The Energy Problem: Choices for an Uncertain Future

Analyzes discussions from National Issues Forums to assess how the public defines the energy problem, what it sees as the causes and solutions, where confusion and tensions over the energy problem lie, and why there is no consensus on how to resolve it

All Unhappy Families: Standardization and Child Welfare Decision-Making.

In the past 15 years, actuarial-based risk assessments designed to make child welfare decision-making more objective have proliferated. However, we know little about how actuarial-based decision-making plays out on the ground. Drawing on qualitative interviews with 66 Child Protective Service (CPS) workers in 2 states, this dissertation extends existing scholarship on actuarial-based risk assessments to foreground how CPS workers and child welfare agencies make meaning of decision-making in a structured environment. In three separate but related empirical papers, I investigate the intended and unintended consequences of using actuarial-based risk assessments to frame decision-making at the level of the organization, the individual, and the risk assessment itself. In the first article, I find that individual workers conceptualize and complete the risk assessment in varied ways. The amount of discretion that workers reported having was often associated with their social status characteristics, suggesting that issues of social power and privilege remained at play in a context intended to constrain their impact. The second article examines differences between a tight vs. loose implementation of the same standardized procedure, highlighting the ways in which distinct approaches to implementation changed the meaning of the intervention itself. In the third article, I look at how one risk assessment is structured. I find that an unintended focus on preventing one type of error in judgment de-emphasizes preventing others, sometimes with a devastating impact for families. Breaking away from rigid dichotomies that pit clinical and actuarial decision-making as mutually exclusive methods, I propose an integrative model that capitalizes on the strengths of both clinical and standardized processes. I argue that it is critical to understand and recognize how subjective assessments are already incorporated into processes for using standardized decision-making tools. The solution is not to find new ways to exclude caseworkers’ judgment but to offer a place for it alongside other approaches to improving case decision-making. I propose creating an integrated clinical and standardized decision-making model as well as revising current risk assessments to reflect a relational and dynamic assessment of case factors.PhDSocial Work and SociologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/111625/1/bosk_1.pd

Public Thinking About Coping With the Cost of Health Care: How Do We Pay for What We Need

Summarizes discussions from the 2008 National Issues Forums held nationwide on the public's views on the U.S. healthcare system, the factors behind rising costs, and proposed solutions. Outlines areas of consensus as well as reservations about reforms

Teachers’ Perceptions of Childcare and Preschool Expulsion

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142342/1/chso12228_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142342/2/chso12228.pd

Visitors by Lindsey Bosk

Visitors There is a need within us all,just like this garden,for water to replenish what is dry and wilted. One drop falls from the grey-blue sky onto a leaf.Another hits my brow, I smile. Like me, the rain does not stay forever,we are both visitors here. The droplets of water pick up speed,as if sensing urgency.Thirsty plants lap up water,the rain is welcome.Unlike the rain, I serve no purpose. I quench no one’s thirst.Nonetheless, I sit in the center of it all,as If I matter most.https://digitalcommons.usm.maine.edu/art-rsp-299/1000/thumbnail.jp

Reinforcing medical authority: clinical ethics consultation and the resolution of conflicts in treatment decisions

Despite substantial efforts in the past 15 years to professionalise the field of clinical ethics consultation, sociologists have not re‐examined past hypotheses about the role of such services in medical decision‐making and their effect on physician authority. In relation to those hypotheses, we explore two questions: (i) What kinds of issues does ethics consultation resolve? and (ii) what is the nature of the resolution afforded by these consults? We examined ethics consultation records created between 2011 and mid‐2015 at a large tertiary care US hospital and found that in most cases, the problems addressed are not novel ethical dilemmas as classically conceived, but are instead disagreements between clinicians and patients or their surrogates about treatment. The resolution offered by a typical ethics consultation involves strategies to improve communication rather than the parsing of ethical obligations. In cases where disagreements persist, the proposed solution is most often based on technical clinical judgements, reinforcing the role of physician authority in patient care and the ethical decisions made about that care.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154312/1/shil13003.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154312/2/shil13003_am.pd

The embeddedness of organizational performance: multiple membership multiple classification models for the analysis of multilevel networks

We present a Multiple Membership Multiple Classification (MMMC) model for analysing variation in the performance of organizational sub-units embedded in a multilevel network. The model postulates that the performance of organizational sub-units varies across network levels defined in terms of: (i) direct relations between organizational sub-units; (ii) relations between organizations containing the sub-units, and (iii) cross-level relations between sub-units and organizations. We demonstrate the empirical mer- its of the model in an analysis of inter-hospital patient mobility within a regional community of health care organizations. In the empirical case study we develop, organizational sub-units are departments of emergency medicine (EDs) located within hospitals (organizations). Networks within and across levels are delineated in terms of patient transfer relations between EDs (lower-level, emergency transfers), hospitals (higher-level, elective transfers), and between EDs and hospitals (cross-level, non-emergency transfers). Our main analytical objective is to examine the association of these interdependent and par- tially nested levels of action with variation in waiting time among EDs – one of the most commonly adopted and accepted measures of ED performance. We find evidence that variation in ED waiting time is associated with various components of the multilevel network in which the EDs are embedded. Before allowing for various characteristics of EDs and the hospitals in which they are located, we find, for the null models, that most of the network variation is at the hospital level. After adding these characteris- tics to the model, we find that hospital capacity and ED uncertainty are significantly associated with ED waiting time. We also find that the overall variation in ED waiting time is reduced to less than a half of its estimated value from the null models, and that a greater share of the residual network variation for these models is at the ED level and cross level, rather than the hospital level. This suggests that the covari- ates explain some of the network variation, and shift the relative share of residual variation away from hospital networks. We discuss further extensions to the model for more general analyses of multilevel network dependencies in variables of interest for the lower level nodes of these social structures

Between overt and covert research: concealment and disclosure in an ethnographic study of commercial hospitality

This article examines the ways in which problems of concealment emerged in an ethnographic study of a suburban bar and considers how disclosure of the research aims, the recruitment of informants, and elicitation of information was negotiated throughout the fieldwork. The case study demonstrates how the social context and the relationships with specific informants determined overtness or covertness in the research. It is argued that the existing literature on covert research and covert methods provides an inappropriate frame of reference with which to understand concealment in fieldwork. The article illustrates why concealment is sometimes necessary, and often unavoidable, and concludes that the criticisms leveled against covert methods should not stop the fieldworker from engaging in research that involves covertness

A case study evaluation of implementation of a care pathway to support normal birth in one English birth centre: anticipated benefits and unintended consequences

Background: The policy drive for the UK National Health Service (NHS) has focused on the need for high quality services informed by evidence of best practice. The introduction of care pathways and protocols to standardise care and support implementation of evidence into practice has taken place across the NHS with limited evaluation of their impact. A multi-site case study evaluation was undertaken to assess the impact of use of care pathways and protocols on clinicians, service users and service delivery. One of the five sites was a midwifery-led Birth Centre, where an adapted version of the All Wales Clinical Pathway for Normal Birth had been implemented. Methods: The overarching framework was realistic evaluation. A case study design enabled the capture of data on use of the pathway in the clinical setting, use of multiple methods of data collection and opportunity to study and understand the experiences of clinicians and service users whose care was informed by the pathway. Women attending the Birth Centre were recruited at their 36 week antenatal visit. Episodes of care during labour were observed, following which the woman and the midwife who cared for her were interviewed about use of the pathway. Interviews were also held with other key stakeholders from the study site. Qualitative data were content analysed. Results: Observations were undertaken of four women during labour. Eighteen interviews were conducted with clinicians and women, including the women whose care was observed and the midwives who cared for them, senior midwifery managers and obstetricians. The implementation of the pathway resulted in a number of anticipated benefits, including increased midwifery confidence in skills to support normal birth and promotion of team working. There were also unintended consequences, including concerns about a lack of documentation of labour care and negative impact on working relationships with obstetric and other midwifery colleagues. Women were unaware their care was informed by a care pathway. Conclusion: Care pathways are complex interventions which generate a number of consequences for practice. Those considering introduction of pathways need to ensure all relevant stakeholders are engaged with this and develop robust evaluation strategies to accompany implementation