Clinical governance: striking a balance between checking and trusting

Clinical governance emerged as one of the big ideas central to the latest round of health reforms. It places with health care managers, for the first time, a statutory duty for quality of care on an equal footing with the pre-existing duty of financial responsibility (Warden 1998). Clinical governance tries to encourage an appropriate emphasis on the quality of clinical services by locating the responsibility for that quality along defined lines of accountability. This paper explores some of the implications of clinical governance using the economic perspective of principal-agent theory. It examines the ways in which principals seek to overcome the potential for agent opportunism either by reducing asymmetries of information (for example, by using performance data) or by aligning objective functions (for example, by creation of a shared quality culture). As trust and mutuality (or their absence) underpin all principal-agent relationships these issues lie at the heart of the discussion. The analysis emphasises the need for a balance between techniques that seek to compel performance improvements (through externally applied measurement and management), and approaches that trust to intrinsic professional motivation to deliver high quality services. Of crucial importance in achieving this balance is the creation and maintenance of the right organisational culture.governance

Doppler lidar observations of sensible heat flux and intercomparisons with a ground-based energy balance station and WRF model output

This is an open access article - Copyright @ 2009 E. Schweizerbart'sche VerlagsbuchhandlungDuring the Convective and Orographically induced Precipitation Study (COPS), a scanning Doppler lidar was deployed at Achern, Baden-Wüttemberg, Germany from 13th June to 16th August 2007. Vertical velocity profiles ('rays') through the boundary layer were measured every 3 seconds with vertical profiles of horizontal wind velocity being derived from performing azimuth scans every 30 minutes. During Intense Observation Periods radiosondes were launched from the site. In this paper, a case study of convective boundary layer development on 15th July 2007 is investigated. Estimates of eddy dissipation rate are made from the vertically pointing lidar data and used as one input to the velocity-temperature co-variance equation to estimate sensible heat flux. The sensible heat flux values calculated from Doppler lidar data are compared with a surface based energy balance station and output from the Weather Research and Forecasting (WRF) model.Funding is obtained from NER

Adapting Social Design Research Methods for Socially Distanced Practice

Social Design Research, due to its interactive and democratic nature, typically requires access to participants at all stages of the Design process (enquiry, insight gathering, ideation, and testing). This ensures that the designers’ practice is informed with contextual knowledge gained through relationship-building and ethnography, which are key features of Social Design Research [1]. Due to the impact of the COVID-19 pandemic, the delivery of Design education, and the approaches taken by lecturers and students had to adapt. The methods, attitudes and approaches to Design research and practice have evolved due to these changes due to the use of newly adopted digital collaborative environments. This paper presents the adaptations to existing Social Design Research methods and new ones which have been generated by the students through the undertaking of a project aimed at designing for social value delivered to first year Product Design students at the University of Derby

Are Recent Peculiar Velocity Surveys Consistent?

We compare the bulk flow of the SMAC sample to the predictions of popular cosmological models and to other recent large-scale peculiar velocity surveys. Both analyses account for aliasing of small-scale power due to the sparse and non-uniform sampling of the surveys. We conclude that the SMAC bulk flow is in marginal conflict with flat COBE-normalized Lambda-CDM models which fit the cluster abundance constraint. However, power spectra which are steeper shortward of the peak are consistent with all of the above constraints. When recent large-scale peculiar velocity surveys are compared, we conclude that all measured bulk flows (with the possible exception of that of Lauer & Postman) are consistent with each other given the errors, provided the latter allow for `cosmic covariance'. A rough estimate of the mean bulk flow of all surveys (except Lauer & Postman) is ~400 km/s towards l=270, b=0.Comment: 8 pages, 3 figures. To appear in Proceedings of the Cosmic Flows Workshop, Victoria, B. C., Canada, July 1999, eds. S. Courteau, M. Strauss, and J. Willic

A Logical Approach to Reasoning by Analogy

We analyze the logical form of the domain knowledge that grounds analogical inferences and generalizations from a single instance. The form of the assumptions which justify analogies is given schematically as the "determination rule", so called because it expresses the relation of one set of variables determining the values of another set. The determination relation is a logical generalization of the different types of dependency relations defined in database theory. Specifically, we define determination as a relation between schemata of first order logic that have two kinds of free variables: (1) object variables and (2) what we call "polar" variables, which hold the place of truth values. Determination rules facilitate sound rule inference and valid conclusions projected by analogy from single instances, without implying what the conclusion should be prior to an inspection of the instance. They also provide a way to specify what information is sufficiently relevant to decide a question, prior to knowledge of the answer to the question