An evaluation of a training intervention to support the use of evidence in healthcare commissioning in England

AIM: Clinical commissioning groups (CCGs) in England are responsible for the health of their populations through the services they provide, yet we know that the use of evidence to inform commissioning decisions is low. A programme of training in seven CCGs in England was instigated in a joint piece of work by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care and Academic Health Science Network in the West of England, to help build an evidence informed culture in commissioning. METHODS: Evidence workshops were delivered in each of the seven CCGs in the West of England by an experienced senior lecturer (the author) and local healthcare librarians. The workshop was developed by the author and an information scientist and included guidance and demonstration of a systematic evidence search covering both traditional and grey literature, and a brief look at quality of evidence including a critical appraisal activity. Participants were asked to evaluate the workshop on the day and to indicate an intended action they would take as a result of the workshop; a short follow-up interview was carried out with a sample of participants between 3 and 6 months later, to identify any longer term impact of the training. RESULTS: A total of 63 staff in a variety of commissioning-related roles attended the workshops between March and September 2016. 95% rated the workshop overall as either 'excellent' or 'good'. Of particular value was the involvement of the local healthcare librarian, helping to promote their expertise and services; and the discussion of grey literature as a valuable source of evidence. A variety of intended actions as a result of the training included initiating a thorough search for evidence for new projects, use of bibliographic databases, and making use of local library services for evidence searching. Follow-up interviews with nine staff revealed a positive impact in the longer-term. This ranged from simply triggering an interest in using evidence, boosting motivation and sharing information with colleagues; to changes in processes such as broadening the responsibility for finding and filtering evidence for business cases; to one clear case of financial savings resulting from a search for evidence by a senior commissioning manager. CONCLUSION: Offering short, interactive training workshops is valued by healthcare commissioners and can make a difference to their approach to and use of evidence in decision-making. There is a need for a flexible approach to the concept of evidence in healthcare commissioning, which includes the use of grey literature, and training can encourage and support the systematic search for an appraisal of this type of evidence. Tools for improving and sustaining this aspect of evidence use by commissioners are included here

An asset-based approach of the Romanian research-development and innovation system

The present paper experiments a new model of analysis for the Research-Development and Innovation (RDI) field of research, namely the Asset-Based Development strategy or Appreciative Planning and Action, which unfolds at the community level the same core principle that Appreciative Inquiry Methods at the organizational level: strengths elevating, strengths combining, strengths extending systems. Following the four “D stages” (Discovery, Dream, Design and Destiny/ Deliver) pattern, the authors outlined many strengths and achievements of the Romanian RDI system in order to depict the positive trends, structures and mechanism, as well as to map out the main routes towards fulfilling a new vision. Building upon ideas, opinions, studies, interviews of different representatives of the research community (managers, scientists, professors, users etc) expressed in specialised literature, newspapers, journals, or in direct contact and dialogue with them, we intended this approach encompass the appreciative contributions of the main stakeholders: universities, public and private research institutes, the business sector, public policy-makers. In this complex and rather rigid RDI system, whose elements are heterogeneous institutions and communities, that interacting each other in a special environment such as a network structure, effective change is still to be brought by individuals who possess the necessary power to continue transform their mind and attitudes and thus to initiate, diffuse change and, influencing the RDI environment. This might be a viable way to improve, in a positive manner, the RDI system’s efficiency.Asset-Based Development; Appreciative Inquiry; Romanian RDI System; Appreciative evaluation; Appreciative intervention; Summative assessment

Implementing a Health Maintenance Organisation in West Africa

The purpose of this report is to determine whether health maintenance organisations (HMOs) can provide a suitable and viable form of financial health protection and service provision in selected West African countries, supplementary to existing healthcare provision and coverage. Burkina Faso, Côte d’Ivoire, The Gambia, Guinea-Bissau, Liberia and Sierra Leone were chosen as country examples. Chapter 1 provides the context for the health and healthcare situation in West Africa as well as specific country profiles, whilst Chapter 2 describes factors to be considered when establishing an HMO. The range of technical di-mensions of an HMO introduced in this report includes: administration, human resources, financing, accreditation, service availability and readiness, the benefits catalogue, paying providers, drugs and quality management. Each of these dimensions is further discussed in Chapters 3 – 10. The administration of an HMO consists of nine interconnected fields: management dash-board, quality management, IT department, purchasing and coordination, finance and ac-counting, health plan and benefit package, member management, human resources, and marketing. In Chapter 3, the authors give a more in-depth analysis of the fields of marketing and member management. Recommendations provided in this chapter include the use of different marketing approaches to bridge the gap between communities and the HMO by establishing informative advertising (e.g., via a mobile responsive website, social media, posters, flyers, radio, and recorded information). Chapter 4 focuses on an HMO’s human resources, particularly in regard to staff recruiting, development and retention. Staff development expands staff competence by increasing employees’ motivation and job satisfaction, which leads to an increase in their performance and productivity, thereby improving staff retention. Furthermore, staff retention is important for ensuring a long-term commitment to the HMO. In conclusion, the success of an HMO is crucially dependent on motivating staff and enabling them to exercise, develop and share their skills. Chapter 5 covers the financial aspects of an HMO, including dimensions related to its target population, financial barriers, funding resources, management of funds, and specific coun-try challenges. In order to calculate the necessary resources, this chapter make clear that an HMO must consider cost projections for the benefit package, infrastructure development, administration, expansion and a reserve. To establish an accreditation system, HMOs can interact with stakeholders from different fields and levels of service delivery and administration, as examined in Chapter 6. The polit-ical and social conditions of a country must be considered by the HMO in order to effective-ly implement an accreditation system. Besides this, an HMO can seek to improve the per-formance quality of healthcare by supporting the establishment of an accreditation scheme. Reliable information on service availability and readiness is necessary for successful health systems management as it allows health services to be tracked in terms of how they have responded to changed inputs and processes. In Chapter 7, the authors analyse the Service Availability and Readiness Assessment (SARA) tool, and recommend its application within the HMO, as it offers a standardised approach to monitoring the supply of services by providing a standard set of tracer indicators. To implement a health benefit package (HBP), the authors assess existing models, such as the one introduced by Glassman et al. (2017) which specifies ten core elements of an HBP design and helps to enable discussions on the most relevant aspects in designing an HBP for an HMO. Chapter 8 presents a coinsurance scheme within the HBP design which will affect the service utilisation of members as well as utilisation management as one method for cost control. In addition, actuarial calculations are proposed using Sierra Leone as a case example. Chapter 9 describes the pharmaceutical supply chain required by an HMO. Important steps of the HMO’s medicine supply chain include: selection, quantification and forecasting, pro-curement, storage, and distribution of medical products. Medicines provided by the HMO must be safe, available, accessible, and affordable at all times and for all members. Stock-outs must be avoided, and therefore this chapter recommends employing community-based health workers in order to ensure distribution to patients in rural areas. Quality management is an important field in an HMO analysed in Chapter 10 of this report. It includes patient safety, efficiency, and patient satisfaction; all factors that must be con-sidered during the implementation of an HMO. The chapter concludes by noting that quality is highly subjective and must therefore be applied to the specific context of an HMO within a specific country. Finally, Chapters 11 and 12 of the report include implementation challenges of an HMO in West Africa, as well next steps that should be followed. Although similar challenges con-cerning the social, political, or structural environment can be found in most West African countries, direct transfer of elaborated information to other countries and healthcare situa-tions is not always possible. As well as these situational challenges, HMOs encounter dif-ferent questions such as how to balance the scope of available services against the cover-age of diverse geographical areas, engagement of various stakeholders and reflection of respective values, interests and perspectives of local populations. Limitations of the report include a lack of specificity in general, and the use of many specific country settings, as observations and examples for one HMO dimension may not always be transferable to other regions and healthcare situations. Therefore, this report is not meant to provide concrete conclusions or solutions in regard to the implementation of an HMO in a specific country setting. In conclusion, this report states that HMOs have the potential to play a substantial role in healthcare system strengthening, provision of quality healthcare services and the preven-tion of financial burden due to ill-health. As a result, an HMO can support West African countries in their role to fulfil their obligation of protecting the health of their citizens. Addi-tionally, the authors strongly believe that an HMO must reflect the cultural, societal and political environment in which it is implemented. Therefore, it is essential that research be conducted prior to its implementation in addition to including the relevant local stakeholders as early as possible in the process

A Reasoned Approach to the Integration of Design and Fabrication Technologies in Architecture Education

Integrating industrial technologies within education curricula, as well as creating fabrication laboratories, has become inevitable for Architecture Departments: digital design tools(eg: CGandCADsoftware)and digital fabrication tools(eg: cutting, printing, and milling technologies)have become standard assets almost every University has a digital fabrication lab, or at least a 3D printer, or a laser cutting machine. The education system itself is striving to find new pedagogic methods to best involve students in the learning process: learning-by-doing, project-based learning, gamification,“tailored” curricula, etc. All of these methods require simplification of the basic theoretical set of knowledge which is fundamental in any profession, especially in Architecture. Moreover,thefirstoutcomesofappliedlearning-by-doing programs show that such programs are as time-demanding as traditional programs [1]. On the other hand, the use of advanced tools such as parametric/generative software and prototyping/fabrication machines demands a high degree of interdisciplinary preparation, always crossing the boundaries of the specific field of study. Therefore, the integration of design and fabrication technologies in Architecture Education is not a simple process and it requires a redesign of the whole curriculum as well as the creation of an educational transition system from secondary schools to university. Switchingfromstandardarchitecturaldesignprocessestoadvanceddigitaldesignand fabrication enhanced processes is possible by learning how to code

A practical approach to cellular communications standards education

The cellular communications industry is steadily growing and expanding to solve the needs of governments, businesses and communities. Standards are fundamental to enable cooperation while promoting competition. The companies involved contribute and agree on appropriate technical specifications to ensure diversity, compatibility and facilitate worldwide commercial deployment and evolution. The specifications of cellular communications standards are extensive, complex and intentionally incomplete to spur innovation and differentiation. This makes standards education a difficult endeavor, but it is highly demanded by the wireless industry. This paper describes a practical approach to teaching cellular communications standards. Our methodology leverages software-defined radio technology and uses the abstraction layer and operating environment (ALOE) to provide a practical learning environment that facilitates developing many of the needed technical and soft skills without the inherent difficulty and cost associated with radio frequency components and regulation. We define six learning stages that assimilate the standardization process and identify key learning objectives for each. We discuss our experiences when employing the proposed methodology at Barcelona Tech in Spain, compare the approach with an equivalent class at Virginia Tech in the US and make the following observations: (1) The complexity of standards need to be abstracted and presented in a form suitable for a given class. (2) Educating about cellular communications standards is most effective when students are immersed in the process. (3) Hands-on activities need careful preparation and close guidance.Peer ReviewedPostprint (published version

An innovative approach to multi-method integrated assessment modelling of global climate change

© 2020, University of Surrey. All rights reserved. Modelling and simulation play an increasingly significant role in exploratory studies for informing policy makers on climate change mitigation strategies. There is considerable research being done in creating Integrated Assessment Models (IAMs), which focus on examining the human impacts on climate change. Many popular IAMs are created as steady state optimisation models. They typically employ a nested structure of neoclassical production functions to represent the energy-economy system, holding aggregate views on variables, and hence are unable to capture a finer level of details of the underlying system components. An alternative approach that allows modelling populations as a collection of individual and unevenly distributed entities is Agent-Based Modelling, often used in the field of Social Simulation. But simulating huge numbers of individual entities can quickly become an issue, as it requires large amounts of computational resources. The goal of this paper is to introduce a conceptual framework for developing hybrid IAMs. This novel modelling approach allows us to reuse existing rigid, but well-established IAMs, and adds more flexibility by replacing aggregate stocks with a community of vibrant interacting entities. We provide a proof-of-concept of the application of this conceptual framework in form of an illustrative example. Our test case takes the settings of the US. It is solely created for the purpose of demonstrating our hybrid modelling approach; we do not claim that it has predictive powers

FORMATION AND APPLICATION OF AN AGENT-ORIENTED MODEL IN THE MANAGEMENT OF THE OIL INDUSTRY OF THE REPUBLIC OF KAZAKHSTAN

Kazakhstan is one of the few countries in the world rich in oil, deservedly called “black gold” because it is the most important source of energy. The relevance of the study of this paper is determined by the fact that the management of the oil industry affects not only the management process itself, but also the social aspects of the implementation of the development strategy of the state as a whole. It is necessary to identify aspects of management activity and define criteria by which it is possible to calculate the effectiveness of managerial decision-making in the analyzed industry. Agent models allow us to identify the main criteria for the effectiveness of managerial decision-making and optimize social and economic costs for their implementation within the framework of interdepartmental planning. The novelty of the research is determined by the fact that agent models are based not only on the associated parameters of the management process, but also affect the possibility of planning current activities for a long period. The article shows that the formation of agent models should affect both the aspect of the formation of matrices of complex managerial actions and calculations on the accounting of competencies in making managerial decisions. The practical significance of the study is determined by the fact that the development of complex models based on agent forms allows expanding the use of forms of control over the industry by the state and other stakeholders. The implementation of a matrix form of management is proposed, taking into account balanced industry indicators of management quality

A simplified activity-based costing approach for SMEs : the case study of an Italian small road company

Purpose: The paper proposes an original conceptual model for designing a simplified Activity-Based Costing (ABC) approach for Small and Medium-sized Enterprises (SMEs) by focusing on the transport sector. Design/Methodology/Approach: The model is designed starting from the distinctive characteristics of the SMEs’ collaborative culture. The approach is then tested in the case of an Italian small-road company. Findings: The simplified ABC, which was gradually introduced in the SME, allowed the firm to gain confidence with the costing system. Moreover, the discussion of the results led to identifying the main areas to improve. Practical Implications: Costing systems based on collaboration can lead to operational improvements in SMEs operating in dynamic and competitive sectors as transport. Moreover, advanced technologies may hold a crucial role for their development. Originality/Value: Not much research has considered collaboration as a driver for introducing ABC in SMEs. The paper contributes to the literature on simplified managerial approaches, suggesting trends for future research.peer-reviewe

A Study of the Application of Design By Metaphors to the User Interface of Smartphones

The purpose of this study is to integrate user experiences, semiology, and the design by metaphors into user interfaces by experiments. Designs by metaphors are effectively integrated into the user interface of photo retouching apps on smartphones. Problems with the usage of the original interface can be resolved and the quality of product design can be improved. Current photo retouching apps usually come with a complicated user interface that makes users difficult to figure out a straightforward way of using the apps. Users might have less confidence in using the apps and their willingness of using is greatly reduced. The emerging trend of design by metaphors in recent years has resolved the issues that complicate user perception. It also helps designers simplify complicated user interfaces due to the requirement of multiple functions. An effective approach is proposed in this study to help designers create new user interfaces for photo retouching apps by using signs to simplify operation instructions. The resulting visual designs allow users to associate operations with something they are familiar with so that they can comprehend product functions in an effective way. The resulting design is clear at a glance so that users no longer make unintended uses. Moreover, the experiments in study opened a new horizon for the application of design by metaphors to user interfaces. This approach makes designers value product semantics more. As a result, people can enjoy their life in a more convenient and comfortable way.     Keywords: photo retouching app for smartphones, design by metaphors, operational semantics, semiology, user experienc