Health systems research in fragile and conflict affected states: a qualitative study of associated challenges.

BACKGROUND: High quality health systems research (HSR) in fragile and conflict-affected states (FCAS) is essential to guiding the policies and programmes that will improve access to health services and, ultimately, health outcomes. Yet, conducting HSR in FCAS is challenging. An understanding of these challenges is essential to tackling them and to supporting research conducted in these complex environments. Led by the Thematic Working Group on Health Systems in FCAS, the primary aim of this study was to develop a research agenda on HSR in FCAS. The secondary aim was to identify the challenges associated with conducting HSR in these contexts. This paper presents these challenges. METHODS: Guided by a purposely-selected steering group, this qualitative study collected respondents' perspectives through an online survey (n = 61) and a group discussion at the Third Global Symposium on HSR in September 2014 (n = 11). Respondents with knowledge and/or experience of HSR in FCAS were intentionally recruited. RESULTS: Of those ever involved in HSR in FCAS (45/61, 75%), almost all (98%) experienced challenges in conducting their research. Challenges fall under three broad thematic areas: (1) lack of appropriate support; (2) complex local research environment, including access constraints, weak local research capacity, collaboration challenges and lack of trust in the research process; and (3) limited research application, including rapidly outdated findings and lack of engagement with the research process and results. CONCLUSIONS: This study shows that those familiar with HSR in FCAS face many challenges in gaining support for and in conducting and applying high-quality research. There is a need for more sustainable support, including commitment to and long-term funding of HSR in FCAS; investment in capacity building within FCAS to meet the challenges related to implementation of research in these complex environments; relationship and trust building among stakeholders involved in HSR, particularly between local and international researchers and between researchers and participants; and innovative and flexible approaches to research design and implementation in these insecure and rapidly changing contexts

Leadership conversations: the impact on patient environments

Purpose – The aim of this study is to examine 15 NHS acute trusts in England that achieved high scores at all their hospitals in the first four national Patient Environment audits. No common external explanations were discernible. This paper seeks to examine whether the facilities managers responsible for the Patient Environment displayed a consistent leadership style. Design/methodology/approach – Overall, six of the 15 trusts gave permission for the research to take place and a series of unstructured interviews and observations were arranged with 22 facilities managers in these trusts. Responses were transcribed and categorised through multiple iteration. Findings – The research found common leadership and managerial behaviours, many of which could be identified from other literature. The research also identified managers deliberately devoting energy and time to creating networks of conversations. This creation of networks through managing conversation is behaviour less evident in mainstream leadership literature or in the current Department of Health and NHS leadership models. Practical implications – The findings of this study offer managers (particularly those in FM and managers across NHS) a unique insight into the potential impact of leaders giving an opportunity to re-model thinking on management and leadership and the related managerial development opportunities. It provides the leverage to move facilities management from the role of a commodity or support service, to a position as a true enabler of business. Originality/value – Original research is presented in a previously under-examined area. The paper illuminates how facilities management within trusts achieving high Patient Environment Action Team (PEAT) scores is led.</p

Europe’s digital future : focus on key priorities

Customised products and services, flexible working arrangements, productivity growth, and increasing prosperity – these are just some of the advantages promised by a digitised and connected economy. Business managers and politicians are keen to reap the potential benefits of the digital transformation. Such a transformation of the economy, however, is a complex task which goes hand in hand with a significant number of challenges. Digital transformation brings about changes in production and innovation processes, in markets and working environments, and also has societal implications. In particular, there are widespread fears that the increased use of machines and robots for tasks previously completed by humans shall result in job losses. Actors at both European and national levels have launched numerous agendas, initiatives and directives in order to support the digital transformation. The Digital Agenda, part of the Europe 2020 Strategy consists of seven pillars (EU Commission, 2016a): i) Digital Single Market, ii) Interoperability & Standards, iii) Trust & Security, iv) Fast and ultra-fast Internet access, v) Research and innovation, vi) Enhancing digital literacy, skills and inclusion, vii) ICT-enabled benefits for EU society. These seven pillars comprise 132 actions ranging from simplifying Pan-European licensing for online works (action 1), to investing in High-Performance Computing (action 132)

A 'likely benefit' from aligning Web 2.0 technologies with an institutions learning and teaching agenda

This paper demonstrates a ‘likely benefit’, and a practical view of expected challenges, when incorporating Web 2.0 technologies in a contemporary higher education context. After first exploring which factors potentially influence a shift in thinking about learning and teaching in a Web 2.0 context this paper then addresses the important role, or the affordance, of an integrated Learning Management System (LMS) and the pedagogical applications of Web 2.0 technologies. It then uses a series of case study from the University of Southern Queensland, a large distance education provider in Australia, to support these propositions. Overall, this paper suggests that the goals and ideals of Web 2.0/ Pedagogy 2.0 can be achieved, or at least stimulated, within an institutional LMS environment, as long as the LMS environment is aligned with these ideals

Research 2.0 : improving participation in online research communities

Web 2.0 thinking and technologies create a number of new opportunities to conduct research broadly labeled as Research 2.0. Research 2.0 is a growing area of academic and commercial interest, which includes research undertaken in online research communities. This research in progress paper explores the practice of online research communities using a case study example operated by the commercial market research company Virtual Surveys Limited (VSL) in the UK on behalf of their client United Biscuits UK Ltd. The preliminary findings are based on VSL and academics working together to improve the online research community participants’ response rate and the quality of contributions. Data collected for this study is based on meetings, participant observation, and a pilot survey of United Biscuits online research community (snackrs.com) members. Using the responses of 112 snackrs.com community members, a preliminary typology of motivational factors is proposed. This can be used to refine the recruitment and development of activities in an online research community. Also, a model for supporting online research communities to ensure longitudinal engagement based on an adaptation of Salmon’s (2004) 5 Stage Model for e-moderation is proposed, extending the 5 stages to 7 – adding the stages of selection and disengagemen

Excellent patient environments within acute NHS trusts: external influences and trust characteristics

Purpose – The purpose of this paper is to investigate the possible common factors in 15 Acute Hospital Trusts in the UK that achieved excellent scores at all their sites in four years of national Patient Environment audits. Design/methodology/approach – A desk-based study tested for external factors, organisational commonalities or particular contractual arrangements which the sample might have in common. A second piece of work was then undertaken; an ethnographic study that examined the behaviours exhibited by 22 managers in six of the trusts. The second phase of research will be described in a separate paper. Findings – The research found that no external, organisational or contractual commonalities could be identified as shared by the trusts that formed the Research Group. This led the researchers to ask further questions as to the management/leadership of the FM Managers who had achieved consistantly high standards of Patient Environment over the four year period. Practical implications – The research reveals that the trusts which achieved high standards of Patient Environment had no shared advantage in terms of external, organisational or contract characteristics. Thus, it should be possible for all trusts to achieve consistently high standards. Originality/value – This is believed to be the only study looking at influences and characteristics that are outside the FM Managers’ control and impact on the FMs’ ability to deliver consistantly high standards.</p

On Using Blockchains for Safety-Critical Systems

Innovation in the world of today is mainly driven by software. Companies need to continuously rejuvenate their product portfolios with new features to stay ahead of their competitors. For example, recent trends explore the application of blockchains to domains other than finance. This paper analyzes the state-of-the-art for safety-critical systems as found in modern vehicles like self-driving cars, smart energy systems, and home automation focusing on specific challenges where key ideas behind blockchains might be applicable. Next, potential benefits unlocked by applying such ideas are presented and discussed for the respective usage scenario. Finally, a research agenda is outlined to summarize remaining challenges for successfully applying blockchains to safety-critical cyber-physical systems

Practical post-modernism: FM and socially constructed realities

The theme of the paper, with examples, is that strategic FM should engage not with elaborate structural functional models of building service supply but with the socially constructed realities of organisations and their results. Several, evidence based, examples of FM creating different conversations will be provided, viz: • The creation of excellent patient environments in English Hospitals is not a function of structure (whether or not there is an integrated FM Directorate), sourcing (in house or outsourced) or a particular business process. It is a function of leadership exercised through context specific conversations. • The creation of effective new ‘knowledge’ environments is not a function of a particular design or project structure. It is a reflection of FMs ability to create conversations for changes in business results. • The failure of FM to capture strategic attention deriving from an obsession with considerations of unit costs and building condition rather than overall costs and business outcomes. • The role of perceptions and assertions in creating or blocking effective business relationships between FM providers and clients In the process the paper will challenge academic FM, whether research or education, to stop being in thrall to ‘practice’ to a degree that is arguably greater than is found in other areas of business and management, let alone other established disciplines. FM has too many models, too little theory and too little empirical evidence of specific business contributions. It is too concerned with supplying facilities rather than considering the purpose for which a given facility is managed.</p