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

Eat Until You\u27re Full: The Pursuit of Autonomy and Health through the Adoption of Organic Agriculture in Mae Ta, Thailand

This research explores the role that farmers\u27 concerns about health and community autonomy play in the emergence of an organic agriculture movement in the village of Mae Ta in northern Thailand. In the midst of the push for export-oriented and urban-centered development, many rural people have migrated to urban areas for work or adopted contract farming of chemical-intensive cash crops. Yet farmers in Mae Ta chose a unique alternative: sufficiency-based organic polyculture. Why take on such a risk without solid policy and market support for organic agriculture in Thailand? I investigated these questions through six weeks of participant observation and 19 interviews with organic and conventional farmers and community members. I found that health concerns were among the most significant proximate causes of farmers\u27 transitions to organic farming, but these concerns were not isolated to physiological effects of chemical application: they were tied to issues of food sovereignty and stress due to constrained autonomy. This research draws on Paul Farmer\u27s theory of structural violence and health, as well as current debates revisiting and redefining the peasantry. Mae Ta farmers\u27 decisions to convert to organic polyculture can be seen as a response to the impact of economic restructuring on the health of rural communities

Using nurses and office staff to report prescribing errors in primary care

Objective. To implement a prescribing-error reporting system in primary care offices and analyze the reports. Design. Descriptive analysis of a voluntary prescribing-error-reporting system Setting. Seven primary care offices in Vermont, USA. Participants. One hundred and three prescribers, managers, nurses and office staff. Intervention. Nurses and office staff were asked to report all communications with community pharmacists regarding prescription problems

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