28 research outputs found
Embedding Justice: Shaming Rituals in Reintegrative Justice Systems: Spain, California, and New South Wales
This research explores alternative justice processes that activate culturally specific rituals intending to reintegrate the offender back into the community. This study uses an ethnographic research design that began on the Camino de Santiago in northern Spain in 2012 and expanded to therapeutic justice programs amidst varying political-cultural contexts in California and New South Wales, Australia. The analysis expands upon theory on rituals of reintegrative shaming in restorative justice settings and forwards the concept of “Embedding Justice.” Embedding Justice is the symbolic activation of cultural beliefs and values through justice rituals undergone at the community level. I illustrate the ritual mechanisms shared across these three sites in Embedding Justice shaming rituals and consider their implications for the study of reintegrative justice
A tripartite interprofessional collaboration in Limpopo province: Community health worker training in diabetes and hypertension
Implementing and evaluating a sustainable early child development program in Limpopo, South Africa: A pilot study
Views of institutional leaders on maintaining humanism in today’s practice
Objective
To explore leadership perspectives on how to maintain high quality efficient care that is also person-centered and humanistic.
Methods
The authors interviewed and collected narrative transcripts from a convenience sample of 32 institutional healthcare leaders at seven U.S. medical schools. The institutional leaders were asked to identify factors that either promoted or inhibited humanistic practice. A subset of authors used the constant comparative method to perform qualitative analysis of the interview transcripts. They reached thematic saturation by consensus on the major themes and illustrative examples after six conference calls.
Results
Institutional healthcare leaders supported vision statements, policies, organized educational and faculty development programs, role modeling including their own, and recognition of informal acts of kindness to promote and maintain humanistic patient-care. These measures were described individually rather than as components of a coordinated plan. Few healthcare leaders mentioned plans for organizational or systems changes to promote humanistic clinician-patient relationships.
Conclusions
Institutional leaders assisted clinicians in dealing with stressful practices in beneficial ways but fell short of envisaging systems approaches that improve practice organization to encourage humanistic care
How Physicians Draw Satisfaction and Overcome Barriers in their Practices: “It Sustains Me”
Objective
Major reorganizations of medical practice today challenge physicians’ ability to deliver compassionate care. We sought to understand how physicians who completed an intensive faculty development program in medical humanism sustain their humanistic practices.
Methods
Program completers from 8 U.S. medical schools wrote reflections in answer to two open-ended questions addressing their personal motivations and the barriers that impeded their humanistic practice and teaching. Reflections were qualitatively analyzed using the constant comparative method.
Results
Sixty-eight physicians (74% response rate) submitted reflections. Motivating factors included: 1) identification with humanistic values; 2) providing care that they or their family would want; 3) connecting to patients; 4) passing on values through role modelling; 5) being in the moment. Inhibiting factors included: 1) time, 2) stress, 3) culture, and 4) episodic burnout.
Conclusions
Determination to live by one’s values, embedded within a strong professional identity, allowed study participants to alleviate, but not resolve, the barriers. Collaborative action to address organizational impediments was endorsed but found to be lacking.
Practice implications
Fostering fully mature professional development among physicians will require new skills and opportunities that reinforce time-honored values while simultaneously partnering with others to nurture, sustain and improve patient care by addressing system issues
Prevalence and consequences of patient safety incidents in general practice in the Netherlands: a retrospective medical record review study
Contains fulltext :
97252.pdf (publisher's version ) (Open Access)BACKGROUND: Patient safety can be at stake in both hospital and general practice settings. While severe patient safety incidents have been described, quantitative studies in large samples of patients in general practice are rare. This study aimed to assess patient safety in general practice, and to show areas where potential improvements could be implemented. METHODS: We conducted a retrospective review of patient records in Dutch general practice. A random sample of 1,000 patients from 20 general practices was obtained. The number of patient safety incidents that occurred in a one-year period, their perceived underlying causes, and impact on patients' health were recorded. RESULTS: We identified 211 patient safety incidents across a period of one year (95% CI: 185 until 241). A variety of types of incidents, perceived causes and consequences were found. A total of 58 patient safety incidents affected patients; seven were associated with hospital admission; none resulted in permanent disability or death. CONCLUSIONS: Although this large audit of medical records in general practices identified many patient safety incidents, only a few had a major impact on patients' health. Improving patient safety in this low-risk environment poses specific challenges, given the high numbers of patients and contacts in general practice
Intervenir sobre la cultura organizacional: ¿qué aspectos se pueden considerar?
La cultura organizacional (co) es un macroconstructo que involucra una gran variedad de componentes y funciones organizacionales (Warner, 2014). Reyes y Moros (2018) señalan que tiene su origen en el estudio realizado en Hawthorne por Elton Mayo y otros investigadores de la Escuela de las Relaciones Humanas de la Administración, en el que buscaban identificar la influencia de las condiciones físicas y ambientales en el desempeño individual. Para Reyes y Moros (2018), la co se siguió desarrollando en los años setenta con Pettigrew, para ser entendida como un sistema de significados que tanto pública como colectivamente es aceptado para operar en un tiempo y por un grupo determinado. Los autores la definen como “… un sistema de significados compartidos por los miembros de la organización, los cuales son el resultado de una construcción social constituida a través de símbolos y como tal deben ser interpretados”1a edició
Practical Wisdom And Health Care
Healthcare in the developed world increasingly involves managing chronic conditions rather than curing acute ones. And managing chronic conditions typically requires that patients be partners rather than merely complaint executers of medical directives. To foster and sustain such partnerships, medical practitioners must possess not only technical competence, but moral competence. Medical education must be education in character—in virtue—and the cardinal virtue that must be educated is practical wisdom. We describe three institutional settings—inner-city health clinics, a program in medical education, and a program in a major medical center that provides palliative care—in which virtue education is taken as seriously as medical education, with good results for both the patients and the staff. Improving the health outcomes of an aging population will require that medical institutions commit themselves to allowing virtue to be nurtured and deployed