Implementing social health insurance in Ireland: Report of a meeting and workshop held in Dublin, on December 6th 2010

We considered two basic questions, 'Is it possible to implement Social Health Insurance in Ireland?', and 'How can this be done?'. Can Social Health Insurance be implemented in Ireland? Our answer is a very definite yes. Furthermore, there would be many opportunities, while working towards this end, to improve the performance of our health care system. How can it be implemented? This process will need to be actively managed. There are many difficulties in the Irish health services, but also many opportunities. The greatest strengths are the talented, well-trained and very committed staff. Getting and keeping the support of these staff, for the necessary changes in service delivery, will be critical. Ireland has the capacity to make these changes, but without high quality management, a detailed focussed plan for change, and political support, little will happen. Each step in the change needs to be planned to maintain services, improve service delivery, improve service accountability, and improve service governance. Each sector of the service will need someone to lead the change, and mind that service during the change. Primary care remains under-developed. The HSE plan to develop primary care teams (PCT) has not succeeded. There are several established PCTs which work well. In other areas there are informal arrangements for collaboration, which work well. Overall, there are many useful lessons to learn from the experience so far. Future developments will need to place general practice at the centre of primary care. The mechanisms for doing this will vary from place to place, but need to be developed urgently. Acute hospitals face a crisis of governance. Maurice Hayes' (1) recent report on Tallaght hospital gives an idea of the scale of the changes needed. Tallaght is, we believe, not atypical, and is reputed to be by no means the worst governed hospital in the system. This, alone, should provide a pressing motive for change. Redesigning Irish hospitals to a new mission of supporting primary care, of supporting care in the community where possible can, and must, be done. Long-term care for older people is also a challenge. We advise moving to an integrated needs based system with smooth transitions between different degrees of support at home, and different degrees of support in specialized housing facilities including nursing homes. A similar model should apply to other forms of long-term care, for example for people with a substantial disability. Information systems and management processes both need a major overhaul. The health service remains strikingly under-managed, and fixing this will need a substantial culture change within the services. Wide use of standardized formal project management processes will be vital. There is a separate plan being developed to improve health service IT systems, and implementing this needs to be a high priority. We have not considered other key sectors, for example mental health, disability services, and social services. This does not mean that these are unimportant, merely that we had limited time, and a great deal to cover

From planning to resilience: The role (and value) of the emergency plan

This is the author’s version of a work that was accepted for publication in Technological Forecasting & Social Change. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Technological Forecasting & Social Change 121 (2017) 17–30. DOI 10.1016/j.techfore.2016.12.004.The study of resilience in the emergency management field is nowadays in effervescence. Traditionally, the robustness of organizations against disasters is based on several pillars: equipment, staff training, organization and, especially, planning. All of these dimensions are aimed at increasing the preparedness and recovery of organizations against disasters. While the approaches to resilience in emergency management focus on the processes that implement these dimensions, we approach resilience-building processes from a different perspective: instead of focusing on planning-related activities, we pay attention to the principal outcome of such activities, namely emergency plan. We show how the management of the emergency plan can contribute to reinforcing an organization's resilience. First, we identify the major resilience-related emergency plan components and suggest improved emergency plans that consider the characteristics that contribute to resilience. Secondly, we show how to reinforce the resilience of the organizations that have emergency plans. Our study is based on QuEP, a quality-based framework for the assessment and improvement of emergency plan management within organizations. We have extended and integrated the resilience characteristics as practices of the QuEP's maturity level hierarchy to make up QuEP + R. We describe its resilience model and give details of a supporting tool, currently under development. © 2016 Elsevier Inc. All rights reserved.The work of M. C. Penades and J. H. Canos& was partially funded by MINECO under grant CALPE (TIN2015-68608-R) and A.G. NCifiez received support from SENESCYT scholarship program of the Republic of Ecuador.Penadés Gramage, MC.; Núñez Ávila, AG.; Canos Cerda, JH. (2016). From planning to resilience: The role (and value) of the emergency plan. Technological Forecasting and Social Change. 121(3):17-30. https://doi.org/10.1016/j.techfore.2016.12.004S1730121

Healthcare improvement as planned system change or complex responsive processes? A longitudinal case study in general practice

Background: Interest in how to implement evidence-based practices into routine health care has never been greater. Primary care faces challenges in managing the increasing burden of chronic disease in an ageing population. Reliable prescriptions for translating knowledge into practice, however, remain elusive, despite intense research and publication activity. This study seeks to explore this dilemma in general practice by challenging the current way of thinking about healthcare improvement and asking what can be learned by looking at change through a complexity lens. Methods. This paper reports the local level of an embedded case study of organisational change for better chronic illness care over more than a decade. We used interviews, document review and direct observation to explore how improved chronic illness care developed in one practice. This formed a critical case to compare, using pattern matching logic, to the common prescription for local implementation of best evidence and a rival explanation drawn from complexity sciences interpreted through modern sociology and psychology. Results: The practice changed continuously over more than a decade to deliver better chronic illness care in line with research findings and policy initiatives - re-designing care processes, developing community linkages, supporting patient self-management, using guidelines and clinical information systems, and integrating nurses into the practice team. None of these improvements was designed and implemented according to an explicit plan in response to a documented gap in chronic disease care. The process that led to high quality chronic illness care exhibited clear complexity elements of co-evolution, non-linearity, self-organisation, emergence and edge of chaos dynamics in a network of agents and relationships where a stable yet evolving way of organizing emerged from local level communicative interaction, power relating and values based choices. Conclusions: The current discourse of implementation science as planned system change did not match organisational reality in this critical case of improvement in general practice. Complexity concepts translated in human terms as complex responsive processes of relating fit the pattern of change more accurately. They do not provide just another fashionable blueprint for change but inform how researchers, policymakers and providers participate in improving healthcare. 2013 Booth et al.; licensee BioMed Central Ltd

Shoreline management plans in England and Wales: a scientific and transparent process

Coastal change, including severe winter storms, requires decision-makers to understand the nature of coastal hazards so they can manage the risks and protect coastal communities. This study has provided the first structured quantitative analysis of the scientific underpinning and transparency associated with key policies dictating the future of the coastline in England and Wales. Based on a content analysis of first and second generation shoreline management plans, it has queried the visibility, clarity and transparency of evidence. Results point to improved evidence and understanding at the regional-scale, but issues associated with the transparency of the science informing policy at local levels. Inconsistencies in performance appear to relate to differing approaches of the consultancies preparing the plans rather than the nature of the coasts, the types of policies or the government guidance informing plan development. The study points to a need for a more thorough quality assurance process at national level and calls for clearer guidance on how these regional coastal adaptation plans and their supporting science should be read and interpreted by relevant stakeholder audiences. There are clear lessons from this study for planning processes elsewhere, especially those involving the downscaling of regionally based data and information. There are also potential applications of our criteria-based approach to other planning systems which require scientific scrutiny and transparency

Supporting adaptiveness of cyber-physical processes through action-based formalisms

Cyber Physical Processes (CPPs) refer to a new generation of business processes enacted in many application environments (e.g., emergency management, smart manufacturing, etc.), in which the presence of Internet-of-Things devices and embedded ICT systems (e.g., smartphones, sensors, actuators) strongly influences the coordination of the real-world entities (e.g., humans, robots, etc.) inhabitating such environments. A Process Management System (PMS) employed for executing CPPs is required to automatically adapt its running processes to anomalous situations and exogenous events by minimising any human intervention. In this paper, we tackle this issue by introducing an approach and an adaptive Cognitive PMS, called SmartPM, which combines process execution monitoring, unanticipated exception detection and automated resolution strategies leveraging on three well-established action-based formalisms developed for reasoning about actions in Artificial Intelligence (AI), including the situation calculus, IndiGolog and automated planning. Interestingly, the use of SmartPM does not require any expertise of the internal working of the AI tools involved in the system

Sustainable Livelihoods Enhancement and Diversification (SLED): A Manual for Practitioners

The aim of this document is to provide development practitioners with an introduction to the SLED process as well as guidance for practitioners facilitating that process. The Sustainable Livelihoods Enhancement and Diversification (SLED) approach has been developed by Integrated Marine Management Ltd (IMM) through building on the lessons of past livelihoods research projects as well as worldwide experience in livelihood improvement and participatory development practice. It aims to provide a set of guidelines for development and conservation practitioners whose task it is to assist people in enhancing and diversifying their livelihoods. Under the Coral Reefs and Livelihoods Initiative (CORALI), this approach has been field tested and further developed in very different circumstances and institutional settings, in six sites across South Asia and Indonesia. While this process of testing and refining SLED has been carried out specifically in the context of efforts to manage coastal and marine resources, it is an approach that can be applied widely wherever natural resources are facing degradation because of unsustainable human use. The SLED approach provides a framework within which diverse local contexts and the local complexities of livelihood change can be accommodated

Principles for aerospace manufacturing engineering in integrated new product introduction

This article investigates the value-adding practices of Manufacturing Engineering for integrated New Product Introduction. A model representing how current practices align to support lean integration in Manufacturing Engineering has been defined. The results are used to identify a novel set of guiding principles for integrated Manufacturing Engineering. These are as follows: (1) use a data-driven process, (2) build from core capabilities, (3) develop the standard, (4) deliver through responsive processes and (5) align cross-functional and customer requirements. The investigation used a mixed-method approach. This comprises case studies to identify current practice and a survey to understand implementation in a sample of component development projects within a major aerospace manufacturer. The research contribution is an illustration of aerospace Manufacturing Engineering practices for New Product Introduction. The conclusions will be used to indicate new priorities for New Product Introduction and the cross-functional interactions to support flawless and innovative New Product Introduction. The final principles have been validated through a series of consultations with experts in the sponsoring company to ensure that correct and relevant content has been defined

Principles in Patterns (PiP) : Institutional Approaches to Curriculum Design Institutional Story

The principal outputs of the PiP Project surround the Course and Class Approval (C-CAP) system. This web-based system built on Microsoft SharePoint addresses and resolves many of the issues identified by the project. Generally well received by both academic and support staff, the system provides personalised views, adaptive forms and contextualised support for all phases of the approval process. Although the system deliberately encapsulates and facilitates existing approval processes thus achieving buy-in, it is already achieving significant improvements over the previous processes, not only in reducing the administrative overheads but also in supporting curriculum design and academic quality. The system is now embedded across three faculties and is now considered by the University of Strathclyde to be a "core institutional service". Alongside the C-CAP system the PiP Project also cultivated a suite of approaches: an incremental systems development methodology; a structured and replicable evaluation approach, and; Strathclyde's Lean Approach to Efficiencies in Education Kit (SLEEK) business process improvement methodology Each is based on recognised formal techniques, providing the basis for a rigorous approach. This is contextualised within and adapted to the HE institutional context thus building the foundation not only for the project but ultimately for institution wide process improvement. This "institutional story" report summarises the principal outcomes of the Project

The State of Adaptation in the United States: An Overview

Over the past two decades the adaptation landscape has changed dramatically. From its early days as a vague theoretical concept, which was often viewed as a threat to advocating for the reduction of greenhouse gas emissions, it has developed into a widely, albeit not universally, recognized governmental mandate to reduce societal vulnerability to climate change. While it is important to appreciate the progress that we are making on this issue, it is impossible to ignore the urgent need to do more. Smart investment can be made by reflecting on what is already underway in order to determine where to build on existing efforts and where to innovate new approaches to fill the gaps in the path forward. In this report we provide illustrative examples of the variety of work on climate change adaptation that is underway in the United States. This is by no means an exhaustive survey of the field; however it does provide insight into the dominant focus of work to date, the resultant gaps, and the opportunities available for advancing this essential aspect of sustainability. We focus on four areas of activity -- agriculture, natural resources, human communities, and policy. The general trends relevant to these sectors can be applied more broadly to other sectors and countries. Adaptation can be thought of as a cycle of activities that ultimately -- if successful -- reduces vulnerability to climate change. This process starts with identifying the impacts of climate change to determine the types of problems climate change might pose. This includes all of the research on the causes and the global, regional, and local manifestations of climate change, often referred to as impacts assessments