Towards safer, better healthcare: harnessing the natural properties of complex sociotechnical systems

Objectives: To sustain an argument that harnessing the natural properties of sociotechnical systems is necessary to promote safer, better healthcare. Methods: Triangulated analyses of discrete literature sources, particularly drawing on those from mathematics, sociology, marketing science and psychology. Results: Progress involves the use of natural networks and exploiting features such as their scale-free and small world nature, as well as characteristics of group dynamics like natural appeal (stickiness) and propagation (tipping points). The agenda for change should be set by prioritising problems in natural categories, addressed by groups who self select on the basis of their natural interest in the areas in question, and who set clinical standards and develop tools, the use of which should be monitored by peers. This approach will facilitate the evidence-based practice that most agree is now overdue, but which has not yet been realised by the application of conventional methods. Conclusion: A key to health system transformation may lie under-recognised under our noses, and involves exploiting the naturally-occurring characteristics of complex systems. Current strategies to address healthcare problems are insufficient. Clinicians work best when their expertise is mobilised, and they flourish in groupings of their own interests and preference. Being invited, empowered and nurtured rather than directed, micromanaged and controlled through a hierarchy is preferable.5 page(s

The pure effect of social preferences on regional location choices: The evolving dynamics of convergence to a steady state population distribution

This paper tracks the consequences of individuals’ desire to align their location with their social preferences. The social preference studied in the paper is distaste for relative deprivation, measured in a cardinal manner. Location is conceived as social space, with individuals choosing to relocate if, as a result, their relative deprivation will be reduced, holding their incomes constant. Conditions are provided under which the associated dynamics reaches a spatial steady state, the number of periods it takes to reach a steady state is specified, and light is shed on the robustness of the steady state outcome. By way of simulation it is shown that for large populations, a steady state of the relocation dynamics is almost always reached, typically in one period, and that cycles are more likely to occur when the populations’ income distributions are more equal

Who is to blame? The relationship between ingroup identification and relative deprivation is moderated by ingroup attributions

Contradictory evidence can be found in the literature about whether ingroup identification and perceived relative deprivation are positively or negatively related. Indeed, theoretical arguments can be made for both effects. It was proposed that the contradictory findings can be explained by considering a hitherto unstudied moderator: The extent to which deprivation is attributed to the ingroup. It was hypothesised that identification would only have a negative impact on deprivation, and that deprivation would only have a negative impact on identification, if ingroup attributions are high. To test this, attributions to the ingroup were experimentally manipulated among British student participants (N = 189) who were asked about their perceived deprivation vis-à-vis German students, yield ing support for the hypotheses

What unites Europe and what divides it? Solidarity and the European heritage reconsidered

Despite the on-set on new divisions, there is a strong case to be made for the view that ultimately Europe is more united than divided. There is still significant continuity with the post-war project of reconstruction and peace and that this common ground that constitutes the European heritage needs to be given greater recognition. One of the defining features of European self-understanding is opposition to war

Measuring change in vulnerable adolescents: Findings from a peer education evaluation in South Africa

Introduction: In the context of poverty and HIV and AIDS, peer education is thought to be capable of providing vulnerable youth with psychosocial support as well as information and decision-making skills otherwise limited by scarce social and material resources. As a preventative education intervention method, peer education is a strategy aimed at norms and peer group influences that affect health behaviours and attitudes. However, too few evaluations of peer-led programmes are available,and they frequently fail to reflect real differences between those who have been recipients of peer education and those who have not. This article reports on an evaluation of a pilot peer-led intervention, entitled Vhutshilo, implemented on principles agreed upon through a collaborative effort in South Africa by the Harvard School of Public Health and the Centre for theSupport of Peer Education (the Rutanang collaboration). Vhutshilo targeted vulnerable adolescents aged 14–16 years living in some of South Africa’s under-resourced communities. Methodology: The research design was a mixed-method (qualitative and quantitative), longitudinal, quasi-experimental evaluation. Tools used included a quantitative survey questionnaire (n ¼ 183) and semi-structured interviews (n ¼ 32) with beneficiaries of peer education. Surveys were administered twice forbeneficiaries of peer education (n ¼ 73), immediately after completion of the programme (post-test) and 4 months later (delayed post-test), and once for control group members (n ¼ 110). The three main  methodological limitations in this study were the use of a once-off control group assessment as the baseline for comparison, without a pre-test, due to timing and resource constraints; a small sample size (n ¼ 183), which reduced the statistical power of the evaluation; and the unavailability of existing tested survey questions to measure the impact of peer education and its role in behaviour change. Findings: This article reports on the difficulties of designing a comprehensive evaluation within time and financial constraints, critically evaluates survey design with multi-item indicators, and discusses six statistically significant changes observed in Vhutshilo participants out of a 92-point survey. Youth struggling with poor quality education and living in economically fraught contexts with little social support, nonetheless, showed evidence of having greater knowledge of support networks and an expanded emotional repertoire by the end of the Vhutshilo programme, and 4 months later. At both individual and group level, many with low socio-economic status showed great improvement with regard to programme indicator scores. Conclusion: For the poorest adolescents, especially those living in the rural parts of South Africa, peer education has the potential to change future orientation, attitudes and knowledge regarding HIV and AIDS, including an intolerance for multiple concurrent partnerships. When well organised and properly supported, peer education programmes (and the Vhutshilo curriculum, in particular) provide vulnerable youth with opportunities to develop  psychosocial skills and informational resources that contribute to the changing of norms, attitudes and behaviours. However, the article also flags the need for effective peer education evaluations that take into account limited financial resources and that possess tested indicators of programme effectiveness

'Word from the street' : when non-electoral representative claims meet electoral representation in the United Kingdom

Taking the specific case of street protests in the UK – the ‘word from the street’– this article examines recent (re)conceptualizations of political representation, most particularly Saward’s notion of ‘representative claim’. The specific example of nonelectoral claims articulated by protestors and demonstrators in the UK is used to illustrate: the processes of making, constituting, evaluating and accepting claims for and by constituencies and audiences; and the continuing distinctiveness of claims based upon electoral representation. Two basic questions structure the analysis: first, why would the political representative claims of elected representatives trump the nonelectoral claims of mass demonstrators and, second, in what ways does the ‘perceived legitimacy’ of the former differ from the latter