Decentralisation, Decision Space and Directions for Future Research; Comment on “Decentralisation of Health Services in Fiji: A Decision Space Analysis”

Decentralisation continues to re-appear in health system reform across the world. Evaluation of these reforms reveals how research on decentralisation continues to evolve. In this paper, we examine the theoretical foundations and empirical references which underpin current approaches to studying decentralisation in health systems

Wearing the Future-Wearables to Empower Users to Take Greater Responsibility for Their Health and Care:Scoping Review

BACKGROUND: Wearables refer to devices that are worn by individuals. In the health care field, wearables may assist with individual monitoring and diagnosis. In fact, the potential for wearable technology to assist with health care has received recognition from health systems around the world, including a place in the strategic Long Term Plan shared by the National Health Service in England. However, wearables are not limited to specialist medical devices used by patients. Leading technology companies, including Apple, have been exploring the capabilities of wearable health technology for health-conscious consumers. Despite advancements in wearable health technology, research is yet to be conducted on wearables and empowerment. OBJECTIVE: This study aimed to identify, summarize, and synthesize knowledge on how wearable health technology can empower individuals to take greater responsibility for their health and care. METHODS: This study was a scoping review with thematic analysis and narrative synthesis. Relevant guidance, such as the Arksey and O’Malley framework, was followed. In addition to searching gray literature, we searched MEDLINE, EMBASE, PsycINFO, HMIC, and Cochrane Library. Studies were included based on the following selection criteria: publication in English, publication in Europe or the United States, focus on wearables, relevance to the research, and the availability of the full text. RESULTS: After identifying 1585 unique records and excluding papers based on the selection criteria, 20 studies were included in the review. On analysis of these 20 studies, 3 main themes emerged: the potential barriers to using wearables, the role of providers and the benefits to providers from promoting the use of wearables, and how wearables can drive behavior change. CONCLUSIONS: Considerable literature findings suggest that wearables can empower individuals by assisting with diagnosis, behavior change, and self-monitoring. However, greater adoption of wearables and engagement with wearable devices depend on various factors, including promotion and support from providers to encourage uptake; increased short-term investment to upskill staff, especially in the area of data analysis; and overcoming the barriers to use, particularly by improving device accuracy. Acting on these suggestions will require investment and constructive input from key stakeholders, namely users, health care professionals, and designers of the technology. As advancements in technology to make wearables viable health care devices have only come about recently, further studies will be important for measuring the effectiveness of wearables in empowering individuals. The investigation of user outcomes through large-scale studies would also be beneficial. Nevertheless, a significant challenge will be in the publication of research to keep pace with rapid developments related to wearable health technology

The paradox of health policy: revealing the true colours of this ‘chameleon concept’ Comment on “The politics and analytics of health policy”

Health policy has been termed a ‘chameleon concept’, referring to its ability to take on different forms of disciplinarity as well as different roles and functions. This paper extends Paton’s analysis by exploring the paradox of health policy as a field of academic inquiry—sitting across many of the boundaries of social science but also marginalised by them. It situates contemporary approaches within disciplinary traditions, explaining its inter- and multi-disciplinary character. It also presents a ‘way of seeing’ health policy in terms of three axes: central/local, profession/management, and health/healthcare. The paper concludes with a call for a new research agenda which recognises health policy’s pedigree but also one which carves a distinctive future of relevance and rigour

(Re) Making the Procrustean Bed? Standardization and Customization as Competing Logics in Healthcare

Recent years have witnessed a parallel and seemingly contradictory trend towards both the standardization and the customization of healthcare and medical treatment. Here, we explore what is meant by ‘standardization’ and ‘customization’ in healthcare settings and explore the implications of these changes for healthcare delivery. We frame the paradox of these divergent and opposing factors in terms of institutional logics – the socially constructed rules, practices and beliefs which perpetuate institutional behaviour. As the tension between standardization and customization is fast becoming a critical fault-line within many health systems, there remains an urgent need for more sustained work exploring how these competing logics are articulated, adapted, resisted and co-exist on the front line of care delivery

NHS Dentistry in Britain:A long overdue check up

There has been longstanding international fascination with the British National Health Service since it was established in 1948. The British population itself has offered enduring support for the principles and institutions of public provision. However, coverage of the NHS has typically been uneven in academic and policy debates. There is limited understanding of some darker corners of NHS provision resulting in a partial picture of public service provision. Public dentistry has been a Cinderella service in broader debates about the NHS and a check-up is overdue. We offer a long-term view of dentistry that assesses the current state of dental health policy, including its gradual decay. We examine the purpose of dentistry and the challenge of injecting fundamental National Health Service values (weighted capitation and a focus on need) into services and which necessitates redistribution and tackling shibboleths of NHS provision. Alongside the role of political values and public attitudes, we examine the interests of professional stakeholders and how the combination of values, attitudes and interests does not currently cohere into a sustainable policy. We explore how dentistry might recover purpose and respond to need. Discussion is prescient considering an acknowledged crisis in British dental care, including widespread public and media coverage, and with 2024 being a general election year with NHS provision a familiar battleground