisation, economic restructuring and technological change, museums therefore may be seen as a contradiction. Traditionally seen as temples for the muses, today’s museums are being challenged to be ethical for society and to build their reputation. As a solution, proposes a cooperative model of cultural organisational ethics that attempts to provide a framework by which arts organisations can put in place ethical artefacts that enhance organisational reputation, rather than detract from it.

Ethical behaviour: the foundation stone for entrepreneurial activity in arts organisations

Entrepreneurship is being touted as the way forward for arts organisations unsure of the level of continued government funding available and confronted with the need to ever improve. At a time when leadership and governance in cultural organisations have changed in line with cultural expectations, how is their ethical stance assessed? In an age of globalisation, economic restructuring and technological change, museums are sometimes seen to be something of a contradiction. Traditionally seen as temples for the muses, today's museums are being challenged to be ethical for society. As a solution, this paper proposes a Cooperative Model of Cultural Organisational Ethics that attempts to provide a framework by which arts organisations can put in place ethical artefacts that enhance organisational performance, rather than detract from it.

International standards of business conduct: framework and illustration

Purpose: – The purpose of this paper is to describe the insights and a proposal into the structure of standards of business conduct and its intended applications.

Design/methodology/approach: – The case study is based upon an inductive content analysis of corporate ethics artefacts.

Findings: – It is concluded that the standards of business conduct may be highly prescriptive in world wide corporations, but that there should be an explicit commitment to a flexible and dynamic approach to the application of standards of business conduct.

Research limitations/implications: – An examination of the actual behaviour of a corporation's operations was beyond the scope of the present research, but such a study has potential for future research. This would open up the wider question of how corporations can minimise the gap between corporate intentions and actual outcomes in business operations across national and cultural boundaries.

Practical implications: – These diverse national and cultural contexts that world wide corporations encounter must be taken into consideration in the content of their standards of business conduct.

Originality/value: – The authors emphasise the concern of recognising that the contexts surrounding standards of business conduct are dynamic. Corporate codes of ethics should be regarded as dynamic artefacts. A framework of application is proposed.

Risk management and ethical environment : effects on internal audit and accounting control procedures

This study examines the impact of the scope of risk management and ethical environment on internal audit activities and the quality of accounting control procedures (ACPQ). The conceptual framework for the study is guided by COSO’s frameworks on internal controls and enterprise risk management and data from a questionnaire survey of 64 Australian firms are analysed using a structural equation model. The results of the study support that (1) internal audit activities have a significant intervening effect on the relationship between the scope of risk management and ACPQ, and (2) a direct and positive relationship exists between ethical environment and ACPQ. Our findings suggest that widening the scope of risk management activities do not directly improve ACPQ, but that it leads to more extensive internal audit activities and in turn such activities promote better ACPQ. Further, the results indicate that fostering a more ethical environment directly leads to higher ACPQ. These results have implications for the design of internal controls, namely with respect to the role of internal audit activities and ethical environment in enhancing ACPQ.

Is groin injecting an ethical boundary for harm reduction?

Background
Femoral vein (or groin) injecting by street drug users is an emerging public health issue in the UK. It has been proposed that groin injecting is becoming normalised among UK injecting drug users (IDUs), yet harm reduction strategies are currently piecemeal and some may be crossing the boundary of responsible provision of information. This paper discusses the interventions available to service providers dealing with groin injecting and explores the utility of ethical frameworks for informing service provider decisions.

Methods
Methods analysis of possible service provider responses using White and Popovits’ ethical decision-making framework.

Results
The use of ethical frameworks suggest that different types of groin injectors should receive different interventions. Injectors for whom the groin is a site of ‘last resort’ should be given information about how to inject there less dangerously, whereas ‘convenience’ groin injectors should be actively encouraged to inject elsewhere.

Conclusion
Groin injecting is a behaviour which represents a boundary for some harm reduction practices (such as providing ‘how to’ booklets to all injectors) as well as being an argument for more complex and environmentally appropriate harm reduction responses such as drug consumption rooms and training IDUs to maintain healthier injecting sites.

Fear and loathing in public policy : ethical issues in laws for sex offenders

Laws intended to increase protection from sex offenders are often prompted by sensational crimes that provoke public outrage. As public policy, questions have been raised about the legality and effectiveness of these legislative initiatives as enacted in North America, Australasia and the UK since the early 1990s. Mental health professionals involved in the implementation of these laws are faced with ethical concerns that distinguish this area of forensic practice from other clinical roles. This article presents a brief description of the impetus for specific laws allowing for involuntary civil commitment, extended supervision and community notification of sex offenders in different jurisdictions. A model of human rights is then used to consider the ways in which these laws threaten the rights of offenders, and provides a framework for identifying ethical concerns inherent in professional practice in this area.

A holistic model of corporate governance - a new research framework

Purpose – The purpose of this paper is to propose a new model of corporate governance that is holistic – incorporating internal and macro perspectives across legal, regulatory, sociological, ethical, human resource management, behavioural and corporate strategic frameworks. Researchers have signalled the need for “new theoretical perspectives and new models of governance” due to a dearth of research that is context-driven, empirical, and encapsulating the full spectrum of reasons and actions contributing to corporate crises.

Design/methodology/approach – The approach consists of theory building by reviewing the literature and examining the gaps and limitations.

Findings – The proposed model is a distinctive contribution to theory and practice in three ways. First, it integrates the firm-specific, micro factors with the country-specific, macro factors to illustrate the holistic nature of corporate governance. Second, shareholders and stakeholders are shown to be only one component of the model. Third, it veers away from singular approaches, to dealing with corporate governance using a multi-disciplinary perspective. The paper argues that such a holistic and integrated view is a necessity for understanding governance systems.

Research limitations/implications – The challenge is to operationalize the model and test it empirically.

Practical implications – The model is instructive and of use for practitioners in attempting to understand, explain and develop governance models that are appropriate to their national and industry settings.

Originality/value – This paper argues that narrow-based models are limited in their approach and in a sound and integrative review of the up-to-date literature contributes to theory-building on corporate governance.

Beyond codes of ethics : an integrated framework for stimulating morally responsible behaviour in organisations

This paper contributes to the study of ethics programmes by the building of a theoretical model for implementing an ethics programme and examining the application of this model to an actual implementation case study. Ethics programmes aim at stimulating ethical behaviour in the organisation and assisting employees to act in a morally responsible way. It is proposed that for an organisational ethics programme to be effective, five dominant conditions are necessary: awareness of formal organisational goals and corresponding informal norms; suitable procedures for decision making; correct distribution of resources; presence of necessary skills; and personal intentions for ethical behaviour. Following detailed discussion of each condition, and with reference to an actual case example, the conditions will be further developed and supplemented with suggested organisational activities that could be used to support these conditions.

A human rights-based practice framework for sexual offenders

Human rights create a protective zone around people and allow them the opportunity to further their own valued personal projects without interference from others. In our view, the emphasis on community rights and protection may, paradoxically, reduce the effectiveness of sex offender rehabilitation by ignoring or failing to ensure that offenders' core human interests are met. In this paper we consider how rights-based values and ideas can be integrated into therapeutic work with sex offenders in a way that safeguards the interests of offenders and the community. To this end we develop a rights-based normative framework (the Offender Practice Framework: OPF) that is orientated around the three strands of justice and accountability, offender needs and risk, and the utilization of empirically supported interventions and strength-based approaches. We examine the utility of this framework for the different phases of sex offender practice.

Moral repair with offenders : ethical issues arising From victimization experiences

In this article, the authors examine the relevance of the concept of moral repair for sex offenders who have been victims of sexual or physical abuse. First, they briefly review the literature on victimization rates and effects in sexual offenders. Second, the notion of moral repair and its constituent tasks is examined with particular emphasis given to Margaret Walker's recent analysis of the concept. Third, the concept of moral repair is applied to offenders and its implications and possible constraints discussed. Fourth, the authors outline a normative framework for addressing victimization issues with sexual offenders, drawing on the resources of human rights theory and strength-based treatment approaches. Finally, they conclude with a brief consideration of the ethical and clinical implications of their normative model.

A conceptual framework of corporate and business ethics across organizations

Purpose – The objective of this paper is to introduce and describe a conceptual framework of corporate and business ethics across organizations in terms of ethical structures, ethical processes and ethical performance.

Design/methodology/approach – A framework is outlined and positioned incorporating an ethical frame of reference in the field of organizational chain management.

Findings – A number of areas and sub-areas of corporate and business ethics are framed in the context across organizations.

Research limitations/implications – The introduced framework should be seen as a seed for further development and refinement. It provides opportunities for further research of ethical concerns across organizations.

Practical implications – Organizations may benefit from the findings and insights presented and they may be used to enhance their ability to manage, monitor and evaluate ethical business practices across organizations.

Social implications – Changing societal and market patterns may enforce organizations to address ethical concerns across organizations. A myopic approach restricted to the judicial system may become insufficient and unsatisfactory from the perspective of other stakeholders of the organization.

Originality/value – The framework makes a contribution bringing in ethical concerns across organizations, providing a basis for their ethical values and culture, as well as asymmetric relationships in terms of power and dependence. The authors believe that a true learning organization needs to realise the importance of an extended view of its endeavors of corporate and business ethics in terms of ethical structures, ethical processes and ethical performance across organizations.

Developing an ethics education framework for accounting

The purpose of this paper is to propose a framework of ethics education that promotes the structured learning of ethics in the accounting discipline. The Ethics Education Framework (EEF) is based on three key inter-related components that include: Rest’s (1986) Four-Component Model of ethical decision-making and behaviour; the key cognitive and behavioural objectives of ethics education; and the discrete and pervasive approaches to delivering content. The EEF provides university students and professional accountants a structure to learn to identify, analyse and resolve ethical issues, to the point of action. The EEF is a four-stage learning continuum represented as a set of building blocks which introduces ethical concepts and then reinforces and develops new levels of understanding with progressive stages. This paper describes the EEF, and includes a discussion of how it compares with other ethics education models, and an analysis of the support through responses by professional organisations (based on an Exposure Draft issued by the International Federation of Accountants (IFAC), as the initial International Education Practice Statement). The IFAC has now revised its International Education Standard (IES 4) in relation to ethics, with a commentary period till July 2011.

Cloud computing services : theoretical foundations of ethical and entrepreneurial adoption behaviour

Clouicomputing is an emerging service technology that has ethical and entrepreneurial implications. Due to technological innovations increasing the attention placed on cloud computing services, more people are focusing on the security and privacy issues determined by ethical guidelines and how the technology is evolving as an entrepreneurial service innov.ation. This paper presents a theoretical perspective on how a person adopts cloud computing. The literature on technology innovation and adoption behaviour is examined with a focus on social cognitive theory. A theoretical framework is then presented, which indicates a number of propositions to describe the intention of a person to adopt cloud computing services. The role of technology marketing capability, sustained learning and outcome expectancy are included in helping to understand the role of cloud computing applications. Suggestions for future research and practical implications are stated.