From theory to 'measurement' in complex interventions: methodological lessons from the development of an e-health normalisation instrument

<b>Background</b> Although empirical and theoretical understanding of processes of implementation in health care is advancing, translation of theory into structured measures that capture the complex interplay between interventions, individuals and context remain limited. This paper aimed to (1) describe the process and outcome of a project to develop a theory-based instrument for measuring implementation processes relating to e-health interventions; and (2) identify key issues and methodological challenges for advancing work in this field.<p></p> <b>Methods</b> A 30-item instrument (Technology Adoption Readiness Scale (TARS)) for measuring normalisation processes in the context of e-health service interventions was developed on the basis on Normalization Process Theory (NPT). NPT focuses on how new practices become routinely embedded within social contexts. The instrument was pre-tested in two health care settings in which e-health (electronic facilitation of healthcare decision-making and practice) was used by health care professionals.<p></p> <b>Results</b> The developed instrument was pre-tested in two professional samples (N = 46; N = 231). Ratings of items representing normalisation 'processes' were significantly related to staff members' perceptions of whether or not e-health had become 'routine'. Key methodological challenges are discussed in relation to: translating multi-component theoretical constructs into simple questions; developing and choosing appropriate outcome measures; conducting multiple-stakeholder assessments; instrument and question framing; and more general issues for instrument development in practice contexts.<p></p> <b>Conclusions</b> To develop theory-derived measures of implementation process for progressing research in this field, four key recommendations are made relating to (1) greater attention to underlying theoretical assumptions and extent of translation work required; (2) the need for appropriate but flexible approaches to outcomes measurement; (3) representation of multiple perspectives and collaborative nature of work; and (4) emphasis on generic measurement approaches that can be flexibly tailored to particular contexts of study

The Business Case for Quality: Ending Business as Usual in American Health Care

Examines some of the reasons why establishing a business case for improving health care is so difficult, and considers possible solutions. Includes comments on quality provisions of the Medicare Prescription Drug Improvement and Modernization Act of 2003

Application Areas of the Shared Service Concept within the Romanian Health System

The Romanian healthcare system can be characterized by chronic under financing, leading to poor services towards the patients, corruption and high debts of the public institutions towards their suppliers. In order to cope with the situation, the Romanian state approved in 2010 the emergency ordinance 48/2010 on the decentralization of the health systems. Due to this legislation more than 370 hospitals across the country had been transferred under the administration of local public administration officials, whereas only roundabout 60 hospitals remained under the control of the Ministry of Health. As a consequence, local authorities have to familiarize themselves with questions concerning the proper management of the assigned hospitals. The present paper explores the different application areas of the shared service concept and the benefits this concept can add to the healthcare system. Three areas from the administration and from the operative function of the hospitals had exemplarily been selected in order to demonstrate the potential of shared services in terms of reducing the existing costs, while increasing the quality and performance of the services in question. In order to provide a holistic picture, possible disadvantages are highlighted and explained. The paper concludes that the benefits of the shared service concept can counterbalance the possible negative aspects and support the Romanian health system in overcoming this crisis and improve overall performance.Healthcare, Local Public Services, Shared Services, Contracting out, Privatization

Network Performance Monitor and Electronic Mail/Smtp Gateway for the Regis Academic Research Network

The Academic Research Network (ARN) is in need of a means of monitoring servers and other nodes on the network. That need is driven by the requirement to remotely monitor and support the sprawling network resources between campuses, provide real-time network status reports, and immediate reports of downed nodes. An additional need is electronic mail (e-mail) to serve the practicum students and administrators, but primarily to provide a mail gateway through which Internet mail can be transported in order to provide the aforementioned alerts

An American Conversation on the Post-2015 Development Agenda

In the closing months of 2013, over 1,000 Americans gathered in communities large and small to discuss the world they want in 2030. They came together to answer a call to action from Secretary-General Ban Ki-moon for every UN member state to seek public input for a new and ambitious development agenda to replace the Millennium Development Goals when they expire in 2015.From October to December 2013, the United Nations Association of the United States of America (UNA-USA), a program of the United Nations Foundation, held day-long consultations in 12 cities across America. The 16 proposed development themes listed on the MY World 2015 website of the United Nations Development Programme (UNDP) served as the starting point for each conversation with participants ranking each theme while adding new ideas of their own.This report provides a window into the conversations that unfolded as Americans stepped back from their daily routines to think about how a new development agenda might impact their own lives as well as the lives of citizens of other UN member states around the world. The conversations included a diverse audience from age 15 to 95 and revealed both cross cutting themes and a few surprising findings

Doing Well and Doing Good: Pioneer Employers Discover Profits and Deliver Opportunity for Frontline Workers

A new study of business practices reveals powerful ways to create strategic and financial gains. Lower-wage workers, when supported by effective policies, boost productivity, quality, innovation, and revenues from new markets. In the process, the value added by frontline employees rises and they garner significant and sustained wage gains and career advancement. The successful formulas of these firms are models adoptable by thousands of similar businesses

The Promise of Health Information Technology: Ensuring that Florida's Children Benefit

Substantial policy interest in supporting the adoption of Health Information Technology (HIT) by the public and private sectors over the last 5 -- 7 years, was spurred in particular by the release of multiple Institute of Medicine reports documenting the widespread occurrence of medical errors and poor quality of care (Institute of Medicine, 1999 & 2001). However, efforts to focus on issues unique to children's health have been left out of many of initiatives. The purpose of this report is to identify strategies that can be taken by public and private entities to promote the use of HIT among providers who serve children in Florida

Vertical foreclosure: a policy framework

Whenever you phone your mother, switch on the light, or buy health insurance you purchase a service or product from a chain of vertically related industries. Providers of these products or services need access to a telecommunications network, an electricity network or to health care services. In such industries, integration and exclusive contracts between vertically related firms may have important welfare enhancing effects, but can also deny or limit rivals' access to input or customers, leading to foreclosure. Foreclosure can harm welfare if it reduces competition. This document provides policymakers with a framework to assess the potential for welfare reducing foreclosure of vertical integration and vertical restraints and describes possible remedies. The framework consists of four steps. Each step requires its own detailed analysis. First, market power should exist either upstream or downstream. Second, a theory of foreclosure should be formulated that explains why foreclosure is a profitable equilibrium strategy. Third, the existence and magnitude of potential welfare enhancing effects of the vertical restrains or vertical integration should be assessed. Fourth, suitable policies to address foreclosure should be found.

Opportunities For Funding Innovation

equity, business angels and the NewConnect market, and describes the possibilities of using them. The article stresses that firms seeking capital to grow through innovation can use a wide range of financing options as long as their projects are underpinned by solid documentation, have a specified time horizon, and are attractive for investdors.W artykule zaprezentowano pogląd, że konkurencyjność firmy należy upatrywać przede wszystkim w zdolności do bycia innowacyjnym. Wskazano na stymulatory aktywności firm i efekty z tytułu realizacji innowacji. Przede wszystkim zwrócono uwagę na źródła i formy pozyskiwania kapitału na ich urzeczywistnienie. Szczególną uwagę poświęcono leasingowi, venture capital, private equity, aniołom biznesu i NewConnect. Podkreślono, że istnieje szeroka paleta tych ofert dla firm potrzebujących kapitału na rozwój poprzez innowacje. Jednakże pod warunkiem, że projekty te będą dobrze udokumentowane, określony będzie horyzont czasowy ich wykonalności i będą stanowiły atrakcyjne wyzwanie dla inwestorów

Health Care Costs: A Primer 2012: Key Information on Health Care Costs and Their Impact

Examines changes in U.S. healthcare spending, compared with other countries and per capita; what it pays for; who pays; and how healthcare costs affect families and employers. Examines why healthcare costs outpace economic growth and how to slow growth