39 research outputs found

    The 2015 Garrod Lecture:why is improvement difficult?

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    The pressing need to measure and improve antibiotic use was recognized.40 years ago, so why have we failed to achieve sustained improvement at scale? In his 2014 Reith Lectures about the future of medicine, the US surgeon Atul Gawande said that failure in medicine is largely due to ineptitude (failure to use existing knowledge) rather than ignorance (lack of knowledge). Consequently, it is notable that most interventions to improve antimicrobial prescribing are either designed to educate individual practitioners or patients about pol-icies or to restrict prescribing to make practitioners follow policies. Interventions that enable practitioners to apply existing knowledge through decision support, feedback and action planning are relatively uncommon. There is an urgent need to improve the design and reporting of interventions to change behaviour. However, achieving sustained improvement at scale will also require a more profound understanding of the role of con-text. What makes contexts receptive to change and which elements of context, under what circumstances, are important for human performance? Answering these questions will require interdisciplinary work with social scientists to integrate complementary approaches from human factors and ergonomics, improvement science and educational research. We need to rethink professional education to embrace complexity and enable teams to learn in practice. Workplace-based learning of improvement science will enable students and early-career professionals to become change agents and transform training from a burden on clinical teams into a driver for improvement. This will make better use of existing resources, which is the key to sustainability at scale

    The UK's exit charge from the EU: insights from modes of accounting

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    Whatever the final charge on the UK for leaving the EU, the money itself is relatively marginal to the former's public finances. However, this charge is politically sensitive and financially aggravating during one of the longest periods of fiscal austerity in the UK's history. The ways in which leaving is conceptualized have implications for any continuing financial obligations that must be managed within the context of fiscal austerity and political uncertainty. Yet, leaving the EU is a unique transaction: it is not analogous, for example, to a divorce settlement, the leaving of a club, the termination of a commercial contract, the leaving of a treaty‐based international organization, or secession from a state. Analysing the formulation of the charge in terms of the four modes of government accounting—financial reporting, statistical accounting, budgeting, and fiscal sustainability projections—enhances its fiscal transparency. It evidences not only the weakness and inconsistency of the UK's negotiating position but also the dominance in EU thinking of the short‐term budgetary calculations of the 2014–20 Multiannual Financial Framework over its long‐term sustainability without a large net contributor. The final amount paid by the UK will depend on the resolution of competing perspectives as well as on liabilities and contingent liabilities associated with the increasingly complex EU financial architecture

    Score a goal for climate: Assessing the carbon footprint of travel patterns of the English Premier League clubs

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    Football is the most popular sport, globally and in the United Kingdom. However it generates a range of negative environmental impacts, such as climate change, due to an extensive amount of travel involved. The growing contribution of football clubs to the global carbon footprint has been recognised, but never consistently assessed. This study assesses the carbon footprint of the English Premier League (EPL)clubs, using the patterns of their domestic travel in the 2016/2017 season as a proxy for analysis. The study shows that, within the 2016/17 season, the EPL clubs produced circa 1134 tonnes of CO 2- eq. as a result of their travel, where transportation accounts for 61% of the carbon footprint. To reduce this carbon footprint, a careful review of the current corporate travel and procurement practices in the EPL clubs is necessary. This is in order to optimise the travel itineraries, prioritise more climate-benign modes of transport and contract budget accommodation providers with the ‘green’ credentials
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