Performance measurement for the strategic management of healthcare estates

Purpose The purpose of this study is to explore the role of performance measurement in current practices for strategic management of health-care estates. Design/methodology/approach The research adopts a constructivist grounded theory approach, combining different methodologies of a pan-European qualitative questionnaire, interviews with international health-care providers and a case study of National Health Services (NHS) Scotland. Here, documentation analysis, observations and in-depth interviews involving NHS stakeholders were undertaken. Findings The analysis shows evidence that measuring estate performance has limited value for individual NHS boards regarding strategic decisions related to long-term planning and investment. This was due to design issues and the prioritisation of clinical delivery, which contribute to the neglect of the estate as a consideration in long-term strategic planning. This misalignment results in a tool which is valuable for accountability but which is less helpful to NHS boards in shaping future decisions around the estate. Practical implications Responding to a gap in understanding of the application of performance measurement in the context of health-care estates, this research provides three recommendations to promote a more effective and relevant performance measurement system. These actively recognise the importance of the estate within strategic decision-making as helping to inform the long-term planning and management of the estate within the individual NHS boards. Originality/value This paper shows the current role of performance measurement for the strategic management of health-care estates and identifies issues related to its applicability and value. </jats:sec

Attitudes and Beliefs of New Teachers Towards Induction Requirements

There is worldwide teacher shortage that is affecting the access to quality education. In past 5 years, as high as 50% of new teachers have been leaving the field during their first 5 years, after receiving a teaching credential. To help slow attrition rates in California, induction has become a required element for new teachers to transition from a preliminary credential to a clear credential. The purpose of this qualitative study was to explore and examine the effect on teaching and retention of novice teachers based on their beliefs and attitudes regarding California induction policy requirements. The research question to guide this study was: How do the attitudes and beliefs of new teachers, regarding California induction policy requirements, affect teaching and retention after participating in a university-based online induction program? The sample was a purposeful convenience sample consisting of 11 teachers who were required to complete an induction program in California. The data collection instruments were initial interviews, archival data in the form of Individual Learning Plans (ILPs), and follow-up interviews. Inductive analysis was used. Throughout the study, the constant comparative analysis method was used. The findings showed the attitudes and beliefs of induction participants in California do affect teaching and retention. While induction has positive effects on teaching and retention rates, the policy tied to induction sometimes elicit negative attitudes and beliefs in new teachers. These findings shed light on the importance of providing teachers’ attitudes and beliefs towards induction to policymakers

Developing a Systems and Community-based Approach for Removing Excess Fluoride from Drinking Water in Rural Northern Ghana

Excess fluoride in drinking water is a serious health risk in many parts of the world – particularly in developing countries. Unfortunately, removing excess fluoride from drinking water can be costly and, as a result, beyond the capacity of many poor communities. The health impacts of those who consume high fluoride water over several years range from mild dental fluorosis, which is cosmetic, to crippling skeletal fluorosis, which is disabling. This research addresses the problem of dental fluorosis in an area of northern Ghana with pockets of high fluoride groundwater, which is the primary source of drinking water. It investigates the viability of using laterite collected in the study area and Ghanaian bauxite, for use in low-cost, small-scale fluoride adsorption filters. It also considers whether activated alumina would be a more appropriate sorbent, though the cost would be notably higher since it must be purchased and imported. The possibility of delivering alternative, untreated low fluoride water to fluoridic areas is evaluated as well. In addition to addressing the ongoing challenge of providing clean and reliable sources of drinking water in rural northern Ghana, this research documents the distribution of dental fluorosis in the study area and estimates daily fluoride intake from drinking water and food, in order to determine whether the World Health Organization (WHO) recommended limit of 1.5 mg L-1 for fluoride in drinking water is appropriate for Ghana, which is hot year-round and where water consumption is expected to be high.The laboratory results indicate that, at the pH of the local groundwater (~7) and equal sorbent-to-solution ratios of 6.67 g L-1, activated alumina is notably better at adsorbing fluoride than bauxite or laterite, and bauxite is slightly better than laterite. Activated alumina has the advantage of a high surface area and high fluoride adsorption at pH 6-7. Bauxite is a very good sorbent per unit area but is limited by a low surface area and adsorbs fluoride best at pH <6. Laterite has higher surface area than bauxite but, due to its mineralogy, adsorbs best at pH <4.5. The field data collected in the study area identified communities with high fluoride (3.1-4.5 mg L-1) and low fluoride (<0.5 mg L-1) groundwater. Bongo granite is the source of groundwater fluoride, and concentrations decrease with distance from granitic areas. The low fluoride areas may be good locations for collecting groundwater and piping to communities with high fluoride groundwater. Survey data indicate that the WHO recommended fluoride limit of 1.5 mg L-1 is too high for Ghana, due to high water intake. But when considering that providing low fluoride water is not cost-free, the WHO recommended limit is currently acceptable for older children and adults. However children under 6-8 years need a limit <1.0 mg L-1 (ideally 0.6 mg L-1), and even lower in the first two years of life, since they are the most vulnerable to dental fluorosis. The survey results also show that only 24% of participants understand the cause of damaged teeth. Therefore, an aggressive long-term educational program is needed along with providing low fluoride water, in order to help affected communities understand the importance of drinking treated or alternative sources of low fluoride water

Young Citizens of the World Unite! A Case for the Model United Nations in Middle School Classrooms

In this manuscript, the authors describe the benefits and theoretical connections the Junior Model United Nations (JMUN) program has with middle school classrooms. The lens used to view the JMUN program is informed by literature on the needs of young adolescents, inquiry learning, and global citizenship. Findings from this literature illuminate nuances in the interaction between inquiry learning through the C3 Framework and active learning participation. Implications for middle school students, in-service teachers, and teacher candidates are discussed

Nitrogen saturation in streams and forests of the Maryland Piedmont

Human activities have dramatically increased nitrogen (N) inputs to the landscape. Consequently, delivery of N to coastal waters, largely as nitrate (NO3-N), has increased, resulting in widespread eutrophication and harmful hypoxic conditions. The ability to mitigate the downstream effects of elevated N inputs requires a clear understanding of the transport and transformation of N in stream ecosystems. Here, I examine N processing in urban and forested watersheds of the Maryland Piedmont. I provide extensive evidence that three high-N streams draining urban and forested watersheds of the Maryland Piedmont are unable to remove NO3-N as a result of both N saturation and phosphorus limitation. My findings illustrate that when elevated NO3-N concentrations occur in the absence of other stressors that stimulate autotrophic activity (e.g. reduced canopy cover, increased nutrients) uptake cannot compensate for increased N loads. A review of the literature indicates that systems that are similarly unable to remove NO3-N vary widely in terms of land use and background N concentrations, highlighting the limitations of our understanding of N saturation in stream ecosystems. I also provide the first documentation of N saturation in both the aquatic and terrestrial components of an un-manipulated forested watershed. Detailed examination of N dynamics within the forested watershed reveals that the forest is severely N-saturated despite receiving atmospheric N inputs that are small relative to other parts of the Northeast and Mid-Atlantic. Because groundwater delivers a disproportionate fraction of the N load to the channel, in-stream N concentrations are elevated when deep groundwater flowpaths dominate, and the watershed is a source of N during dry periods, I hypothesize that hydrogeologic factors that control groundwater susceptibility to NO3-N contamination and promote delivery of NO3-N via subsurface flowpaths may exacerbate N-saturation response. My results suggest that we cannot rely on in-stream processing to reduce N loads even in minimally impacted watersheds. As a result, it is critical that management efforts reduce N loading to streams and take advantage of opportunities for increasing N removal in impaired systems only after other options have been exhausted

Quality of antenatal care and associated factors in a rural county in Kenya: an assessment of service provision and experience dimensions.

BackgroundThis study aimed to assess the quality of antenatal care (ANC) women received in Migori county, Kenya-including both service provision and experience dimensions-and to examine factors associated with each dimension.MethodsWe used survey data collected in 2016 in Migori county from 1031 women aged 15-49 who attended ANC at least once in their most recent pregnancy. ANC quality service provision was measured by nine questions on receipt of recommended ANC services, and experience of care by 18 questions on information, communication, dignity, and facility environment. We summed the responses to the individual items to generate ANC service provision and experience of care scores. We used both linear and logistic regression to examine predictors.ResultsThe average service provision score was 10.9 (SD = 2.4) out of a total of 16. Most women received some recommended services once, but not at the frequency recommended by the Kenyan Ministry of Health. About 90% had their blood pressure measured, and 78% had a urine test, but only 58 and 14% reported blood pressure monitoring and urine test, respectively, at every visit. Only 16% received an ultrasound at any time during ANC. The average experience score is 27.3 (SD = 8.2) out of a total score of 42, with key gaps demonstrated in communication. About half of women were not educated on pregnancy complications. Also, about one-third did not often understand the purposes of tests and medicines received and did not feel able to ask questions to the health care provider. In multivariate analysis, women who were literate, employed, and who received all their ANC in a health center had higher experiences scores than women who were illiterate (coefficient = 1.52, CI:0.26,2.79), unemployed (coefficient = 2.73, CI:1.46,4.00), and received some ANC from a hospital (coefficient = 1.99, CI: 0.84, 3.14) respectively. The wealthiest women had two times higher odds of receiving an ultrasound than the poorest women (OR = 2.00, CI:1.20,3.33).ConclusionQuality of ANC is suboptimal in both service provision and experience domains, with disparities by demographic and socioeconomic factors and facility type. More efforts are needed to improve quality of ANC and to eliminate the disparities