Search

Think tanks seek to shape the business of government by offering policy expertise in a number of areas, including health care. This expertise tends to be presented as ‘the view from nowhere’ – independent, value-neutral expertise that can inform policy. We challenge this view by examining what ‘independence’ means and how it is performed. We present an interpretive policy analysis of data collected from four UK-based think tanks that have sought to influence health policy. Our analysis demonstrates how a sample of healthcare think tanks publicly positioned themselves as ‘independent’ organizations. They drew on technocratic health planning discourse to emphasize a range of knowledge-related activities, artifacts and instrumental language that, informants suggested, allowed them to feed emerging evidence into policy and improve health services. Such positioning seemed to provide them with legitimacy in the eyes of decision makers. A parallel set of think tank activities (e.g., meetings with parliamentarians) took place ‘back-stage’ and focused on influencing health policy and, in the context of recent proposals to reform the English National Health Service, lending broad though not unqualified support to government proposals to extend market principles in health care. Informants appeared to seek to neutralize their presentation of such ‘back-stage’ influencing through a range of discursive strategies. [ABSTRACT FROM AUTHOR]

Objective: To explore general practitioners' (GP) perspectives on the meaning of 'timeliness' in dementia diagnosis. Design: Narrative interview study. Setting: UK academic department of primary care. Participants: Seven practising GPs with experience of conveying a diagnosis of dementia. Methods: GPs' narrative commentaries of encounters with patients with suspected dementia were audio-recorded and transcribed resulting in 51 pages of text (26 757words). A detailed narrative analysis of doctors' accounts was conducted. Results: Diagnosis of dementia is a complex medical and social practice. Clinicians attend to multiple competing priorities while providing individually tailored patient care, against a background of shifting political and institutional concerns. Interviewees drew on a range of explanations about the nature of generalism to legitimise their claims about whether and how they made a diagnosis, constructing their accounts of what constituted 'timeliness'. Three interlinked analytical themes were identified: (1) diagnosis as a collective, cumulative, contingent process; (2) taking care to ensure that diagnosis--if reached at all--is opportune; (3) diagnosis of dementia as constitutive or consequential, but also a diagnosis whose consequences are unpredictable. Conclusions: Timeliness in the diagnosis of dementia involves balancing a range of judgements and is not experienced in terms of simple chronological notions of time. Reluctance or failure to make a diagnosis on a particular occasion does not necessarily point to GPs' lack of awareness of current policies, or to a set of training needs, but commonly reflects this range of nuanced balancing judgements, often negotiated with patients and their families with detailed attention to a particular context. In the case of dementia, the taken-for-granted benefits of early diagnosis cannot be assumed, but need to be 'worked through' on an individual case-by-case basis. GPs tend to value 'rightness' of time over concerns about 'early' diagnosis. [ABSTRACT FROM AUTHOR]

The article discusses a study on the presence of Black capped Chickadee (Poecile carolinensis) in a geographic location suspected to contain only Carolina Chickadee. The researchers took standard measurements of wing chord and tail length of 358 chickadees in southwestern Ohio and compared the collected data to the published criteria of tail length and tail/wing ratio. Morphometric measurements were found to be insufficient to accurately identify chickadees.

Background: Health informatics research has traditionally been dominated by experimental and quasi-experimental designs. An emerging area of study in organisational sociology is routinisation (how collaborative work practices become business-as-usual). There is growing interest in the use of ethnography and other in-depth qualitative approaches to explore how collaborative work routines are enacted and develop over time, and how electronic patient records (EPRs) are used to support collaborative work practices within organisations. Methods/design: Following Feldman and Pentland, we will use 'the organisational routine' as our unit of analysis. In a sample of four UK general practices, we will collect narratives, ethnographic observations, multi-modal (video and screen capture) data, documents and other artefacts, and analyse these to map and compare the different understandings and enactments of three common routines (repeat prescribing, coding and summarising, and chronic disease surveillance) which span clinical and administrative spaces and which, though 'mundane', have an important bearing on quality and safety of care. In a detailed qualitative analysis informed by sociological theory, we aim to generate insights about how complex collaborative work is achieved through the process of routinisation in healthcare organisations. Discussion: Our study offers the potential not only to identify potential quality failures (poor performance, errors, failures of coordination) in collaborative work routines but also to reveal the hidden work and workarounds by front-line staff which bridge the model-reality gap in EPR technologies and via which "automated" safety features have an impact in practice. [ABSTRACT FROM AUTHOR]

The idea that policy should be based on best research evidence might appear to be self-evident. But a closer analysis reveals a number of problems and paradoxes inherent in the concept of "evidence-based policymaking." The current conflict over evidence-based policymaking parallels a long-standing "paradigm war" in social research between positivist, interpretivist, and critical approaches. This article draws from this debate in order to inform the discussions over the appropriateness of evidence-based policymaking and the related question of what is the nature of policy-making. The positivist, empiricist worldview that underpins the theory and practice of evidence-based medicine (EBM) fails to address key elements of the policymaking process. In particular, a narrowly "evidence-based" framing of policymaking is inherently unable to explore the complex, context-dependent, and value-laden way in which competing options are negotiated by individuals and interest groups. Sociolinguistic tools such as argumentation theory offer opportunities for developing richer theories about how policymaking happens. Such tools also have potential practical application in the policymaking process: by enhancing participants' awareness of their own values and those of others, the quality of the collective deliberation that lies at the heart of policymaking may itself improve. [ABSTRACT FROM AUTHOR]