Critical systems heuristics: a tool for the inclusion of ethics and values in complex policy decisions

From the introduction Drawing on a study of members of the UK’s Agriculture and Biotechnology Commission, this paper explores the use of Critical Systems Heuristics (CSH) as a structured approach to the inclusion of ethics and values in complex policy decisions. CSH was devised by Ulrich in a planning context, as a way of making explicit the value assumptions underlying practical judgements by means of critical reflection. It is rooted in Critical Systems Thinking, which challenged earlier notions of systems thinking by introducing a more socially aware and critical form of systems practice. Ulrich used the concept of system boundaries to provide a conceptual framework for dealing with the facts and values that underlie a decision. The CSH framework encourages people to consider critically such matters as what counts as an ethically-defendable 'improvement', who should benefit, and what should count as relevant knowledge and sources of expertise. This paper highlights some of the advantages and disadvantages of CSH as a tool for achieving a more inclusive, critical and self-reflective approach to decision making about genetically modified crops

Computers in recreation and sport management

This study was undertaken by the Department of Recreation Studies to investigate computer utilisation by sport and recreation professionals in not-for-profit sporting and recreation organisations in Western Australia, with a view to identifying the preparation needed by recreation students. One hundred and fifty (150) selected organisations from four generic groups (local government, sports adminstration organisations, recreation organisations for special populations and community recreation organisations) were surveyed. The results revealed a broad range of computer applications, predominantly for administration. The most common applications by all four groups were word processing, database management and financial management. Financial management systems were used more than any other application by professional recreation and sports personnel throughout the course of their employment. Computer skill training occurred mostly on-the-job. The main barrier to effective computer utilisation was lack of funds, and the most positive contribution of the computer was perceived to be time· efficiency. All organisations considered computer awareness and competency desirable job selection criteria, reflecting the need for students of recreation and sports administration to be computer literate as a pre-requisite for future employment

Farmers' understandings of genetically modified crops within local communities

Background Much of the debate around the science and technology of genetically modified (GM) crops has focussed on the policies and practices of national governments and international organisations or on the acceptability of GM products with consumers. Little work had been done with the primary users of such technologies – farmers. Further, the management of knowledge has become a significant issue for all sectors of the economy and yet little attention had again been given to farmers as a particular societal group of small to medium sized enterprises subject to ‘knowledge-based’ influences from many other societal groups. Aims and objectives This project investigated the attitudes, intentions and practices of farmers regarding the new technology of GM crops (both those with experience of them and those without) in relation to their social setting. The relationship building research approach we developed had three phases that used three different, and progressively more interactive, discussion and mapping techniques to engage with (often the same) participants. Telephone and face-to-face interviews with farmers, and a workshop with farmers and others involved in agriculture, helped: 1. Explore how farmers construct their understandings of GM crops through their interactions with others, in particular family members, neighbouring farmers, seed companies, farming advisors and the local community. 2. Ascertain the acceptability to farmers of recommended management practices for GM crops used in the Government sponsored Farm Scale Evaluations (FSEs). 3. Develop models of social learning systems appropriate to support individual farmers within informal social settings who decide to adopt contentious new technologies such as GM crops. Key findings Farmers’ understandings of GM crops as a new technology: Farmers view GM crops as a technology derived from new practices in plant breeding that build upon previous technologies and contribute to the running of the whole farm business. They are responding to them much as they would to any new technology, as a technology that provides improvements that are assessed for their value in practice by experimentation in the individual farm context. Farmers who had been involved in the FSEs, and those who had not, believed that GM crops offer clear economic and environmental benefits to themselves and the wider public. New technologies, such as GM crops are attractive to farmers as a way of reconciling conflicting demands to deliver high quality products at low cost and also to farm in an environmentally responsible way. Farmers’ acceptance of recommended management practices: The farmers involved in the FSEs had no problems following the recommended management practices and several could see ways in which to modify them to create benefits to themselves and to others if GM crops were licensed in the UK, in particular by using lower rates of herbicide. Farmers’ social learning systems and links to their communities: Farmers’ learning is dominated by informal learning, beyond any initial formal training, and this occurs through experimenting and the use of tacit knowledge arising from using new technologies in practice on their own farm. They also actively engage with other farmers (their network of practice) and many organisations that impact on their work (their community of influencers). That is, they draw on and exchange knowledge and experience from the range of people in their social environment. Farmers’ network of practice is widely distributed rather than being local while their community of influencers is complex, but relatively stable and consistent over time, and largely not local, although the degree of influence of individual members of the community may change. Some influence over practice is one-way (e.g. regulations that impose restrictions on what can be done) while some influences result from two-way negotiation (e.g. with agricultural advisers on agronomic matters). Key individuals within organisations in their community of influencers are often important, rather than simply the organisations themselves. Most farmers have to act individually at the boundary between their network of practice and community of influencers in order to find and exchange information and knowledge. For example, with the decline in public funding for the former Agricultural Development and Advisory Service (ADAS) there is a lack of official people working at the boundary between farmers’ network of practice and other key communities of practice within a farmer’s community of influencers. Similarly, there is a less effective connection between both the scientific research occurring in the agricultural science community of practice and agricultural policy development occurring in government departments and agencies, with the day-to-day agricultural practices and long term plans of farmers. The value of our research approach: Farmers appreciated the use of a more participatory approach that sought the inclusion of their views, as users, into the broader conversations about new technologies. They also valued the interactive, relationship-building nature of the research approach. Dissemination of findings An integral part of the project has been the sharing of the outcomes of each phase of the study with the participants and with key stakeholders in the agricultural sector. A project website, project reports, conference papers, journal articles and an executive summary document are being used to disseminate the findings to different audiences. Implications for policy and practice Based on our findings there is a need for: • An enabling environment that is responsive to farmers’ needs, with clear, consistent and long-term policy signals about the future of agriculture, to allow them time to adapt to changing demands. • Improved connections between farmers and consumers. • Greater awareness amongst policy makers, regulators, scientists and the supermarkets, of what farmers can and cannot do. • Independent, trustworthy, sources of research and advice for farmers. • The valuing of farmers’ informal learning from experience, for example in the shaping of agricultural research. The following features are among those that would most improve the systems of support available to farmers in their decisions about new technologies: • horizon-scanning on behalf of farmers, to synthesise information, look at the potential of new technologies, and develop clear long-term directions for agriculture • government-sponsored intermediaries qualified in and knowledgeable about agriculture, to improve the links between government policies, scientific research and the grassroot

Farmers' understandings of genetically modified crops within local communities

Background Much of the debate around the science and technology of genetically modified (GM) crops has focussed on the policies and practices of national governments and international organisations or on the acceptability of GM products with consumers. Little work had been done with the primary users of such technologies – farmers. Further, the management of knowledge has become a significant issue for all sectors of the economy and yet little attention had again been given to farmers as a particular societal group of small to medium sized enterprises subject to ‘knowledge-based’ influences from many other societal groups. Aims and objectives This project investigated the attitudes, intentions and practices of farmers regarding the new technology of GM crops (both those with experience of them and those without) in relation to their social setting. The relationship building research approach we developed had three phases that used three different, and progressively more interactive, discussion and mapping techniques to engage with (often the same) participants. Telephone and face-to-face interviews with farmers, and a workshop with farmers and others involved in agriculture, helped: 1. Explore how farmers construct their understandings of GM crops through their interactions with others, in particular family members, neighbouring farmers, seed companies, farming advisors and the local community. 2. Ascertain the acceptability to farmers of recommended management practices for GM crops used in the Government sponsored Farm Scale Evaluations (FSEs). 3. Develop models of social learning systems appropriate to support individual farmers within informal social settings who decide to adopt contentious new technologies such as GM crops. Key findings Farmers’ understandings of GM crops as a new technology: Farmers view GM crops as a technology derived from new practices in plant breeding that build upon previous technologies and contribute to the running of the whole farm business. They are responding to them much as they would to any new technology, as a technology that provides improvements that are assessed for their value in practice by experimentation in the individual farm context. Farmers who had been involved in the FSEs, and those who had not, believed that GM crops offer clear economic and environmental benefits to themselves and the wider public. New technologies, such as GM crops are attractive to farmers as a way of reconciling conflicting demands to deliver high quality products at low cost and also to farm in an environmentally responsible way. Farmers’ acceptance of recommended management practices: The farmers involved in the FSEs had no problems following the recommended management practices and several could see ways in which to modify them to create benefits to themselves and to others if GM crops were licensed in the UK, in particular by using lower rates of herbicide. Farmers’ social learning systems and links to their communities: Farmers’ learning is dominated by informal learning, beyond any initial formal training, and this occurs through experimenting and the use of tacit knowledge arising from using new technologies in practice on their own farm. They also actively engage with other farmers (their network of practice) and many organisations that impact on their work (their community of influencers). That is, they draw on and exchange knowledge and experience from the range of people in their social environment. Farmers’ network of practice is widely distributed rather than being local while their community of influencers is complex, but relatively stable and consistent over time, and largely not local, although the degree of influence of individual members of the community may change. Some influence over practice is one-way (e.g. regulations that impose restrictions on what can be done) while some influences result from two-way negotiation (e.g. with agricultural advisers on agronomic matters). Key individuals within organisations in their community of influencers are often important, rather than simply the organisations themselves. Most farmers have to act individually at the boundary between their network of practice and community of influencers in order to find and exchange information and knowledge. For example, with the decline in public funding for the former Agricultural Development and Advisory Service (ADAS) there is a lack of official people working at the boundary between farmers’ network of practice and other key communities of practice within a farmer’s community of influencers. Similarly, there is a less effective connection between both the scientific research occurring in the agricultural science community of practice and agricultural policy development occurring in government departments and agencies, with the day-to-day agricultural practices and long term plans of farmers. The value of our research approach: Farmers appreciated the use of a more participatory approach that sought the inclusion of their views, as users, into the broader conversations about new technologies. They also valued the interactive, relationship-building nature of the research approach. Dissemination of findings An integral part of the project has been the sharing of the outcomes of each phase of the study with the participants and with key stakeholders in the agricultural sector. A project website, project reports, conference papers, journal articles and an executive summary document are being used to disseminate the findings to different audiences. Implications for policy and practice Based on our findings there is a need for: • An enabling environment that is responsive to farmers’ needs, with clear, consistent and long-term policy signals about the future of agriculture, to allow them time to adapt to changing demands. • Improved connections between farmers and consumers. • Greater awareness amongst policy makers, regulators, scientists and the supermarkets, of what farmers can and cannot do. • Independent, trustworthy, sources of research and advice for farmers. • The valuing of farmers’ informal learning from experience, for example in the shaping of agricultural research. The following features are among those that would most improve the systems of support available to farmers in their decisions about new technologies: • horizon-scanning on behalf of farmers, to synthesise information, look at the potential of new technologies, and develop clear long-term directions for agriculture • government-sponsored intermediaries qualified in and knowledgeable about agriculture, to improve the links between government policies, scientific research and the grassroot

Feasibility of a structured group education session to improve self-management of blood pressure in people with chronic kidney disease: an open randomised pilot trial

Objectives: We aimed to test, at pilot level, a structured group educational intervention to improve self-management of blood pressure in people with chronic kidney disease (CKD). The current paper explores patient acceptability of the intervention. Design: This was an open randomised pilot trial. Participants were randomly assigned to either: ● A control group (n=41) receiving standard clinical management of hypertension. ● An intervention group (n=40) receiving standard clinical care plus the educational intervention. Setting: Renal outpatient clinics at a single study centre. Participants: Patients with early CKD and hypertension were identified and approached for recruitment. Intervention: An evidence-based structured group educational intervention (CHEERS) using the principles of social cognitive theory to improve knowledge and self-management skills. Outcomes: Recruitment, uptake of the intervention and patient satisfaction were evaluated to explore patient acceptability of the intervention and to determine any differences between patients regarding recruitment and retention. Measures: Data on age, sex and ethnicity were collected for all patients approached to take part. For recruited patients, data were also collected on self-efficacy (ability to self-manage). Reasons given by patients declining to take part were recorded. Patients attending the educational session also completed an evaluation form to assess satisfaction. Results: A total of 267 patients were approached, and 30% were randomly assigned. Lack of time (48%) and lack of interest (44%) were the main reasons cited for non-participation in the study. Men were significantly more likely to be recruited (p=0.048). The intervention was rated enjoyable and useful by 100% of participants. However, 37.5% of the intervention group failed to attend the educational session after recruitment. Participants failing to attend were significantly more likely to be older (p=0.039) and have lower self-efficacy (p=0.034). Conclusion: The findings suggest that delivering and evaluating an effective structured group educational intervention to promote better blood pressure control in patients with CKD would be challenging in the current context of kidney care

Population aging and heat exposure in the 21st century: which U.S. regions are at greatest risk and why?

BACKGROUND AND OBJECTIVES: The co-occurring trends of population aging and climate change mean that rising numbers of U.S. older adults are at risk of intensifying heat exposure. We estimate county-level variations in older populations' heat exposure in the early (1995-2014) and mid (2050) 21st century. We identify the extent to which rising exposures are attributable to climate change versus population aging. RESEARCH DESIGN AND METHODS: We estimate older adults' heat exposure in 3,109 counties in the 48 contiguous U.S. states. Analyses use NASA NEX Global Daily Downscaled Product (NEX-GDDP-CMIP6) climate data and county-level projections for the size and distribution of the U.S. age 69+ population. RESULTS: Population aging and rising temperatures are documented throughout the United States, with particular "hotspots" in the Deep South, Florida, and parts of the rural Midwest. Increases in heat exposure by 2050 will be especially steep in historically colder regions with large older populations in New England, the upper Midwest, and rural Mountain regions. Rising temperatures are driving exposure in historically colder regions, whereas population aging is driving exposure in historically warm southern regions. DISCUSSION AND IMPLICATIONS: Interventions to address the impacts of temperature extremes on older adult well-being should consider the geographic distribution and drivers of this exposure. In historically cooler areas where climate change is driving exposures, investments in warning systems may be productive, whereas investments in health care and social services infrastructures are essential in historically hot regions where exposures are driven by population aging.U.S. Department of Energy; Office of Science; Biological and Environmental Research Program; Earth and Environmental Systems Modeling; DE-SC0022141 - MultiSector Dynamics under Cooperative Agreementhttps://academic.oup.com/gerontologist/advance-article/doi/10.1093/geront/gnad050/7146279Published versio

Nursing workload measures and case-mix: an investigation of the reliability and validity of nursing workload measures

The general aim of this one-year project, funded by the Department of Health and in collaboration with CASPE, has been to investigate the relationship between case-mix and nursing workload measures. Specifically, this report focuses on the underlying issue of examining methodologies and instruments used for measuring workload and the assessment of the sensitivity of chosen measures. The relationship between diagnosis and the process of outcome of patient care is also described at the individual patient level and the overall relationship of case-mix and nursing workload is explored at ward level. The rationale for the choice of Nursing Workload Management Systems (NWMs) and the study design adopted to assess the NWMs chosen is described. Thus, data were collected on three wards over a 6-day period to generate workload estimates, actual nursing hours worked, case-mix (DRG) information, and outcome measurement, The intra-system differences described focus on the financial implications of the choice of parameters used to generate workload estimates. Inter-system differences are described in terms of comparison with actual hours worked and the financial implications of over- and under- staffing estimates. Although the correlations between workload estimates are high, there are variations which loosely reflect other known differences between the NWMs. Correlations between workload estimates of over-staffing, per capita hours paid, case-mix and outcome measurement were low, showing that there was little difference between three of the NWMs (FIP, EXCELCARE and SENS) and confirming that the Criteria for Care behaved differently. Analysis at an individual case level was conducted to see whether it was necessary to take account of diagnostic group. This suggested that there was a relationship between the main diagnostic group and the quality and outcome of patient care even after taking into account the strong association between diagnostic group and patient dependency levels, although this relationship disappeared after taking ward effect into account. The overall conclusion reached is that the NWMs reviewed produced inconsistent and unreliable estimates of nursing workload. These estimates also make insufficient allowance for the skill-mix manipulation required to deliver good quality care. Recommendations are made based on these findings.case-mix, nursing, workload, skill mix

Research on the Experience of Staff With Disabilities Within the NHS Workforce

This is the report of a quantitative research project commissioned by NHS England, focusing on the experiences of staff with disabilities working within the NHS, drawing upon two national data sets: • The 2014 NHS staff survey, completed by 255,000 staff, reporting their experiences of working in the NHS • The Electronic Staff Record (ESR), comprising data on the entire NHS workforce, gathered for workforce planning, personnel and wage payment purposes. The research tender required a focus on the following issues: a. What is staff with disabilities’ representation at all levels of the NHS and covering different types of disability? b. Why is there a disparity between the proportion of staff who declare a disability on the Electronic Staff Record System and of those who declare a disability on the anonymous NHS staff survey? c. How well are staff supported who become disabled during the course of their employment? Is there a process for recording this on the staff survey? d. What are appraisal rates for staff with disabilities compared to non-disabled staff? e. Do staff with disabilities have similar levels of access to training and development as non-disabled staff? f. How well do NHS organisations make reasonable adjustments for staff with disabilities, from the recruitment process to the end of employment? g. What difference does the ‘two ticks’ symbol make to recruitment and employment? h. What are the numbers of staff with disabilities who are the subject of employment processes and procedures, for example disciplinary and capability processes? i. What are the turn-over, retention and stability rates for staff with disabilities within the NHS? The key findings were: Staff with disabilities’ representation at all levels of the NHS and covering different types of disability Levels of reported disability are around 17% in the NHS Staff survey, and around 3% in the ESR. Neither data set allows for more specific analysis between different types or degrees of disability. The most likely reasons for the disparity between reported levels of disability are: 1. Differences in definition of disability used in the two data sets 2. Differing conditions for self-disclosure (NHS staff survey is anonymous) 3. Time of disclosure (ESR reports disability at the time of staff appointment, and is not reliably updated) Differences in quality of support between staff with and without disabilities There was not a specific survey question that addressed this issue, but it was possible to identify a number of questions that the report argues can be taken as acting as ‘indicators’: What are the levels of bullying and harassment?; How far do staff feel ‘Pressure to work when feeling unwell’?; Do staff feel their organisation acts fairly with regard to career progression? Relative to non-disabled staff, staff with disabilities felt more bullied, in particular from their managers (12 percentage points more); more pressure to work when feeling unwell (11 percentage points more); and less confident that their organisation acts fairly with regard to career progression (8 points difference). The report concludes that, relative to non-disabled staff, staff with disabilities rate themselves as substantially less well supported. Appraisal rates Rates of appraisal between staff with and without disabilities were broadly comparable. However there were substantial differences in how the value of appraisal was rated. Staff with disabilities are less satisfied with the effects of their appraisal. 7 percentage points fewer felt that appraisals improved their performance. Moreover, 9 percentage points more disabled staff report that their appraisal left them feeling that their work is not valued by their organisation. Experience of training The NHS staff survey indicates that most staff had training within the last 12 months and only 5 - 25% staff received no training in each specified topic. There is very little disparity between disabled and non-disabled staff in the proportion not receiving training in any of the topics, or in their satisfaction with the training. Reasonable adjustments The NHS Staff survey asks if ‘employer has made adequate adjustment(s) to enable you to carry on your work’. 40% respond ‘Yes’, 14% ‘No’ and 46% ‘No adjustment required’. The proportion responding ‘No’ varies substantially depending on the Trust involved, from a low of 5% to a high of 41%. The proportion also varies by ethnicity, with white British staff with disabilities expressing the lowest rate of dissatisfaction with the adjustments their employer made, while all other ethnic categories have consistently higher rates. The relatively small groups of Bangladeshi and ‘Other black background’ staff have the highest rates of dissatisfaction. Job satisfaction Staff with disabilities rate themselves as more dissatisfied with the recognition, support, responsibility and opportunities they have in their jobs, even though there is no difference in the satisfaction they report in the quality of care they give to patients. Staff with disabilities felt less recognised for their good work undertaken (8 percentage points fewer); they felt less supported by their immediate managers (5 percentage points fewer); they felt less supported by their work colleagues (3 percentage points fewer); they were more dissatisfied with the levels of responsibility they had been given (4 percentage points fewer); they felt they had less opportunity to use their skills (5 percentage points fewer); and finally, they were substantially less satisfied with their level of remuneration, and they thought they were valued less highly by their organisation for the contribution they were making (both 9 percentage points fewer). What difference does the ‘two ticks’ symbol make to recruitment and employment? The evidence from previous studies suggests that the Two Ticks award does not make a great deal of difference in terms of an organisation’s awareness of disability issues or in its capacity to address any inequalities or inadequacies in practice. We found in our study that the great majority of Trusts now have ‘Two Tick’ status. Using the NHS Jobs website, Trust websites and other evidence available online, as well as a DWP list, an estimate was made of the current ‘Two Ticks’ status of every Trust. 18 of 244 (7%) Trusts were found to not have the award. A comparison was made between Trusts with and without the ‘Two Ticks’ award of the extent to which staff who declare a disability report that their employer failed to make ‘adequate adjustments’ to enable them to carry out their work. Although in our study, there was a consistent finding that Trusts that have the ‘Two Ticks’ award have marginally higher average rates of ‘adequate adjustments’ reported by staff with disabilities, the difference is small, the number of ‘No award’ Trusts is small (just 1 in the case of Ambulance and Community Trusts) and the range among all Trusts is very large (from 5% to 41 %). Given also that the overall performance of Trusts was poor with respect to a variety of issues summarized above, such as levels of bullying and harassment, impact of appraisal etc., it would seem that ‘Two Ticks’ status achieves relatively little in terms of improved performance against these metrics