Global Research Priorities to Better Understand the Burden of Iatrogenic Harm in Primary Care: An International Delphi Exercise

There is a need to identify and reach agreement on key foci for patient safety research in primary care contexts and understand how these priorities differ between low-, middle-, and high-income settings. We conducted a modified Delphi exercise, which was distributed to an international panel of experts in patient safety and primary care. Family practice and pharmacy were considered the main contexts on which to focus attention in order to advance patient safety in primary care across all income categories. Other clinical contexts prioritised included community midwifery and nursing in low-income countries and care homes in high-income countries. The sources of patient safety incidents requiring further study across all economic settings that were identified were communication between health care professionals and with patients, teamwork within the health care team, laboratory and diagnostic imaging investigations, issues relating to data management, transitions between different care settings, and chart/patient record com- pleteness. This work lays the foundation for a range of research initiatives that aim to promote a more comprehensive appreciation of the burden of unsafe primary care, develop understanding of the main areas of risk, and identify interventions that can enhance the safety of primary care provision internationall

Lost in space? The role of place in the delivery of social welfare law advice over the telephone and face-to-face

Advice that is provided exclusively over the telephone has been promoted by government as more convenient and accessible than face-to-face appointments. The resulting push towards telephone-only provision, as implemented by the Legal Aid, Sentencing and Punishment of Offenders Act 2012, challenges the long history of association between social welfare law advice and local delivery within disadvantaged communities. This article reports on qualitative research comparing telephone and face-to-face advice which uncovers the continuing relevance of place in the dynamics and mechanics of social welfare law provision. Familiarity with the geographical location, knowledge of local policies and procedures, relationships with opponents and allies, and an understanding of the ‘local legal culture’ mean that face-to-face advisers are often able to conduct their legal casework more effectively. Conversely, local knowledge is unlikely to be available to Community Legal Advice telephone advisers. This research suggests that, in addition, telephone-only advisers may be developing a more narrow understanding of the essential qualities of casework. These findings are particularly significant in view of the likely future expansion of remote methods of delivery in legal aid work

Performance of public private partnerships: an evolutionary perspective

PPPs are held to be a powerful way of mobilising private finance and resources to deliver public infrastructure. Theoretically, research into procurement has begun to acknowledge difficulties with the classification and assessment of different types of procurement, particularly those which do not sufficiently acknowledge variety within specific types of procurement methods. This paper advances a theoretical framework based on an evolutionary economic conceptualisation of a routine, which can accommodate the variety evident in procurement projects, in particular PPPs. The paper tests how the various elements of a PPP, as advanced in the theoretical framework, affect performance across 10 case studies. It concludes, that a limited number of elements of a PPP affect their performance, and provides strong evidence for the theoretical model advanced in this paper