The Frontier Framework (and its eight Frontier Archetypes): A new conceptual approach to representing staff and patient well-being in health systems.

This paper proposes a new conceptual framework for jointly analysing the production of staff and patient welfare in health systems. Research to date has identified a direct link between staff and patient well-being. However, until now, no one has produced a unified framework for analysing them concurrently. In response, this paper introduces the "Frontier Framework". The new conceptual framework is applicable to all health systems regardless of their structure or financing. To demonstrate the benefits of its use, an empirical example of the Frontier Framework is constructed using data from the UK's National Health Service. This paper also introduces eight "Frontier Archetypes", which represent common patterns of welfare generation observable in health organisations involved in programmes of change. These archetypes may be used in planning, monitoring or creating narratives about organisational journeys

Evolutionary approaches to the concept of drift in policy studies

Within the important seam of policy studies dedicated to understanding how institutions and policies change over time, attention is increasingly being paid to cataloguing patterns of change in the absence of ‘big’. The concept of policy drift has been widely referenced in this line of work as an intuitively appealing label for an empirical pattern seemingly observed across many different policy sectors. Although evolutionary approaches are not explicitly acknowledged in this line of inquiry, in this paper we argue that they have much to contribute. First, evolutionary thinking helps clarify drift as a distinct concept from those which are often co-listed as competitors for the analysis of cumulative, sub-surface and endogenous policy change: displacement, layering, conversion or exhaustion. Second, an evolutionary approach casts light on the role of agency in drift sequences, something poorly understood and articulated in the drift literature. It remains unclear whether policy drift should be understood as something caused directly by a political strategy employed by an influential policy actor, or, rather, as a policy sequence that is unintended by any actor in the policy process. This paper presents the argument, using an evolutionary metaphor, that it is the latter, leaving an important but necessarily separate question of the agency of policy actors: to recognise their interests in, and capacity to develop, appropriate responses to the consequences of policy drift. The third contribution of the evolutionary metaphor is to this question of agency: it extends the existing drift literature beyond a simple dichotomy of maintaining or reversing drift by identifying acclimatisation and adaptation as distinct responses to drift in the policy environment. The paper is structured to develop the argument that the nascent literature on evolutionary approaches in policy studies can help bolster our understanding of drift

Developing the evidence-base for school sex education programmes: Contributions of an augmented Theory of Planned Behaviour, gender and school year across three contraceptive methods

Background Positive adolescent sexual health is supported by effective school based sex education. Methods to promote positive sexual health need to reflect determinants of contraception intention, which must include understanding gender and age (year group) differences. To date, there has been limited theory-based exploration of these determinants in school-age participants, placing limitations on sexual health educators to tailor learning most effectively. MethodsCross sectional survey data was collected from UK school pupils (N = 1378) aged 12-16 years. Measures included Theory of Planned Behaviour, Prototype Willingness, anticipated regret and knowledge items. Linear regression determined significant predictors of intention to use condoms, the oral contraceptive pill and the emergency contraceptive pill. t-tests and ANOVAs were used to assess differences by gender and school year. ResultsThree distinct predictive models emerged for condom, pill and EC, predicting 36%, 18% and 23% variance respectively. Attitude, gender and anticipated regret for unprotected sex significantly predicted intention for all types (p<.001). The influence of other explanatory variables differed by contraceptive. Girls scored higher on all variables except condom intention, and intention scores peaked in year 10. ConclusionCondoms, pill and EC intention have different predictive profiles, with girls more strongly motivated and year 10 a crucial stage for intention. Social comparisons and control beliefs exert differential effects across contraceptive types whilst attitudes and anticipated regret are consistently strong influences. Findings suggest clear scope for supporting sexual health and wellbeing through modified school sex education

Infodemic now: how do we know when the news is fake?

The COVID-19 crisis is exacerbated by the infodemic that ensued – false information about the virus is spreading rapidly worldwide. But how do we know when the news is fake, ask Darrin Baines (Bournemouth University) and Rob Elliott (Birmingham Business School)

Political, process and programme failures in the Brexit fiasco: exploring the role of policy deception

We propose a conceptual framework of policy deception to help identify, analyse and explain Brexit as a policy fiasco. The framework casts light on the political use of the device of an in/out European Union (EU) referendum by David Cameron. The paper develops the argument that the referendum did not offer a binary choice between two policy options for the United Kingdom's (UK) relationship with the EU representing different, but commensurable preferences, because one option was 'baseless' in that it was unfounded in any policy analysis. The label of policy deception usefully reveals that many of the political, process and programme failures at the heart of the Brexit fiasco have their roots in the referendum. We conclude that the concept of policy deception contributes usefully to emerging work on why the Brexit policy fiasco occurred, and is likely to be a fruitful topic for future work

Underage drinking as a natural part of growing up: a UK study of parental beliefs.

Purpose: Parental beliefs about underage drinking are known to influence the drinking behaviours of their children. The purpose of this paper is to explore parental beliefs about their own child drinking alcohol and young people in general, in order to ascertain whether there is a need to target such beliefs in the design of public health interventions. Design/methodology/approach: Parents of 11–18 year olds attending one of nine schools in the Midlands of England, UK were invited to take part. Participants completed a newly designed 40-item questionnaire measuring parental beliefs about the impact and causes of underage drinking; talking to their child about alcohol; and how much and how often they thought their child consumed alcohol. Findings: In total, 185 parents took part in the study, reporting on their eldest child aged 18 or under. The majority of parents agreed that underage drinking is detrimental to child health and wellbeing. However, over 60 per cent believed that alcohol consumption is a “natural part of growing up”, and stronger agreement with this belief was associated with higher parental reports of alcohol consumption in their children. Social implications: The majority of parents recognised the risks and negative effects of alcohol; however, many also believe it is a natural part of growing up. Parents may hold conflicting beliefs about underage drinking, which could impact on the drinking beliefs and behaviours of their children. Originality/value: Public health interventions may need to counter the common parental belief that underage drinking is a normal part of growing up and therefore to be expected. Clear messages about the impact parent beliefs and behaviour have on young people drinking, to ensure parents recognise that messages are aimed at themselves, and not just “other parents” are imperative

Portfolio frontier analysis: Applying mean-variance analysis to health technology assessment for health systems under pressure.

The COVID-19 pandemic is challenging how healthcare technologies are evaluated, as new, more dynamic methods are required to test the cost effectiveness of alternative interventions during use rather than before initial adoption. Currently, health technology assessment (HTA) tends to be static and a priori: alternatives are compared before launch, and little evaluation occurs after implementation. We suggest a method that builds upon the current pre-launch HTA procedures by conceptualizing a mean-variance approach to the continuous evaluation of attainable portfolios of interventions in health systems. Our framework uses frontier analysis to identify the desirability of available health interventions so decision makers can choose diverse portfolios based upon information about expected returns and risks. This approach facilitates the extension of existing methods and assessments beyond the traditional concern with pre-adoption data, a much-needed innovation given the challenges posed by COVID-19

The Fourth Industrial Revolution: Will it change pharmacy practice?

The industrial world is at the beginning of a Fourth Industrial Revolution (4IR). This era will radically change the human use of technology, with major implications for the ways people live and work. This commentary asks: will 4IR change pharmacy practice? The first three revolutions created the pharmaceutical industry and gave pharmacists a near-monopoly over drug supply. 4IR could do the opposite and create alternative, non-pharmaceutical means of treating patients as well reducing the involvement in medicines supply. If the pharmacy sector becomes stuck in traditional, linear thinking that assumes the future will be an extension of the past, then the fourth revolution may be less of an opportunity and more of a threat. The sector faces the "innovator's dilemma" when responding to 4IR. Should the pharmacy profession disrupt their current activities in order to: (i) do things better, (ii) do new things, and (iii) deter competition? To maintain its position in the medical marketplace, pharmacy needs to discover how to work with AI, robotics, IoT, autonomous vehicles, 3-D printing, nanotechnology, biotechnology, materials science, energy storage, and quantum computing. If the new game is understood, pharmacists may become the playmaster of tomorrow. If not, then the practice of pharmacy may be replaced by innovative new ways of meeting patient pharmaceutical needs