Emerging prenatal genetic tests : developing a health technology assessment (HTA) framework for informed decision-making

Delphi Process In preparation for the first Delphi exercise, a list of questions was produced from the academic literature, webbased sources and interviews with experts. These questions were structured into broad dimensions and a draft questionnaire piloted. A final list of 73 questions formed the basis of the first Delphi survey. Participants were asked to grade the perceived importance of each question for inclusion in HTA reports on new prenatal genetic tests (4 = Essential; 3 = Desirable, but not essential; 2 = Useful but should not be required; 1 = Of little/ no importance; 0 = I have no basis for judgement). Secondly, they were asked to indicate whether a question should be addressed during test development or whether the question could be addressed later once the technology is ready for implementation. Finally, Panel members were encouraged to identify any other questions which appeared to be missing from the initial list. For copy of questionnaire, see Annex 1: Delphi Round 1 Questionnaire. Respondents were also asked to provide personal details to give some indication of their HTA experience and specialist expertise. Analysis of responses demonstrated that SAFE Delphi panel members represent a highly experienced, multidisciplinary international group of experts with the knowledge required to define which key questions should be addressed in HTA reports on new prenatal genetic tests. Delphi Responses Responses were received from 77/90 (86%) of Panel members. These were analysed with a cut-off of 75% (±3%) applied as an indicator of Panel consensus for all questions. Thus, any question which three out of four respondents rated as essential or desirable was retained, whilst those not achieving this level of agreement were provisionally excluded. In addition, mean scores were also calculated (excluding 0 = I have no basis for judgement) for each question. A mean score >3.25 ± 0.05 was taken as an indication that the Panel had identified a particular question as being of the highest priority to address in HTA

Growth and structural change: trends, patterns and policy options

economic growth, structural change, convergence, diffusion of technological knowledge

The administrative burden reduction policy boom in Europe: comparing mechanisms of policy diffusion

Much has been written on the diffusion of public management and regulatory reform tools. Available evidence suggests that cross-national policy diffusion is an increasingly significant phenomenon, especially in the European context. While internationalisation of policy discourses and expert communities are regarded as key driving forces of policy diffusion, public management reforms are also said to be particularly vulnerable to mechanisms of 'diffusion without convergence'. This paper analyses the case of policies aiming at reducing administrative burdens of regulations through the lens of the literature on policy diffusion. The diffusion of the so-called Standard Cost Model for measuring administrative burden between 2003 and 2007 is used as a case to explore the mechanisms facilitating policy diffusion in this domain. The analysis reveals patterns of rapid diffusion. This policy boom has been driven by a combination of different mechanisms of policy diffusion rather than by a single driving factor

Developing and implementing an integrated delirium prevention system of care:a theory driven, participatory research study

Background: Delirium is a common complication for older people in hospital. Evidence suggests that delirium incidence in hospital may be reduced by about a third through a multi-component intervention targeted at known modifiable risk factors. We describe the research design and conceptual framework underpinning it that informed the development of a novel delirium prevention system of care for acute hospital wards. Particular focus of the study was on developing an implementation process aimed at embedding practice change within routine care delivery. Methods: We adopted a participatory action research approach involving staff, volunteers, and patient and carer representatives in three northern NHS Trusts in England. We employed Normalization Process Theory to explore knowledge and ward practices on delirium and delirium prevention. We established a Development Team in each Trust comprising senior and frontline staff from selected wards, and others with a potential role or interest in delirium prevention. Data collection included facilitated workshops, relevant documents/records, qualitative one-to-one interviews and focus groups with multiple stakeholders and observation of ward practices. We used grounded theory strategies in analysing and synthesising data. Results: Awareness of delirium was variable among staff with no attention on delirium prevention at any level; delirium prevention was typically neither understood nor perceived as meaningful. The busy, chaotic and challenging ward life rhythm focused primarily on diagnostics, clinical observations and treatment. Ward practices pertinent to delirium prevention were undertaken inconsistently. Staff welcomed the possibility of volunteers being engaged in delirium prevention work, but existing systems for volunteer support were viewed as a barrier. Our evolving conception of an integrated model of delirium prevention presented major implementation challenges flowing from minimal understanding of delirium prevention and securing engagement of volunteers alongside practice change. The resulting Prevention of Delirium (POD) Programme combines a multi-component delirium prevention and implementation process, incorporating systems and mechanisms to introduce and embed delirium prevention into routine ward practices. Conclusions: Although our substantive interest was in delirium prevention, the conceptual and methodological strategies pursued have implications for implementing and sustaining practice and service improvements more broadly

Randomised controlled trials of complex interventions and large-scale transformation of services

Complex interventions and large-scale transformations of services are necessary to meet the health-care challenges of the 21st century. However, the evaluation of these types of interventions is challenging and requires methodological development. Innovations such as cluster randomised controlled trials, stepped-wedge designs, and non-randomised evaluations provide options to meet the needs of decision-makers. Adoption of theory and logic models can help clarify causal assumptions, and process evaluation can assist in understanding delivery in context. Issues of implementation must also be considered throughout intervention design and evaluation to ensure that results can be scaled for population benefit. Relevance requires evaluations conducted under real-world conditions, which in turn requires a pragmatic attitude to design. The increasing complexity of interventions and evaluations threatens the ability of researchers to meet the needs of decision-makers for rapid results. Improvements in efficiency are thus crucial, with electronic health records offering significant potential

Reputation of Oral and Maxillofacial Surgery in the UK:the patients' perspective

Our intention is to shed theoretical and practical light on the professional reputation of Oral and Maxillofacial Surgery (OMFS) in the UK by drawing on theories from management literature, particularly concerning reputation. Since professional reputation is socially constructed by stakeholders, we used interpretivist methods to conduct a qualitative study of patients (stakeholders) to gain an insight into their view of the profession. Findings from our focus groups highlighted the importance of “soft-wired skills” and showed a perception – reality gap in the interaction between patients and doctors. They also highlighted the importance of consistency, relational coordination, mechanisms to enable transparent feedback, and professional processes of governance. To help understand how best to manage the reputation of the specialty, we also explored how this is affected by the media and the Internet

Sustainability management : insights from the viable system model

A review of current literature on sustainability standards reveals a significant gap between their adoption and the implementation of sustainability into every level of the organisation. In this paper, it is argued that in order to overcome this challenge, an appropriate model of an organisation is needed. The Viable System Model (VSM) is proposed as such a model and, in order to illustrate this argument, it is used to interpret the ISO 26000 standard on Social Responsibility (SR). First, the VSM theory is introduced and presented by modelling the hypothetical company Widget Co. Then, the clauses of ISO 26000 are mapped on the Widget Co. model, together with detailed descriptions and examples on the organisational and managerial implications of its adopting the standard's guidelines. The result is the identification of generic SR functions that need to be performed by the various organisational governance systems, as well as their dynamic interrelations, thus clarifying implementation issues. Moreover, by identifying different SR management layers, VSM is suggested as a way forward to develop an integration model for SR issues and respective sustainability tools. Finally, a discussion is given on the implications of using this approach to integrate sustainability standards and the way this research contributes to recent developments in sustainability research

Inclusive governance in non-profit organisations

The study of private non-profit enterprises that offer general interest services is only at the start. The understanding of existing organisations resists an inclusive, public interest view of governance. This contribution aims at providing a reflection on specific features that non-profit enterprises should have, and outlines four main justifications for including stakeholders in production governance: 1) access to knowledge and other resources, 2) trust creation, 3) internal efficiency, 4) external efficiency. Conclusions elaborate on Hansmann’s classic theory of the firm to suggest that governance solutions need to be assessed on the basis of total costs, considering also the lower level of social costs that is created when governance includes relevant stakeholders. Our model highlights that when social costs are high, even an enterprise with costly decisional processes, such as the multi-stakeholder, can be the most efficient solution amongst other possible alternatives