Adapting structuration theory to understand the role of reflexivity: Problematization, clinical audit and information systems

This paper is an exploratory account of the further development and application of a hybrid framework, StructurANTion, that is based on Structuration Theory and Actor Network Theory (ANT). The use of social theories in general and their use in information systems (IS) research in particular is explored leading to the use of the framework to examine the concept of what are termed humanchine networks in the context of clinical audit, within a healthcare Primary Care Trust (PCT). A particular focus is on the manner in which information systems-based reflexivity contributes to both entrenching a networks’ structurated order as well as contributing to its emancipatory change. The case study compares clinic-centric and patientcentric audit and seeks to further extend the understanding of the role of information and information systems within structurated humanchine activity systems. Conclusions indicate that the use of more socially informed IS methods and approaches can incorporate more emancipatory ideals and lead to greater adoption and usage of more relevant and useful clinical information systems and practices

Patients, Professionals and the Internet: Renegotiating the Healthcare Encounter

The aim of this research was to examine how patient use of internet information impinges on the utilisation of healthcare services. The research had the following objectives: + to quantify the extent, and patterns, of patients use of the internet as a health information resource and identify the factors leading to variations in behaviour. + to identify the search strategies employed by patients in accessing internet health information internet and the evaluative approaches used in assessing information quality. + to analyse the content and dynamics of virtual health communities and how participation in such communities is integrated into engagement with health services. + to document the evolving nature of patient-professional interaction arising from patient access to health information and the subsequent format of the healthcare encounter. + to assess the effect of changing patient access to information and changes in the healthcare encounter on patterns of patient decision making and health behaviours

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

Do managed clinical networks improve quality of diabetes care? : Evidence from a retrospective mixed methods evaluation

Peer reviewedPostprin

Guiding Transformation: How Medical Practices Can Become Patient-Centered Medical Homes

Describes in detail eight change concepts as a guide to transforming a practice into a patient-centered medical home, including engaged leadership, quality improvement strategy, continuous and team-based healing relationships, and enhanced access

Delivering reform in English healthcare: an ideational perspective

A variety of perspectives has been put forward to understand reform across healthcare systems. Recently, some have called for these perspectives to give greater recognition to the role of ideational processes. The purpose of this article is to present an ideational approach to understanding the delivery of healthcare reform. It draws on a case of English healthcare reform – the Next Stage Review led by Lord Darzi – to show how the delivery of its reform proposals was associated with four ideational frames. These frames built on the idea of “progress” in responding to existing problems; the idea of “prevailing policy” in forming part of a bricolage of ideas within institutional contexts; the idea of “prescription” as top-down structural change at odds with local contexts; and the idea of “professional disputes” in challenging the notion of clinical engagement across professional groups. The article discusses the implications of these ideas in furthering our understanding of policy change, conflict and continuity across healthcare settings

The Electronic Health Record Scorecard: A Measure of Utilization and Communication Skills

As the adoption rate of electronic health records (EHRs) in the United States continues to grow, both providers and patients will need to adapt to the reality of a third actor being present during the visit encounter. The purpose of this project is to provide insight on “best” practice patterns for effective communication and efficient use of the EHR in the clinical practice setting. Through the development of a comprehensive scorecard, this project assessed current status of EHR use and communication skills among health care providers in various clinical practice settings. Anticipated benefits of this project are increased comfortability in interfacing with the EHR and increased satisfaction on the part of the provider as well as the patient. Serving as a benchmark, this assessment has the potential to help guide future health information technology development, training, and education for both students and health care providers