Integrating policy and practice in healthcare

There are national and local concerns about a policy-practice gap in healthcare services which bring into question the effectiveness of traditional mechanisms for policy implementation. Using clinical governance as a focus, this report describes the rationale, development and evaluation of an alternative approach designed to integrate health policy with practice within a Mental Health and Learning Disability NHS Trust through a programme of social opportunities. A number of methodological compromises were made due to the pragmatic nature of the project and limited availability of resources to undertake the evaluation. Not all disciplines and services were involved in the approach so different methods may be needed to engage these groups. However, the potential impact of the process for local policy, practice and aspects of practice culture has been critically evaluated using a framework for policy analysis and mixed methods for implementation, data collection and analysis. The findings suggest that the intervention was successful in providing an opportunity for practitioners to meet, network and discuss policy and practice issues and virtually all attendees valued the opportunity to participate. Contextually, the key focus was on meeting the needs of different client groups, i.e. working age adults, older people, children and people with a learning disability. Generally, all practitioners value the principles of user-centred, safe and effective practice that underpin national policy although some are valued more than others and practice in all areas can be improved. Personal responsibility is accepted and satisfactory levels of support are available and accessed. However, culturally there is evidence of conflict created by perceived differences between practitioner and organisational values, increased workload without added value and a need for improved interdisciplinary working and better service integration. This is particularly evident in the adult community mental health services. A theoretical model and process to integrate policy and practice is presented that needs embedding within an organisational approach to learning that provides supportive structures, processes and cultures requiring time, leadership and management commitment. Recommendations are made for the dissemination of findings, further development and testing of the theoretical model and process

Health Care and Change Management in the Context of Prisons: Rapid reviews of the literature in two parts

First paragraph: The literature review of factors promoting or inhibiting change finds that there is no unified science of change management and that there is a general lack of empirical evidence across the board about change management in all domains of human industry. - We have proposed a general five-level evidence framework that can be used to categorise broadly the quality of evidence for and commission research into prison management. - We argue that proposals for change should be subjected to a formal decision making process in keeping with good practice in decision making in which alternatives to the proposed change are also evaluated. - We find that change can occur to structures, processes, outcomes and people (table 6) in planned or unintended ways, gradually or radically. - Despite the lack of empirical evidence we find that there is a broad consensus on the features of successful change management approaches

Methodological Framework for Analysis of Buildings-Related Programs with BEAMS, 2008

The U.S. Department of Energy’s (DOE’s) Office of Energy Efficiency and Renewable Energy (EERE) develops official “benefits estimates” for each of its major programs using its Planning, Analysis, and Evaluation (PAE) Team. PAE conducts an annual integrated modeling and analysis effort to produce estimates of the energy, environmental, and financial benefits expected from EERE’s budget request. These estimates are part of EERE’s budget request and are also used in the formulation of EERE’s performance measures. Two of EERE’s major programs are the Building Technologies Program (BT) and the Weatherization and Intergovernmental Program (WIP). Pacific Northwest National Laboratory (PNNL) supports PAE by developing the program characterizations and other market information necessary to provide input to the EERE integrated modeling analysis as part of PAE’s Portfolio Decision Support (PDS) effort. Additionally, PNNL also supports BT by providing line-item estimates for the Program’s internal use. PNNL uses three modeling approaches to perform these analyses. This report documents the approach and methodology used to estimate future energy, environmental, and financial benefits using one of those methods: the Building Energy Analysis and Modeling System (BEAMS). BEAMS is a PC-based accounting model that was built in Visual Basic by PNNL specifically for estimating the benefits of buildings-related projects. It allows various types of projects to be characterized including whole-building, envelope, lighting, and equipment projects. This document contains an overview section that describes the estimation process and the models used to estimate energy savings. The body of the document describes the algorithms used within the BEAMS software. This document serves both as stand-alone documentation for BEAMS, and also as a supplemental update of a previous document, Methodological Framework for Analysis of Buildings-Related Programs: The GPRA Metrics Effort, (Elliott et al. 2004b). The areas most changed since the publication of that previous document are those discussing the calculation of lighting and HVAC interactive effects (for both lighting and envelope/whole-building projects). This report does not attempt to convey inputs to BEAMS or the methodology of their derivation

Analyzing the Life Cycle Energy Savings of DOE Supported Buildings Technologies

This report examines the factors that would potentially help determine an appropriate analytical timeframe for measuring the U.S. Department of Energy's Building Technology (BT) benefits and presents a summary-level analysis of the life cycle savings for BT’s Commercial Buildings Integration (CBI) R&D program. The energy savings for three hypothetical building designs are projected over a 100-year period using Building Energy Analysis and Modeling System (BEAMS) to illustrate the resulting energy and carbon savings associated with the hypothetical aging buildings. The report identifies the tasks required to develop a long-term analytical and modeling framework, and discusses the potential analytical gains and losses by extending an analysis into the “long-term.

Renewable Electricity Futures Study. Volume 3. End-Use Electricity Demand

The Renewable Electricity Futures (RE Futures) Study investigated the challenges and impacts of achieving very high renewable electricity generation levels in the contiguous United States by 2050. The analysis focused on the sufficiency of the geographically diverse U.S. renewable resources to meet electricity demand over future decades, the hourly operational characteristics of the U.S. grid with high levels of variable wind and solar generation, and the potential implications of deploying high levels of renewables in the future. RE Futures focused on technical aspects of high penetration of renewable electricity; it did not focus on how to achieve such a future through policy or other measures. Given the inherent uncertainties involved with analyzing alternative long-term energy futures as well as the multiple pathways that might be taken to achieve higher levels of renewable electricity supply, RE Futures explored a range of scenarios to investigate and compare the impacts of renewable electricity penetration levels (30%-90%), future technology performance improvements, potential constraints to renewable electricity development, and future electricity demand growth assumptions. RE Futures was led by the National Renewable Energy Laboratory (NREL) and the Massachusetts Institute of Technology (MIT)

Modeling EERE Deployment Programs

The purpose of this report is to compile information and conclusions gathered as part of three separate tasks undertaken as part of the overall project, “Modeling EERE Deployment Programs,” sponsored by the Planning, Analysis, and Evaluation office within the Department of Energy’s Office of Energy Efficiency and Renewable Energy (EERE). The purpose of the project was to identify and characterize the modeling of deployment programs within the EERE Technology Development (TD) programs, address improvements to modeling in the near term, and note gaps in knowledge where future research is needed

Lost Opportunities in the Buildings Sector: Energy-Efficiency Analysis and Results

This report summarizes the results and the assumptions used in an analysis of the potential “lost efficiency opportunities” in the buildings sector. These targets of opportunity are those end-uses, applications, practices, and portions of the buildings market which are not currently being addressed, or addressed fully, by the Building Technologies Program (BTP) due to lack of resources. The lost opportunities, while a significant increase in effort and impact in the buildings sector, still represent only a small portion of the full technical potential for energy efficiency in buildings

Impact of the FY 2009 Building Technologies Program on United States Employment and Earned Income

The Department of Energy (DOE) Office of Energy Efficiency and Renewable Energy (EERE) is interested in assessing the potential economic impacts of its portfolio of subprograms on national employment and income. A special purpose input-output model called ImSET is used in this study of 14 Building Technologies Program subprograms in the EERE final FY 2009 budget request to the Office of Management and Budget in February 2008. Energy savings, investments, and impacts on U.S. national employment and earned income are reported by subprogram for selected years to the year 2025. Energy savings and investments from these subprograms have the potential of creating a total of 258,000 jobs and about $3.7 billion in earned income (2007$) by the year 2025

Analysis of Radiation Doses from Operation of Postulated Commercial Spent Fuel Transportation Systems

This report contains a system study of estimated radiation doses to the public and workers resulting from the transport of spent fuel from commercial nuclear power reactors to a geologic repository. The report contains a detailed breakdown of activities and a description of time/distance/dose-rate estimates for each activity within the system. Collective doses are estimated for each of the major activities at the reactor site, in transit, and at the repository receiving facility. Annual individual doses to the maximally exposed individuals or groups of individuals are also estimated. A total of 17 alternatives and subalternatives to the postulated reference transportation system are identified, conceptualized, and their dose-reduction potentials and costs estimated. Resulting ratios of ..delta..cost/..delta..collective system dose for each alternative relative to the postulated reference transportation system are given. Most of the alternatives evaluated are estimated to provide both cost and dose reductions. Major reductions in transportation system dose and cost are estimated to result from using higher-capacity rail and truck casks, and particularly when replacing legalweight truck casks with ''advanced design'' overweight truck casks. The greatest annual dose reduction to the highest exposed individual workers (i.e., at the repository) is estimated to be achieved by using remote handling equipment for the cask handling operations at the repository. Additional shielding is also effective in reducing doses to both radiation workers at the reactor and repository and to transport workers. 69 refs., 36 figs., 156 tabs