Design principles in housing for people with complex physical and cognitive disability: towards an integrated framework for practice

To develop a research-based environmental framework to guide the design and construction of suitable residential dwellings for individuals with complex disability. An environmental approach to housing design and development recognises that there are physical, psychological and social components relating to housing design, dwelling location and the neighbourhood context, and that these elements interact to affect the physical, psychological, and social wellness of individuals. Following theoretical review and synthesis, a comprehensive set of design features that are conducive to residents’ wellness and quality of life are described. It is clear that housing design and development for people with complex disability ought to consider the physical, social, natural, symbolic, and care environment in relation to housing design, dwelling location, and the neighbourhood context for improved housing outcomes. An integrated housing design and development framework is presented. It is hoped this practical matrix/evaluative tool will inform future inclusive housing design and development decisions in Australia and internationally. The application of this framework is especially relevant to political climates striving to achieve design innovation to increase housing choice for people with complex disability

A realist analysis of hospital patient safety in Wales:Applied learning for alternative contexts from a multisite case study

Background: Hospital patient safety is a major social problem. In the UK, policy responses focus on the introduction of improvement programmes that seek to implement evidence-based clinical practices using the Model for Improvement, Plan-Do-Study-Act cycle. Empirical evidence that the outcomes of such programmes vary across hospitals demonstrates that the context of their implementation matters. However, the relationships between features of context and the implementation of safety programmes are both undertheorised and poorly understood in empirical terms. Objectives: This study is designed to address gaps in conceptual, methodological and empirical knowledge about the influence of context on the local implementation of patient safety programmes. Design: We used concepts from critical realism and institutional analysis to conduct a qualitative comparative-intensive case study involving 21 hospitals across all seven Welsh health boards. We focused on the local implementation of three focal interventions from the 1000 Lives+ patient safety programme: Improving Leadership for Quality Improvement, Reducing Surgical Complications and Reducing Health-care Associated Infection. Our main sources of data were 160 semistructured interviews, observation and 1700 health policy and organisational documents. These data were analysed using the realist approaches of abstraction, abduction and retroduction. Setting: Welsh Government and NHS Wales. Participants: Interviews were conducted with 160 participants including government policy leads, health managers and professionals, partner agencies with strategic oversight of patient safety, advocacy groups and academics with expertise in patient safety. Main outcome measures: Identification of the contextual factors pertinent to the local implementation of the 1000 Lives+ patient safety programme in Welsh NHS hospitals. Results: An innovative conceptual framework harnessing realist social theory and institutional theory was produced to address challenges identified within previous applications of realist inquiry in patient safety research. This involved the development and use of an explanatory intervention–context–mechanism–agency–outcome (I-CMAO) configuration to illustrate the processes behind implementation of a change programme. Our findings, illustrated by multiple nested I-CMAO configurations, show how local implementation of patient safety interventions are impacted and modified by particular aspects of context: specifically, isomorphism, by which an intervention becomes adapted to the environment in which it is implemented; institutional logics, the beliefs and values underpinning the intervention and its source, and their perceived legitimacy among different groups of health-care professionals; and the relational structure and power dynamics of the functional group, that is, those tasked with implementing the initiative. This dynamic interplay shapes and guides actions leading to the normalisation or the rejection of the patient safety programme. Conclusions: Heightened awareness of the influence of context on the local implementation of patient safety programmes is required to inform the design of such interventions and to ensure their effective implementation and operationalisation in the day-to-day practice of health-care teams. Future work is required to elaborate our conceptual model and findings in similar settings where different interventions are introduced, and in different settings where similar innovations are implemented. Funding: The National Institute for Health Research Health Services and Delivery Research programme

The strange geography of health inequalities

Place is undoubtedly relevant to health, and geography is a central character in the story of how rich societies handle inequalities in death and disease. But the text is incomplete, its scope limited by a too-delicate encounter between research and policy, and by a strange subdisciplinary divide. Accounts of the geography in health inequalities are largely, albeit subtly, locked into 'context'. They document the complex extent to which different (material, social and cultural) environments undermine or enhance resilience. They tell the tale of risky places. Our complementary narrative is written around the findings of qualitative 'compositional' research. It is about the way health itself is drawn into the structuring of society and space. This geography is a map of health discrimination, illustrated in the processes of selective placement, entrapment and displacement. By drawing attention to the 'healthism' of politics and policy in 'care-less' competition economies, this enlarged perspective might enhance the role of geography (and geographers) in both understanding and managing health inequalities

Housing for health: can the market care?

For over two decades British public policy has been fuelled by the notion that markets are the most effective way to accumulate and distribute resources. Such markets are driven by price, respond to ability to pay, and are not, for the most part, seen as having a welfare role. Using the example of housing, and drawing on lay experiences of ill health, the authors suggest that British households do, nevertheless, look to markets (in this example, to owner-occupation) to meet some welfare needs. Households value, in particular, the qualities of flexibility and security which they associate with homeownership and which promise both practical and psychosocial gains. However, there is a notable gap between what people aspire to and what they can achieve. This arises not because markets cannot care but because, so far, there has not been sufficient political imagination to make them do so

Housing for health:the role of owner occupation

Housing is widely regarded as playing an important role in the mediation and management of health inequalities. British policy-makers are increasingly looking to the research community to specify what it is about housing environments that impact on health, and to identify what housing interventions constitute healthy public policies. To feed into this debate, this paper begins by reviewing the state of the art of research on housing and health. It shows that the majority of work continues to focus on how housing affects health, while the limited attention to how health status affects housing outcomes has concentrated on medical priority for rehousing in the public sector. It is argued, however, that the market sector now merits closer scrutiny among those concerned with the health selectivity of the housing system. Drawing on a series of qualitative interviews, questions are raised about: how readily people with health problems and mobility difficulties gain access to owner occupation; how easily they sustain a position in that tenure sector; and how effective they are in maintaining their homes as healthy enabling living environments

Housing for health: does the market work?

Markets are mechanisms for distributing goods and services according to people's ability to pay. They are also investment vehicles which can be used to secure financial gains as economies expand. Housing markets embrace both these features, and are popular in Britain as a way of maximising residential choice at the same time as protecting and enhancing personal wealth. All markets create winners and losers, but no systematic social differences in either risks or gains are expected. However, this paper shows that, as home ownership has become the British housing norm, people experiencing ill-health are one social group who can struggle to reap its benefits, either as a consumption good or as a financial asset. The way housing markets (currently) work may therefore tend to reinforce the health divide, though this is neither a necessary nor inevitable state of affairs

Housing for health: does the market work?

Markets are mechanisms for distributing goods and services according to people's ability to pay. They are also investment vehicles which can be used to secure financial gains as economies expand. Housing markets embrace both these features, and are popular in Britain as a way of maximising residential choice at the same time as protecting and enhancing personal wealth. All markets create winners and losers, but no systematic social differences in either risks or gains are expected. However, this paper shows that, as home ownership has become the British housing norm, people experiencing ill-health are one social group who can struggle to reap its benefits, either as a consumption good or as a financial asset. The way housing markets (currently) work may therefore tend to reinforce the health divide, though this is neither a necessary nor inevitable state of affairs.