"A manager in the minds of doctors" : a comparison of new modes of control in European hospitals

Background: Hospital governance increasingly combines management and professional self-governance. This article maps the new emergent modes of control in a comparative perspective and aims to better understand the relationship between medicine and management as hybrid and context-dependent. Theoretically, we critically review approaches into the managerialism-professionalism relationship; methodologically, we expand cross-country comparison towards the meso-level of organisations; and empirically, the focus is on processes and actors in a range of European hospitals. Methods: The research is explorative and was carried out as part of the FP7 COST action IS0903 Medicine and Management, Working Group 2. Comprising seven European countries, the focus is on doctors and public hospitals. We use a comparative case study design that primarily draws on expert information and document analysis as well as other secondary sources. Results: The findings reveal that managerial control is not simply an external force but increasingly integrated in medical professionalism. These processes of change are relevant in all countries but shaped by organisational settings, and therefore create different patterns of control: (1) ‘integrated’ control with high levels of coordination and coherent patterns for cost and quality controls; (2) ‘partly integrated’ control with diversity of coordination on hospital and department level and between cost and quality controls; and (3) ‘fragmented’ control with limited coordination and gaps between quality control more strongly dominated by medicine, and cost control by management. Conclusions: Our comparison highlights how organisations matter and brings the crucial relevance of ‘coordination’ of medicine and management across the levels (hospital/department) and the substance (cost/quality-safety) of control into perspective. Consequently, coordination may serve as a taxonomy of emergent modes of control, thus bringing new directions for cost-efficient and quality-effective hospital governance into perspective

Site Characterization Index for Continuous Power Quality Monitoring Based on Higher-order Statistics

The high penetration of distributed generation (DG) has set up a challenge for energy management and consequently for the monitoring and assessment of power quality (PQ). Besides, there are new types of disturbances owing to the uncontrolled connections of non-linear loads. The stochastic behaviour triggers the need for new holistic indicators which also deal with big data of PQ in terms of compression and scalability so as to extract the useful information regarding different network states and the prevailing PQ disturbances for future risk assessment and energy management systems. Permanent and continuous monitoring would guarantee the report to claim for damages and to assess the risk of PQ distortions. In this context, we propose a measurement method that postulates the use of two-dimensional (2D) diagrams based on higher-order statistics (HOSs) and a previous voltage quality index that assesses the voltage supply waveform in a continous monitoring campaign. Being suitable for both PQ and reliability applications, the results conclude that the inclusion of HOS measurements in the industrial metrological reports helps characterize the deviations of the voltage supply waveform, extracting the individual customers' pattern fingerprint, and compressing the data from both time and spatial aspects. The method allows a continuous and robust performance needed in the SG framework. Consequently, the method can be used by an average consumer as a probabilistic method to assess the risk of PQ deviations in site characterization.This work was supported by the Spanish Ministry of Science and Innovation (Statal Agency for Research), and the EU (AEI/FEDER/UE) via project PID2019-108953RB-C21 Strategies for Aggregated Generation of Photovoltaic Plants: Energy and Meteorological Operational Data (SAGPVEMOD), and the precedent TEC2016-77632-C3-3-R

DESIGN AND EXPLORATION OF NEW MODELS FOR SECURITY AND PRIVACY-SENSITIVE COLLABORATION SYSTEMS

Collaboration has been an area of interest in many domains including education, research, healthcare supply chain, Internet of things, and music etc. It enhances problem solving through expertise sharing, ideas sharing, learning and resource sharing, and improved decision making. To address the limitations in the existing literature, this dissertation presents a design science artifact and a conceptual model for collaborative environment. The first artifact is a blockchain based collaborative information exchange system that utilizes blockchain technology and semi-automated ontology mappings to enable secure and interoperable health information exchange among different health care institutions. The conceptual model proposed in this dissertation explores the factors that influences professionals continued use of video- conferencing applications. The conceptual model investigates the role the perceived risks and benefits play in influencing professionals’ attitude towards VC apps and consequently its active and automatic use

A pragmatic randomised controlled trial of hydrotherapy and land exercises on overall well being and quality of life in rheumatoid arthritis

Background \ud Hydrotherapy is highly valued by people with rheumatoid arthritis yet few studies have compared the benefits of exercises in heated water against exercises on land. In particular, data on quality of life is rarely reported. This is especially important because patients treated with hydrotherapy often report an enhanced sense of well-being. We report a randomised controlled trial in which we compared the effects of hydrotherapy with exercises on land on overall response to treatment, physical function and quality of life in patients with rheumatoid arthritis. \ud \ud Methods \ud One hundred and fifteen patients with RA were randomised to receive a weekly 30-minute session of hydrotherapy or similar exercises on land for 6 weeks. Our primary outcome was a self-rated global impression of change – a measure of treatment effect on a 7-point scale ranging from 1(very much worse) to 7 (very much better) assessed immediately on completion of treatment. Secondary outcomes including EuroQol health related quality of life, EuroQol health status valuation, HAQ, 10 metre walk time and pain scores were collected at baseline, after treatment and 3 months later. Binary outcomes were analysed by Fisher's exact test and continuous variables by Wilcoxon or Mann-Whitney tests. \ud \ud Results \ud Baseline characteristics of the two groups were comparable. Significantly more patients treated with hydrotherapy (40/46, 87%) were much better or very much better than the patients treated with land exercise (19/40, 47.5%), p < 0.001 Fisher's exact test. Eleven patients allocated land exercise failed to complete treatment compared with 4 patients allocated hydrotherapy (p = 0.09). Sensitivity analyses confirmed an advantage for hydrotherapy if we assumed non-completers would all not have responded (response rates 70% versus 38%; p < 0.001) or if we assumed that non-completers would have had the same response as completers (response rates 82% versus 55% p = 0.002). Ten metre walk time improved after treatment in both cases (median pre-treatment time for both groups combined 10.9 seconds, post-treatment 9.1 s, and 3 months later 9.6 s). There was however no difference between treatment groups. Similarly there were no significant differences between groups in terms of changes to HAQ, EQ-5D utility score, EQ VAS and pain VAS. \ud \ud Conclusion \ud Patients with RA treated with hydrotherapy are more likely to report feeling much better or very much better than those treated with land exercises immediately on completion of the treatment programme. This perceived benefit was not reflected by differences between groups in 10-metre walk times, functional scores, quality of life measures and pain scores

Himalayan Trauma: Administrative Thrombosis and Citizens’ Response

In this paper, the author uses excerpts from social media postings and traditional media to highlight how various citizen and volunteer responses to the 2015 earthquake helped fill in the gaps created by institutional dysfunction. Further, he shows how these two types of media played a critical role in facilitating communication between grassroots aid initiatives and earthquake affected people and their families and friends, not only in Kathmandu but also in neglected mountainous areas as well. The author uses a personal, reflexive approach to help situate the distinct experiences of earthquake affected people including trauma patients, people with disabilities, and volunteer aid workers

Achieving Efficiency: Lessons From Four Top-Performing Hospitals

Synthesizes lessons from case studies of how four hospitals achieved greater efficiency, including pursuing quality and access, customizing technology, emphasizing communications, standardizing processes, and integrating care, systems, and providers

Technical Workshop: Advanced Helicopter Cockpit Design

Information processing demands on both civilian and military aircrews have increased enormously as rotorcraft have come to be used for adverse weather, day/night, and remote area missions. Applied psychology, engineering, or operational research for future helicopter cockpit design criteria were identified. Three areas were addressed: (1) operational requirements, (2) advanced avionics, and (3) man-system integration

Aerospace medicine and biology: A continuing bibliography with indexes (supplement 338)

This bibliography lists 139 reports, articles and other documents introduced into the NASA Scientific and Technical Information System during June 1990. Subject coverage includes: aerospace medicine and psychology, life support systems and controlled environments, safety equipment, exobiology and extraterrestrial life, and flight crew behavior and performance