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Sample records for acute nhs trust

  1. Developing a market orientation in the Health Service: a survey of acute NHS Trusts in Scotland.

    PubMed

    Laing, A W; Galbraith, A

    1996-01-01

    Argues that the introduction of the quasi market mechanism into the Health Service has required that managers within NHS trusts acquire new managerial skills relating to market operations and, more importantly, reorientate their organizations towards the marketplace. Examines the pattern of development which has occurred within acute trusts across Scotland in the past three years, and argues that managers in the majority of trusts have developed a remarkably robust and relevant conceptualization of the nature and application of marketing within the NHS, reflecting the difficulties managers have faced in selling the concept of marketing to a generally sceptical body of clinicians. Notes, in part owing to such professional scepticism, that the development of marketing as an implementable approach to operations has lagged significantly behind the managerial conceptualization, although this cannot be attributed solely to resistance from clinicians and other health care professionals. Rather, suggests that such limited progress in implementing a market orientation reflects a range of "structural" barriers, both within individual trusts and the specific market environment faced by trusts.

  2. Implementing the NHS information technology programme: qualitative study of progress in acute trusts

    PubMed Central

    Fulop, Naomi; Reeves, Barnaby C; Hutchings, Andrew; Collin, Simon

    2007-01-01

    Objectives To describe progress and perceived challenges in implementing the NHS information and technology (IT) programme in England. Design Case studies and in-depth interviews, with themes identified using a framework developed from grounded theory. We interviewed personnel who had been interviewed 18 months earlier, or new personnel in the same posts. Setting Four NHS acute hospital trusts in England. Participants Senior trust managers and clinicians, including chief executives, directors of IT, medical directors, and directors of nursing. Results Interviewees unreservedly supported the goals of the programme but had several serious concerns. As before, implementation is hampered by local financial deficits, delays in implementing patient administration systems that are compliant with the programme, and poor communication between Connecting for Health (the agency responsible for the programme) and local managers. New issues were raised. Local managers cannot prioritise implementing the programme because of competing financial priorities and uncertainties about the programme. They perceive a growing risk to patients' safety associated with delays and a loss of integration of components of the programme, and are discontented with Choose and Book (electronic booking for referrals from primary care). Conclusions We recommend that the programme sets realistic timetables for individual trusts and advises managers about interim IT systems they have to purchase because of delays outside their control. Advice needs to be mindful of the need for trusts to ensure longer term compatibility with the programme and value for money. Trusts need assistance in prioritising modernisation of IT by, for example, including implementation of the programme in the performance management framework. Even with Connecting for Health adopting a different approach of setting central standards with local implementation, these issues will still need to be addressed. Lessons learnt in the NHS

  3. Are inspectors’ assessments reliable? Ratings of NHS acute hospital trust services in England

    PubMed Central

    Addicott, Rachael; Robertson, Ruth; Ross, Shilpa; Walshe, Kieran

    2016-01-01

    The credibility of a regulator could be threatened if stakeholders perceive that assessments of performance made by its inspectors are unreliable. Yet there is little published research on the reliability of inspectors’ assessments of health care organizations’ services. Objectives We investigated the inter-rater reliability of assessments made by inspectors inspecting acute hospitals in England during the piloting of a new regulatory model implemented by the Care Quality Commission (CQC) during 2013 and 2014. Multi-professional teams of inspectors rated service provision on a four-point scale for each of five domains: safety; effectiveness; caring; responsiveness; and leadership. Methods In an online survey, we asked individual inspectors to assign a domain and a rating to each of 10 vignettes of service information extracted from CQC inspection reports. We used these data to simulate the ratings that might be produced by teams of inspectors. We also observed inspection teams in action, and interviewed inspectors and staff from hospitals that had been inspected. Results Levels of agreement varied substantially from vignette to vignette. Characteristics such as professional background explained only a very small part of the variation. Overall, agreement was higher on ratings than on domains, and for groups of inspectors compared with individual inspectors. A number of potential causes of disagreement were identified, such as differences regarding the weight that should be given to contextual factors and general uncertainty about interpreting the rating and domain categories. Conclusion Groups of inspectors produced more reliable assessments than individual inspectors, and there is evidence to support the utility of appropriate discussions between inspectors in improving reliability. The reliability of domain allocations was lower than for ratings. It is important to define categories and rating levels clearly, and to train inspectors in their use. Further

  4. Strategic marketing in the NHS: Kwik-health NHS Trust.

    PubMed

    Laing, A W; Galbraith, A

    1995-01-01

    Unlike managers in most service organizations, hospital managers do not have significant control over the shape or cost of the service product or the manner of its delivery. Hence, the crucial issue for hospital management to address is how to develop the marketing of a service the control of which is divorced from those with the strategic market perspective. While the internal management of hospital care in NHS is in its infancy, initial developments such as clinical directorates point the way forward in creating a market orientation within provider units. Ultimately, it must be considered what degree of influence over clinical decisions affecting hospital services is realistic, ethical and desirable for strategic marketing and business services. Arguably there is a case for the adoption of some middle ground, with both sides moving from their present positions but perhaps with the clinicians moving furthest.

  5. Understanding the roles of NHS trust board members.

    PubMed

    Deffenbaugh, J

    1996-01-01

    The establishment of NHS trust boards on a business format was a recent innovation resulting from the NHS reforms. In order to realize benefits for patients, it is essential that boards operate effectively. Explores within the framework of corporate governance, the practical implications of board member roles. Drawing on experience of strategy formulation at board level, analyses and clarifies the roles, and presents recommendations to increase board effectiveness.

  6. A cluster of occupational mental illness in an NHS trust.

    PubMed

    Poole, C J M; Basheer, S

    2007-08-01

    A cluster of clinical cases of occupational mental illness has not previously been reported. A prospective cross-sectional study of patients referred for examination and advice about rehabilitation was undertaken to ascertain a variety of employer's rates of occupational mental illness. A background rate of referral for occupational mental illness of 3.1/1,000 employees per year was found apart from in one NHS trust where the rate was 25.6/1,000. Most patients were nurses and diagnoses were anxiety and/or depression with a median length of time off work of four months. There was no evidence that patients from this employer were vulnerable to mental illness. The high rate of occupational mental illness was associated with organisational change and a hostile working climate. This study shows that NHS trusts may be associated with unhealthy working practices. A cluster of occupational mental illness should be statutorily reportable to the Health and Safety Executive for further investigation.

  7. Effects of stress in an NHS trust: a study.

    PubMed

    Quine, L

    This study of staff in an NHS trust tests two established models of occupational stress. Payne (1979) suggested that support at work can help to neutralise the strain of work demands, while Karasek (1979) suggested that staff whose jobs are characterised by high demands and low control are at greater risk of poor psychological wellbeing and ill health. Support is found for both models, and it is suggested that the two could usefully be combined.

  8. Short message service (SMS) texting as a method of communication during on call: prevalence and experience of medical staff in a large acute NHS Trust in the UK.

    PubMed

    Matharu, J; Hale, B; Ammar, M; Brennan, P A

    2016-10-01

    With the widespread use of smartphones, text messaging has become an accepted form of communication for both social and professional use in medicine. To our knowledge no published studies have assessed the prevalence and use of short message service (SMS) texting by doctors on call. We have used an online questionnaire to seek information from doctors in a large NHS Trust in the UK about their use of texting while on call, what they use it for, and whether they send images relevant to patients' care. We received 302 responses (43% response rate), of whom 166 (55%) used SMS while on call. There was a significant association between SMS and age group (p=0.005), with the 20-30-year-old group using it much more than the other age groups. Doctors in the surgical specialties used it significantly less than those in other speciality groups (p<0 .001). Texting while on call was deemed to be safe and reliable (p<0.001). Eighteen clinicians (11%) admitted to routinely sending images of patients by text, despite some being identifiable. Texting was mainly used to update colleagues on patients' progress and give information about times of ward rounds and meetings. With the increasing use of texting in healthcare, much of which seems to be unregulated, further work and detailed guidance is required on what information may be given to ensure confidentiality and that SMS is a safe and acceptable method of communication to use when on call.

  9. Trusting in the New NHS: instrumental versus communicative action.

    PubMed

    Brown, Patrick R

    2008-04-01

    Recent reforms within the UK National Health Service, particularly the introduction of clinical governance, have been enacted with the apparent aim of rebuilding patient trust. This paper analyses the approach taken by policy makers, arguing that it is based very much on an instrumental conception of trust. The assumptions and limitations of this model are discussed and in so doing, a communicative understanding of trust is proposed as an alternative. It is argued that the instrumental rationality and institutional focus inherent to instrumental trust neglect the importance of the communication between patient and medical professional and its affective dimensions. Communicative trust goes beyond a mere cognitive appreciation of the system and rather is dependent on the qualitative interaction at the access point, where the patient comes to believe that the communicative rationality of their best interests is mirrored by the professional's instrumental rationality. Whilst recent challenges to the confidence of patients in professionals and medical knowledge make some approximation of an ideal speech situation more imperative than previously, the application of an instrumental concept of trust in the NHS makes such interactions less likely, as well as facilitating a divergence between instrumental and communicative rationality in healthcare provision.

  10. Research productivity of staff in NHS mental health trusts: comparison using the Leiden method

    PubMed Central

    Mitchell, Alex J.; Gill, John

    2014-01-01

    Aims and method To examine research productivity of staff working across 57 National Health Service (NHS) mental health trusts in England. We examined research productivity between 2010 and 2012, including funded portfolio studies and all research (funded and unfunded). Results Across 57 trusts there were 1297 National Institute for Health Research (NIHR) studies in 2011/2012, involving 46 140 participants and in the same year staff in these trusts published 1334 articles (an average of only 23.4 per trust per annum). After correcting for trust size and budget, the South London and Maudsley NHS Foundation Trust was the most productive. In terms of funded portfolio studies, Manchester Mental Health and Social Care Trust as well as South London and Maudsley NHS Foundation Trust, Oxford Health NHS Foundation Trust and Cambridgeshire and Peterborough NHS Foundation Trust had the strongest performance in 2011/2012. Clinical implications Trusts should aim to capitalise on valuable staff resources and expertise and better support and encourage research in the NHS to help improve clinical services. PMID:25237485

  11. Improving health service quality from within: the case of United Leeds Teaching Hospitals NHS Trust.

    PubMed

    Lewisohn, C; Reynoso, J

    1995-01-01

    Illustrates how the implementation of the internal customer concept has assisted United Leeds Teaching Hospitals NHS Trust to establish a culture for quality. Explains the conceptual framework on which the notion of the internal customer is derived. Describes how, from 1992 to date, the Trust's quality management approach was designed to apply these management principles in a large teaching hospital setting. Outlines how this quality management approach has been successful in enabling departmental managers to recognize, develop and improve internal customer/supplier relationships. Concludes by explaining that business process re-engineering is now being applied as a prime quality tool to help deliver a major culture change throughout the organization.

  12. Any qualified provider: a qualitative case study of one community NHS Trust's response

    PubMed Central

    Walumbe, Jackie; Swinglehurst, Deborah; Shaw, Sara

    2016-01-01

    Objective To examine how those managing and providing community-based musculoskeletal (MSK) services have experienced recent policy allowing patients to choose any provider that meets certain quality standards from the National Health Service (NHS), private or voluntary sector. Design Intrinsic case study combining qualitative analysis of interviews and field notes. Setting An NHS Community Trust (the main providers of community health services in the NHS) in England, 2013–2014. Participants NHS Community Trust employees involved in delivering MSK services, including clinical staff and managerial staff in senior and mid-range positions. Findings Managers (n=4) and clinicians (n=4) working within MSK services understood and experienced the Any Qualified Provider (AQP) policy as involving: (1) a perceived trade-off between quality and cost in its implementation; (2) deskilling of MSK clinicians and erosion of professional values; and (3) a shift away from interprofessional collaboration and dialogue. These ways of making sense of AQP policy were associated with dissatisfaction with market-based health reforms. Conclusions AQP policy is poorly understood. Clinicians and managers perceive AQP as synonymous with competition and privatisation. From the perspective of clinicians providing MSK services, AQP, and related health policy reforms, tend, paradoxically, to drive down quality standards, supporting reconfiguration of services in which the complex, holistic nature of specialised MSK care may become marginalised by policy concerns about efficiency and cost. Our analysis indicates that the potential of AQP policy to increase quality of care is, at best, equivocal, and that any consideration of how AQP impacts on practice can only be understood by reference to a wider range of health policy reforms. PMID:26908521

  13. Business planning health-check questionnaire: a survey of first, second, third and fourth wave NHS Trusts.

    PubMed

    Bennett, A R; Banks, J M

    1999-02-01

    This paper reports the results of primary research which was carried out in July 1995 with respect to business planning within first, second, third and fourth wave National Health Service (NHS) Trusts. The purpose of the research was to examine current practice in these Trusts in three areas--namely, the levels of responsibility for business planning in general, the business planning processes applied by these Trusts, and the tools and techniques used by business planning managers in the compilation of business plans. The research, based on a 37.5% response rate, concludes that, as a general rule, business planning in first, second, third and fourth wave NHS Trusts tends to be a board-level activity, where senior managers have a job title which reflects this function. Secondly, the research shows that by far the greatest challenge for Trusts lies in the external marketplace. In areas such as patient needs forecasting, competitive (Trust) intelligence, purchaser and general practice fundholder requirements, data are difficult to acquire. Finally, the evidence suggests that there is a significant gap between what is regarded as business planning practice in the NHS and what is actually applied as best practice. The report concludes that business planning in the NHS Trusts sampled appears to be an art rather than a science, and that many assumptions made by business planning managers are founded on qualitative information rather than on specific, measurable data derived from the external and internal market.

  14. Improving service quality in NHS Trust hospitals: lessons from the hotel sector.

    PubMed

    Desombre, T; Eccles, G

    1998-01-01

    This article looks to review recent practice undertaken within the UK hotel sector to improve customer service, and suggests ideals that could be implemented within National Health (NHS) Trust hospitals. At a time of increasing competition, hotel firms are using service enhancement as a means to gain competitive advantage, and therefore developing a range of techniques to measure levels of service quality improvement. With continued change in the health service, where greater focus now lies with patient satisfaction, so there is a requirement for managers to adapt techniques presently being offered in other service industries to improve levels of customer service and ensure patients are targeted to define their levels of satisfaction.

  15. The Guy’s and St Thomas’s NHS Foundation Trust @home service: an overview of a new service

    PubMed Central

    Lee, Geraldine A.; Titchener, Karen

    2017-01-01

    Hospital in the home is a relatively new concept within the UK healthcare system. The Guy’s and St Thomas’s NHS Foundation Trust (GSTT) @home service ‘Bringing hospital care to your home’ was commissioned by Lambeth and Southwark CCG in 2014 to provide acute care in the patients’ place of residence by facilitating rapid discharge from hospital. The service is designed for 260–280 referrals each month from local hospitals, London Ambulance Service, GPs, district nurses and palliative care services. The GSTT@home provides intensive care for a short episode through multidisciplinary team work with the aim of returning the patient to their prior health status following an acute episode of ill health. The main criteria for referrals are adults, living within Lambeth or Southwark with an acute onset of illness often with acute exacerbations of chronic conditions. Care is delivered using 25 clinical pathways using integrated care teams, including those for respiratory disease, heart failure and palliative care services. Recently, the service extended to include overnight palliative care. As care shifts from hospital to the community, it is envisaged that these types of programmes will become an essential component of care provision. This paper describes the service and presents initial service evaluation data. PMID:28356923

  16. Barometer. Acute trusts February 2005.

    PubMed

    2005-03-17

    Almost two thirds of acute trusts rate the quality of commissioning from their PCTs at three out of 10 or less, according to the latest HSJ Barometer survey. This is the lowest score since we began the survey a year ago. Confidence in their performance against the 98 per cent four-hour A&E target fell sharply from a December high to an average of 6.87. The survey also found that fewer than one in seven trusts were confident of winning foundation status by the end of 2006-07.

  17. Service contribution and cost-effectiveness of specialist registrars in NHS trusts: a survey and costing analysis.

    PubMed

    Dafydd, Derfel Ap; Baskaradas, Aroon; Bobdiwala, Shabnam; Anwar, Muhammad Saleem; Abrahams, Rachel; Jeremy, Levy

    2016-06-01

    Since the introduction of the European Working Time Directive, specialist registrars arguably contribute less to clinical service. The purpose of this study was to broadly quantify the service contribution of specialist registrars across a range of specialties and their value to an NHS organisation. A questionnaire-based survey of the clinical activities of specialist registrars in a large NHS trust was undertaken. Simple costing analyses of this -clinical activity were performed. Responses from 66 specialist registrars in 24 specialties showed an average of 51% overall clinical autonomy. Trainees attended an average of 2.7 outpatient clinics per week and spent 3.5 sessions a week doing ward work. Medical trainees took more referrals and attended more clinics. An analysis of costings suggested that surgical trainees might have generated around £700,000 income per year for the trust. Overall, specialist registrars make a substantial contribution to NHS clinical service and are cost-effective.

  18. Barking, Havering and Redbridge University Hospitals NHS Trust Fellowships in Clinical Leadership Programme: An Evaluation.

    PubMed

    Miani, Celine; Marjanovic, Sonja; Jones, Molly Morgan; Marshall, Martin; Meikle, Samantha; Nolte, Ellen

    2013-01-01

    Leadership is seen to be central to improving the quality of healthcare and existing research suggests that absence of leadership is related to poor quality and safety performance. Leadership training might therefore provide an important means through which to promote quality improvement and, more widely, performance within the healthcare environment. This article presents an evaluation of the Fellowships in Clinical Leadership Programme, which combines leadership training and quality improvement initiatives with the placement of temporary external clinical champions in Barking, Havering and Redbridge University Hospitals NHS Trust. We assessed impacts of the Programme on individual and organisational change, alongside core enablers and barriers for Programme success. Analyses drew on the principles of a theory-of-change-led realist evaluation, using logic modelling to specify the underlying causal mechanisms of the Programme. Data collection involved a stakeholder workshop, online questionnaires of programme participants, senior managers and support staff (n=114), and follow-up in-depth semi-structured interviews with a subsample of survey participants (n=15). We observed that the Programme had notable impacts at individual and organisational levels. Examples of individual impact included enhanced communication and negotiation skills or increased confidence as a result of multi-modal leadership training. At the organisational level, participants reported indications of behaviour change among staff, with evidence of spill-over effects to non-participants towards a greater focus on patient-centred care. Our findings suggest that there is potential for combined leadership training and quality improvement programmes to contribute to strengthening a culture of care quality in healthcare organisations. Our study provides useful insights into strategies seeking to achieve sustainable improvement in NHS organisations.

  19. Does telephone triage of emergency (999) calls using advanced medical priority dispatch (AMPDS) with Department of Health (DH) call prioritisation effectively identify patients with an acute coronary syndrome? An audit of 42 657 emergency calls to Hampshire Ambulance Service NHS Trust

    PubMed Central

    Deakin, C D; Sherwood, D M; Smith, A; Cassidy, M

    2006-01-01

    Introduction The National Service Framework for Coronary Heart Disease requires identification of patients with an acute coronary syndrome (ACS) to enable prompt identification of those who may subsequently require pre‐hospital thrombolysis. The Advanced Medical Priority Despatch System (AMPDS) with Department of Health (DH) call prioritisation is now the common triage tool for emergency (‘999') calls in the UK. We retrospectively examined patients with ACS to identify whether this triage tool had been able to allocate an appropriate emergency response. Methods All emergency calls to Hampshire Ambulance Service NHS Trust (HAST) from the Southampton area over an 8 month period (January to August 2004) were analysed. The classification allocated to the patient by AMPDS (version 10.4) was specifically identified. Data from the Myocardial Infarct National Audit Project) were obtained from the receiving hospital in Southampton to identify the actual number of patients with a true ACS. Results In total, 42 657 emergency calls were made to HAST from the Southampton area. Of these, 263 patients were subsequently diagnosed in hospital as having an ACS. Of these 263 patients, 76 presented without chest pain. Sensitivity of AMPDS for detecting ACS in this sample was 71.1% and specificity 92.5%. Positive predictive value was 5.6% (95% confidence interval 4.8 to 6.4%), and 12.5% (33/263) of patients with confirmed ACS were classified as non‐life threatening (category B) incidents. Conclusion Only one of approximately every 18 patients with chest pain has an ACS. AMPDS with DH call prioritisation is not a tool designed for clinical diagnosis, and its extension into this field does not enable accurate identification of patients with ACS. PMID:16498168

  20. Medical leadership arrangements in English healthcare organisations: findings from a national survey and case studies of NHS trusts.

    PubMed

    Dickinson, Helen; Ham, Chris; Snelling, Iain; Spurgeon, Peter

    2013-11-01

    This project sought to describe the involvement of doctors in leadership roles in the NHS and the organisational structures and management processes in use in NHS trusts. A mixed methods approach was adopted combining a questionnaire survey of English NHS trusts and in-depth case studies of nine organisations who responded to the survey. Respondents identified a number of challenges in the development of medical leadership, and there was often perceived to be an engagement gap between medical leaders and doctors in clinical roles. While some progress has been made in the development of medical leadership in the NHS in England, much remains to be done to complete the journey that started with the Griffiths Report in 1983. We conclude that a greater degree of professionalism needs to be brought to bear in the development of medical leadership. This includes developing career structures to make it easier for doctors to take on leadership roles; providing training, development and support in management and leadership at different stages of doctors' careers; and ensuring that pay and other rewards are commensurate with the responsibilities of medical leaders. The time commitment of medical leaders and the proportion of doctors in leadership roles both need to increase. The paper concludes considering the implications of these findings for other health systems.

  1. Addressing Library Anxiety (LA) in student nurses: a study in an NHS Foundation Trust Hospital library and information service.

    PubMed

    Still, Madeleine

    2015-12-01

    Library anxiety is a concept which has been recognised in academic library circles since the early 1990s. It can result in students actively avoiding the library for the duration of their studies. Madeleine Still is Trust Librarian at North Tees & Hartlepool NHS Foundation Trust and while studying for an MSc, recognised that some student nurses were exhibiting signs of library anxiety. She decided to make it the focus of her MSc dissertation, and this article discusses her research project as well as highlighting the measures she has taken to address the issues she uncovered. Madeleine graduated in July 2013 with an MSc in Information & Library Studies from Robert Gordon University.

  2. Yearworth v. North Bristol NHS trust: a property case of uncertain significance?

    PubMed

    Harmon, Shawn H E

    2010-11-01

    It has long been the position in law that, subject to some minor but important exceptions, property cannot be held in the human body, whether living or dead. In the recent case of Yearworth and Others v North Bristol NHS Trust, however, the Court of Appeal for England and Wales revisited the property debate and threw into doubt a number of doctrines with respect to property and the body. This brief article analyses Yearworth, (1) reviewing the facts and the Court's decision with respect to the originators' proprietary and contractual interests in their body and bodily products, (2) considering the significance of relying on property and its use a legal metaphor, (3) questioning the scope of the property right created, and (4) querying whether an alternate conceptual approach to extending rights and a remedy was warranted. It concludes that, while Yearworth engages with, and impacts on, important theoretical and practical issues--from legal, healthcare and research perspectives--it does not offer a great deal of guidance and, for that reason, its precedential significance is in doubt.

  3. Trust-level risk evaluation and risk control guidance in the NHS East of England.

    PubMed

    Card, Alan J; Ward, James R; Clarkson, P John

    2014-08-01

    In recent years, the healthcare sector has adopted the use of operational risk assessment tools to help understand the systems issues that lead to patient safety incidents. But although these problem-focused tools have improved the ability of healthcare organizations to identify hazards, they have not translated into measurable improvements in patient safety. One possible reason for this is a lack of support for the solution-focused process of risk control. This article describes a content analysis of the risk management strategies, policies, and procedures at all acute (i.e., hospital), mental health, and ambulance trusts (health service organizations) in the East of England area of the British National Health Service. The primary goal was to determine what organizational-level guidance exists to support risk control practice. A secondary goal was to examine the risk evaluation guidance provided by these trusts. With regard to risk control, we found an almost complete lack of useful guidance to promote good practice. With regard to risk evaluation, the trusts relied exclusively on risk matrices. A number of weaknesses were found in the use of this tool, especially related to the guidance for scoring an event's likelihood. We make a number of recommendations to address these concerns. The guidance assessed provides insufficient support for risk control and risk evaluation. This may present a significant barrier to the success of risk management approaches in improving patient safety.

  4. Are NHS foundation trusts able and willing to exercise autonomy? 'You can take a horse to water...'.

    PubMed

    Exworthy, Mark; Frosini, Francesca; Jones, Lorelei

    2011-10-01

    Foundation trusts (FTs) have been a central part of the government's National Health Service (NHS) reforms in England since 2004. They illustrate the government's claim to decentralization, by granting greater autonomy to high performing organizations. The number of FTs has grown steadily, reaching 131 in September 2010, over 50% of eligible trusts. Despite this growth, and notwithstanding the fact that organizations which initially became FTs were previously high performing, doubts remain about the implementation of the FT policy. This article examines the implementation of FTs in the NHS and focuses on the nature and exercise of autonomy by FTs. It argues that the ability of FTs to exercise autonomy is in place, but the (relatively limited) extent of implementation may be explained by trusts' lack of willingness to exercise such autonomy. Such unwillingness may be because of continued centralization, unclear policy and financial regimes, fear of negative impacts on relations with other local organizations, and awareness of greater risk to the FT, among others. Addressing the tension between FTs' ability and willingness to exercise autonomy will largely explain the extent to which the government's provider side reforms will be implemented.

  5. Management of Older Inpatients Who Refuse Nonpsychiatric Medication Within Birmingham and Solihull Mental Health NHS Foundation Trust

    PubMed Central

    Umotong, Eno

    2016-01-01

    Abstract The effects of poor medication compliance are well documented and include increased morbidity, early mortality, and financial costs to the society. According to national guidelines, when a competent patient refuses medication, the doctor on duty has a responsibility to ensure the patient understands their proposed course of action. The aims of this audit were to evaluate whether this consultation was taking place within older in-patient units across Birmingham and Solihull Mental Health NHS Foundation Trust when patients refuse nonpsychiatric medicines. Poor compliance was defined as more than five refusals of a nonpsychiatric medication over a 4-week period. A discussion with the duty doctor occurred in 75% of cases (27/36), which resulted in a change in prescription or compliance in 59% (16/27 patients). After patient refusal of medication, a consultation with the duty doctor is likely to improve compliance and uncover salient issues particularly in regards to capacity and drug suitability. PMID:27893528

  6. Standardising the organisation of clinical equipment on surgical wards at North Bristol NHS Trust: a quality improvement initiative

    PubMed Central

    Ward, Joseph; Spencer, Robin; Soo, Eleanor; finucane, katherine

    2015-01-01

    Poorly organised clinical equipment can waste significant amounts of time otherwise available for direct patient care. As a group of foundation year one doctors, we identified the organisation of clinical equipment across surgical wards at North Bristol NHS Trust to be poor with stocks often low and items frequently difficult to locate. Time-motion studies (n=80) were confirmatory demonstrating that the mean time to collect equipment necessary for venepuncture, cannulation, arterial blood gases, or blood cultures ranged from 121 to 174 seconds between different areas. By applying a plan-do-study-act (PDSA) methodology, surveying peers as well as working with nursing staff and senior managers, we were able to purchase and implement clinical equipment trolleys on 10 surgical wards across the trust to reduce the time-taken to locate clinical equipment to between 38 to 45 seconds (p=0.01). We feel the key factors for the success of our initiative were strong multidisciplinary engagement and a simple uniform idea. Clinical equipment trolleys organised in a standardised manner have now been rolled out hospital-wide in the new Southmead Hospital Brunel building. PMID:26734373

  7. How accurate are antenatal weight measurements? A survey of hospital and community clinics in a South Thames Region NHS Trust.

    PubMed

    Harris, H E; Ellison, G T; Holliday, M; Nickson, C

    1998-04-01

    The accuracy of antenatal weight data recorded in obstetric notes was investigated in the 45 hospital and community antenatal clinics within a South Thames Region NHS Trust. In order to assess the reliability and validity of all 60 clinic scales triplicate measurements of body weight for low- and high-weight subjects were recorded on each clinical scale and on a calibrated standard scale. The quality of weighing practice during antenatal care was investigated by means of semi-structured interviews conducted with all 33 midwives who currently provide antenatal care within the Trust. Beam balances had the highest reliability and validity, whereas scales with spring mechanisms were the least accurate. Only 40% of the clinics surveyed had access to beam balances, yet most of the maternal weight measurements recorded during antenatal care are likely to be out by no more than 1-1.5% of body weight. Weighing practice was generally inconsistent, and serial measurements of maternal body weight collected during pregnancy are probably too imprecise to provide a sensitive screen for conditions associated with unusual weight gain and too inaccurate to assess compliance with guidelines for weight gain.

  8. A study and comparative analysis of managerial and leadership effectiveness in the National Health Service: an empirical factor analytic study within an NHS Trust hospital.

    PubMed

    Hamlin, R G

    2002-11-01

    The research described in this article was concerned primarily with identifying the criteria of managerial/leadership effectiveness applying at the middle and front line levels of management within an NHS Trust Hospital using critical incident technique and factor analysis methods. The findings suggest that the self-perceptions of managers and the perceptions of superiors and subordinates are very similar, and only differ on a limited number of criteria. This challenges the 'perspective-specific' models of managerial effectiveness advocated by some researchers. The results are compared against those from a near identical study carried out by the author within one part of the British Civil Service, and the results from a different but comparable factor analytic study carried out by other researchers elsewhere in the NHS. The results suggest the existence of generalized criteria of managerial effectiveness, which lend considerable support to the notion of the 'universally effective manager'. This challenges the 'contingent models' of managerial effectiveness advocated by various expert commentators. In addition, the research supports the new model of transformational leadership offered by Alimo-Metcalfe and Alban-Metcalfe for application within both the NHS and local government, and adds to the empirical base supporting the current drive towards evidence-based practice in management within the healthcare sector.

  9. An investigation into the feasibility of designing a framework for the quantitative evaluation of the Clinical Librarian service at an NHS Trust in Brighton, UK.

    PubMed

    Deshmukh, Archana; Roper, Tom

    2014-12-01

    This feature presents research undertaken by Archana Deshmukh for her MA dissertation at the University of Brighton. She worked closely with Tom Roper, the Clinical Librarian at Brighton and Sussex University Hospitals NHS Trust, in a project to explore the feasibility of applying quantitative measures to evaluate the Clinical Librarian service. The investigation used an innovative participatory approach and the findings showed that although an exclusively quantitative approach to evaluation is not feasible, using a mixed methods approach is a way forward. Agreed outputs and outcomes could be embedded in a marketing plan, and the resulting framework could provide evidence to demonstrate overall impact. Archana graduated in July 2014, gaining a Distinction in the MA in Information Studies, and she is currently looking for work in the health information sector.

  10. Analysing the medicine-management interface in acute trusts.

    PubMed

    Ong, B N; Boaden, M; Cropper, S

    1997-01-01

    The impact of the NHS reforms, and the resulting purchaser-provider split, has refocused attention on the relationship between management and medicine in acute hospitals. It is timely to assess the explanatory power of various theoretical models regarding the management-medicine interface. Argues that this interface is currently rather fluid and that a dynamic and adaptive model is best suited to understanding the way in which doctors and managers develop their relationship within the changing policy context. Two examples illustrate these shifting boundaries.

  11. Are inspectors' assessments reliable? Ratings of NHS acute hospital trust services in England.

    PubMed

    Boyd, Alan; Addicott, Rachael; Robertson, Ruth; Ross, Shilpa; Walshe, Kieran

    2016-10-05

    The credibility of a regulator could be threatened if stakeholders perceive that assessments of performance made by its inspectors are unreliable. Yet there is little published research on the reliability of inspectors' assessments of health care organizations' services.

  12. Benchmarking clinical photography services in the NHS.

    PubMed

    Arbon, Giles

    2015-01-01

    Benchmarking is used in services across the National Health Service (NHS) using various benchmarking programs. Clinical photography services do not have a program in place and services have to rely on ad hoc surveys of other services. A trial benchmarking exercise was undertaken with 13 services in NHS Trusts. This highlights valuable data and comparisons that can be used to benchmark and improve services throughout the profession.

  13. Funding the NHS. Is the NHS underfunded?

    PubMed Central

    Dixon, J.; Harrison, A.; New, B.

    1997-01-01

    Since 1948 there has been constant debate over whether the NHS is underfunded. The debate heats up when crises in the NHS hit the headlines as occurred last year. Various groups, of all shades of the political spectrum, have argued that the NHS is unsustainable with current funding increases because of demands from demographic change, new technology, and increasing expectations. The government is almost a lone voice in arguing that the NHS is sustainable but may not be doing enough to ensure that it remains so in future. This article examines seven broad approaches used to support the case that the NHS is underfunded and concludes that all have flaws. There is no satisfactory answer to the question of whether the NHS is underfunded because the answer requires value judgments that will inevitably give rise to disagreements. PMID:9001484

  14. Using routine data to monitor inequalities in an acute trust: a retrospective study

    PubMed Central

    2012-01-01

    Background Reducing inequalities is one of the priorities of the National Health Service. However, there is no standard system for monitoring inequalities in the care provided by acute trusts. We explore the feasibility of monitoring inequalities within an acute trust using routine data. Methods A retrospective study of hospital episode statistics from one acute trust in London over three years (2007 to 2010). Waiting times, length of stay and readmission rates were described for seven common surgical procedures. Inequalities by age, sex, ethnicity and social deprivation were examined using multiple logistic regression, adjusting for the other socio-demographic variables and comorbidities. Sample size calculations were computed to estimate how many years of data would be ideal for this analysis. Results This study found that even in a large acute trust, there was not enough power to detect differences between subgroups. There was little evidence of inequalities for the outcome and process measures examined, statistically significant differences by age, sex, ethnicity or deprivation were only found in 11 out of 80 analyses. Bariatric surgery patients who were black African or Caribbean were more likely than white patients to experience a prolonged wait (longer than 64 days, aOR = 2.47, 95% CI: 1.36-4.49). Following a coronary angioplasty, patients from more deprived areas were more likely to have had a prolonged length of stay (aOR = 1.66, 95% CI: 1.25-2.20). Conclusions This study found difficulties in using routine data to identify inequalities on a trust level. Little evidence of inequalities in waiting time, length of stay or readmission rates by sex, ethnicity or social deprivation were identified although some differences were identified which warrant further investigation. Even with three years of data from a large trust there was little power to detect inequalities by procedure. Data will therefore need to be pooled from multiple trusts to detect

  15. A local response to implementing Saving Lives in a large acute Trust.

    PubMed

    Edden, Anna Charlotte; Willan, Johanna Louise

    Healthcare-associated infections (HCAIs) are a high priority for health professionals. Under the Health and Social Care Act (2008), NHS organizations that fail to comply with the duties in the act could, in extreme cases, be liable for prosecution. Saving Lives (2007) is a national strategy to prevent and control HCAIs which incorporates seven high-impact interventions or care bundles. These relate to clinical procedures that must be performed correctly and in the same order for each patient, every time, to reduce the risk of a patient contracting an HCAI. Within a large Trust in the north east of England, five practice improvement facilitators were employed to assist with the implementation of the Department of Health's Saving Lives programme. A steering group consisting of senior multidisciplinary team members was set up. One of the aims of the group was to reduce variations in practice and to standardize documentation and clinical practice. This article describes how phase I of the programme was implemented across the Trust and discusses the standardized documentation developed.

  16. Cohort profile of the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLaM BRC) Case Register: current status and recent enhancement of an Electronic Mental Health Record-derived data resource

    PubMed Central

    Perera, Gayan; Broadbent, Matthew; Callard, Felicity; Chang, Chin-Kuo; Downs, Johnny; Dutta, Rina; Fernandes, Andrea; Hayes, Richard D; Henderson, Max; Jackson, Richard; Jewell, Amelia; Kadra, Giouliana; Little, Ryan; Pritchard, Megan; Shetty, Hitesh; Tulloch, Alex; Stewart, Robert

    2016-01-01

    Purpose The South London and Maudsley National Health Service (NHS) Foundation Trust Biomedical Research Centre (SLaM BRC) Case Register and its Clinical Record Interactive Search (CRIS) application were developed in 2008, generating a research repository of real-time, anonymised, structured and open-text data derived from the electronic health record system used by SLaM, a large mental healthcare provider in southeast London. In this paper, we update this register's descriptive data, and describe the substantial expansion and extension of the data resource since its original development. Participants Descriptive data were generated from the SLaM BRC Case Register on 31 December 2014. Currently, there are over 250 000 patient records accessed through CRIS. Findings to date Since 2008, the most significant developments in the SLaM BRC Case Register have been the introduction of natural language processing to extract structured data from open-text fields, linkages to external sources of data, and the addition of a parallel relational database (Structured Query Language) output. Natural language processing applications to date have brought in new and hitherto inaccessible data on cognitive function, education, social care receipt, smoking, diagnostic statements and pharmacotherapy. In addition, through external data linkages, large volumes of supplementary information have been accessed on mortality, hospital attendances and cancer registrations. Future plans Coupled with robust data security and governance structures, electronic health records provide potentially transformative information on mental disorders and outcomes in routine clinical care. The SLaM BRC Case Register continues to grow as a database, with approximately 20 000 new cases added each year, in addition to extension of follow-up for existing cases. Data linkages and natural language processing present important opportunities to enhance this type of research resource further, achieving both volume

  17. A national survey of inpatient medication systems in English NHS hospitals

    PubMed Central

    2014-01-01

    Background Systems and processes for prescribing, supplying and administering inpatient medications can have substantial impact on medication administration errors (MAEs). However, little is known about the medication systems and processes currently used within the English National Health Service (NHS). This presents a challenge for developing NHS-wide interventions to increase medication safety. We therefore conducted a cross-sectional postal census of medication systems and processes in English NHS hospitals to address this knowledge gap. Methods The chief pharmacist at each of all 165 acute NHS trusts was invited to complete a questionnaire for medical and surgical wards in their main hospital (July 2011). We report here the findings relating to medication systems and processes, based on 18 closed questions plus one open question about local medication safety initiatives. Non-respondents were posted another questionnaire (August 2011), and then emailed (October 2011). Results One hundred (61% of NHS trusts) questionnaires were returned. Most hospitals used paper-based prescribing on the majority of medical and surgical inpatient wards (87% of hospitals), patient bedside medication lockers (92%), patients’ own drugs (89%) and ‘one-stop dispensing’ medication labelled with administration instructions for use at discharge as well as during the inpatient stay (85%). Less prevalent were the use of ward pharmacy technicians (62% of hospitals) or pharmacists (58%) to order medications on the majority of wards. Only 65% of hospitals used drug trolleys; 50% used patient-specific inpatient supplies on the majority of wards. Only one hospital had a pharmacy open 24 hours, but all had access to an on-call pharmacist. None reported use of unit-dose dispensing; 7% used an electronic drug cabinet in some ward areas. Overall, 85% of hospitals had a double-checking policy for intravenous medication and 58% for other specified drugs. “Do not disturb” tabards

  18. Galvanising the NHS to Adopt Innovation

    PubMed Central

    Parris, Stuart; Cochrane, Gavin; Marjanovic, Sonja; Ling, Tom; Chataway, Joanna

    2016-01-01

    Abstract The Department of Health and the Wellcome Trust, in co-operation with NHS England, asked RAND Europe to conduct a limited consultation with key stakeholders about the practicality of measures and incentives proposed as part of the NHS Accelerated Access Review (AAR), which aims to assess the pathways for the development, assessment, and adoption of innovative medicines and medical technology. Through a focused engagement exercise with key healthcare stakeholders this project explored the implications of selected interim AAR propositions and feasibility of implementation for key actors, in primary and secondary care as well as commissioners and academia. Specifically, the project investigated the feasibility of implementation of three specific propositions including: a new earmarked fund to encourage AHSNs and other key innovation actors to re-design systems to embrace innovation; mobilising the influence of clinical system leaders to champion change; and encouraging secondary care organisations to take on “innovation champion” roles linked to financial incentives and a new emphasis on accountable care organisations. Data was collected on the feasibility of the three AAR propositions from a workshop with AHSN CEOs and Commercial Directors and interviews with senior NHS staff in three AHSN regions (South West, University College London Partners, and North East, North Cumbria). The study concludes with reflections on the feasibility of each recommendation and identifies factors expected to facilitate or challenge their implementation, as well as considering the wider cross cutting issues that may influence the adoption and diffusion of innovation in the NHS. PMID:28083436

  19. NHS clinical knowledge summaries.

    PubMed

    Richards, Derek

    2009-01-01

    The UK National Health Service (NHS) Clinical Knowledge Summaries, formerly known as PRODIGY, are part of the National Library for Health and provide a source of evidence-based information and practical know-how relating to the common conditions managed in primary care.

  20. Competitive strategies in the NHS.

    PubMed

    Coad, H; Kennedy, B

    1992-04-01

    The NHS has, of necessity since implementation of the NHS and Community Care Act 1990, strengthened its skills in business, marketing and other functions borrowed from industry and commerce. One area where, however, the NHS is currently weak is in competitive intelligence. Hazel Coad and Barbara Kennedy explain what this strategically important function is and how it can help financial viability.

  1. Outcomes of domestic violence screening at an acute London trust: are there missed opportunities for intervention?

    PubMed Central

    Warren-Gash, Charlotte; Bartley, Angela; Bayly, Jude; Dutey-Magni, Peter; Edwards, Sarah; Madge, Sara; Miller, Charlotte; Nicholas, Rachel; Radhakrishnan, Sheila; Sathia, Leena; Swarbrick, Helen; Blaikie, Dee; Rodger, Alison

    2016-01-01

    Objectives Domestic violence screening is advocated in some healthcare settings. Evidence that it increases referral to support agencies or improves health outcomes is limited. This study aimed to (1) investigate the proportion of hospital patients reporting domestic violence, (2) describe characteristics and previous hospital attendances of affected patients and (3) assess referrals to an in-house domestic violence advisor from Camden Safety Net. Design A series of observational studies. Setting Three outpatient clinics at the Royal Free London NHS Foundation Trust. Participants 10 158 patients screened for domestic violence in community gynaecology, genitourinary medicine (GUM) and HIV medicine clinics between 1 October 2013 and 30 June 2014. Also 2253 Camden Safety Net referrals over the same period. Main outcome measures (1) Percentage reporting domestic violence by age group gender, ethnicity and clinic. (2) Rates of hospital attendances in the past 3 years for those screening positive and negative. (3) Characteristics, uptake and risk assessment results for hospital in-house domestic violence referrals compared with Camden Safety Net referrals from other sources. Results Of the 10 158 patients screened, 57.4% were female with a median age of 30 years. Overall, 7.1% reported ever-experiencing domestic violence, ranging from 5.7% in GUM to 29.4% in HIV services. People screening positive for domestic violence had higher rates of previous emergency department attendances (rate ratio (RR) 1.63, 95% CI 1.09 to 2.48), emergency inpatient admissions (RR 2.27, 95% CI 1.37 to 3.84) and day-case admissions (RR 2.03, 95% CI 1.23 to 3.43) than those screening negative. The 77 hospital referrals to the hospital-based domestic violence advisor during the study period were more likely to be taken up and to be classified as high risk than referrals from elsewhere. Conclusions Selective screening for domestic violence in high-risk hospital clinic populations has the

  2. Implementation of a Shoulder Soft Tissue Injury Triage Service in a UK NHS Teaching Hospital Improves Time to Surgery for Acute Rotator Cuff Tears.

    PubMed Central

    Bateman, Marcus; Davies-Jones, Gareth; Tambe, Amol; Clark, David I

    2016-01-01

    Shoulder problems account for 2.4% of GP consultations in the United Kingdom and of those 70% are related to the rotator cuff. Many rotator cuff tears are of a degenerate nature but they can occur as a result of trauma in 8% of cases. Evidence suggests that patients with traumatic rotator cuff tears gain a better outcome in terms of pain and function if the tear is repaired early after injury. A specialist shoulder soft tissue injury clinic was set up in a large UK NHS teaching hospital with the primary purpose in the first year to halve the length of time patients with traumatic rotator cuff tears had to wait to consult a specialist and double the number of patients undergoing surgical repair within three months. The secondary purpose was to ensure that the new clinic was utilised to capacity by the end of the first year. The clinic was later expanded to manage patients with acute glenohumeral joint (GHJ) or acromioclavicular joint (ACJ) dislocations and identify those patients requiring surgical stabilisation. The new service involved referral of all patients presenting to the Accident & Emergency department with recent shoulder trauma and either an inability to raise the arm over shoulder height with a normal set of radiographs, or a confirmed GHJ or ACJ dislocation; to a specialist clinic run by an experienced upper limb physiotherapist. Patients were reassessed and referred for further imaging if required. Those patients found to have traumatic rotator cuff tears or structural instability lesions were listed for expedited surgery. The clinic ran alongside a consultant-led fracture clinic giving fast access to surgical decision-making. The service was reviewed after 3, 6, and 12 months and findings compared to a sample of 30 consecutive patients having undergone rotator cuff repair surgery via the previous pathway. 144 patients were referred to the clinic in the first year: 62 with rotator cuff symptoms, 38 with GHJ instability, 13 with ACJ instability, and 33

  3. A view on NHS reforms.

    PubMed

    Black, D

    1995-01-01

    The current 'reforms' of the NHS arose from concern over the increasing costs of health care; mistrust of the profession, including medicine and nursing; a contrasting excessive trust in the virtues of a managerial and mercantile culture; and possibly a desire to divert criticisms away from central government down to local agencies. The shape of the reforms largely reflected expedients which had been tried in the USA, with apparent neglect of the evidence that the system there had produced exceptionally costly and inequitable health care. With no prior evaluation in this country, and against much professional advice, the reforms were pushed through, and have caused problems. Massive managerial costs stemming from the artificial market have diverted resources, and also attention, from the care of patients. Doctors and nurses have tried to limit the damage, but limitation has its limits. To re-convert health care from a business to a service require abandoning the 'market', with its purchaser-provider split, and its imposition of a costly contractual framework on transactions which are in their nature clinical, not commercial.

  4. Trust and British Gas partner in EPC scheme.

    PubMed

    Bevan, Patrick

    2015-02-01

    In late August last year the St George's Healthcare NHS Trust in south-west London signed what the Trust's Estates and Facilities team described as 'a historic partnership' with British Gas for a £12 m Energy Performance Contract energy reduction scheme--via which the energy company has guaranteed to deliver £1.1 m in annual savings over the next 15 years. The agreement will see British Gas replace four 35-year-old gas-powered steam boilers and an ageing CHP plant in the boiler house at the Trust's main acute facility, the StGeorge's Hospital in Tooting, and upgrade some of the associated infrastructure. British Gas will also maintain the new plant to ensure that the projected savings are achieved while the Trust owns the new assets. The Trust should gain financially--via lower energy costs and carbon emissions, while estates personnel will be better able to complete the many other estate maintenance issues that would otherwise be contracted out at one of London's biggest acute hospitals.

  5. Centralised 3D printing in the NHS: a radiological review.

    PubMed

    Eley, K A

    2017-04-01

    In recent years, three-dimensional (3D) printing has seen an explosion of interest fuelled by improvements in technology and associated reduction in costs. The literature is replete with novel medical applications of custom anatomical models, prostheses, and surgical guides. Although the fundamental core of 3D printing lies in image manipulation, the driving force in many National Health Service (NHS) trusts has come from individual surgical specialties with 3D printers independently run and confined to respective departments. In this review of 3D printing, experience of establishing a new centralised 3D-printing service within an NHS hospital trust is reported, focusing on the requirements and challenges of such an endeavour.

  6. Trust enhances IT service management.

    PubMed

    2007-08-01

    ITIL process adoption may be a prerequisite for the National Programme for IT (NPfIT), but implementation is far from straightforward. IT services company Plan-Net has been assisting Barts and The London NHS Trust with implementing its ambitious ITIL processes deployment.

  7. Medical tourism: a cost or benefit to the NHS?

    PubMed

    Hanefeld, Johanna; Horsfall, Daniel; Lunt, Neil; Smith, Richard

    2013-01-01

    'Medical Tourism' - the phenomenon of people travelling abroad to access medical treatment - has received increasing attention in academic and popular media. This paper reports findings from a study examining effect of inbound and outbound medical tourism on the UK NHS, by estimating volume of medical tourism and associated costs and benefits. A mixed methods study it includes analysis of the UK International Passenger Survey (IPS); interviews with 77 returning UK medical tourists, 63 policymakers, NHS managers and medical tourism industry actors policymakers, and a review of published literature. These informed costing of three types of treatments for which patients commonly travel abroad: fertility treatment, cosmetic and bariatric surgery. Costing of inbound tourism relied on data obtained through 28 Freedom-of-Information requests to NHS Foundation Trusts. Findings demonstrate that contrary to some popular media reports, far from being a net importer of patients, the UK is now a clear net exporter of medical travellers. In 2010, an estimated 63,000 UK residents travelled for treatment, while around 52,000 patients sought treatment in the UK. Inbound medical tourists treated as private patients within NHS facilities may be especially profitable when compared to UK private patients, yielding close to a quarter of revenue from only 7% of volume in the data examined. Costs arise where patients travel abroad and return with complications. Analysis also indicates possible savings especially in future health care and social costs averted. These are likely to be specific to procedures and conditions treated. UK medical tourism is a growing phenomenon that presents risks and opportunities to the NHS. To fully understand its implications and guide policy on issues such as NHS global activities and patient safety will require investment in further research and monitoring. Results point to likely impact of medical tourism in other universal public health systems.

  8. Medical Tourism: A Cost or Benefit to the NHS?

    PubMed Central

    Hanefeld, Johanna; Horsfall, Daniel; Lunt, Neil; Smith, Richard

    2013-01-01

    ‘Medical Tourism’ – the phenomenon of people travelling abroad to access medical treatment - has received increasing attention in academic and popular media. This paper reports findings from a study examining effect of inbound and outbound medical tourism on the UK NHS, by estimating volume of medical tourism and associated costs and benefits. A mixed methods study it includes analysis of the UK International Passenger Survey (IPS); interviews with 77 returning UK medical tourists, 63 policymakers, NHS managers and medical tourism industry actors policymakers, and a review of published literature. These informed costing of three types of treatments for which patients commonly travel abroad: fertility treatment, cosmetic and bariatric surgery. Costing of inbound tourism relied on data obtained through 28 Freedom-of-Information requests to NHS Foundation Trusts. Findings demonstrate that contrary to some popular media reports, far from being a net importer of patients, the UK is now a clear net exporter of medical travellers. In 2010, an estimated 63,000 UK residents travelled for treatment, while around 52,000 patients sought treatment in the UK. Inbound medical tourists treated as private patients within NHS facilities may be especially profitable when compared to UK private patients, yielding close to a quarter of revenue from only 7% of volume in the data examined. Costs arise where patients travel abroad and return with complications. Analysis also indicates possible savings especially in future health care and social costs averted. These are likely to be specific to procedures and conditions treated. UK medical tourism is a growing phenomenon that presents risks and opportunities to the NHS. To fully understand its implications and guide policy on issues such as NHS global activities and patient safety will require investment in further research and monitoring. Results point to likely impact of medical tourism in other universal public health systems

  9. Healthcare Assistants: distributional losses as a consequence of NHS modernisation?

    PubMed Central

    Clark, Ian; Thompson, Amanda

    2015-01-01

    This paper examines the labour process of Healthcare Assistants (HCAs) at a National Health Service (NHS) hospital trust (TUH) in the context of the NHS modernisation agenda. It determines whether application of the modernisation agenda is formalised at TUH and considers how HCAs are affected. The paper is based upon 60 interviews with HCAs, structured questionnaires completed by all interview respondents, observation of HCAs and interviews with non‐clinical managers. The findings show that elements of the modernisation agenda are informally implemented at TUH to the detriment of HCAs. HCAs experience distributional losses in the form of intensification as nurses deflect duties to HCAs and insulate themselves from adverse effects. HCAs resist, using selective absence when pressures mount. They ameliorate losses by re‐internalising their work as a job with caring elements not a genuine caring role. They rationalise their altered behaviour towards patients by blaming the regime's treatment of them as a subordinated group. PMID:27570359

  10. Savings in its sights for Somerset Trust.

    PubMed

    Russell, Colin

    2011-10-01

    Colin Russell, healthcare specialist at Schneider Electric (pictured), explains how the company has recently worked with Taunton and Somerset NHS Foundation Trust to implement a major energy-saving project at the Trust's Musgrove Park Hospital in Taunton. He argues that, at a time when all areas of the service are being asked to reduce costs, such partnerships can potentially save the institution millions of pounds and significantly reduce carbon emissions, while "revitalising" parts of the NHS estate, and ensuring continuity of vital hospital services for facilities managers.

  11. E-therapies in England for stress, anxiety or depression: what is being used in the NHS? A survey of mental health services

    PubMed Central

    Hardy, G; Moore, R K

    2017-01-01

    Objective To document the range of web and smartphone apps used and recommended for stress, anxiety or depression by the National Health Service (NHS) in England. Design The study was conducted using Freedom of Information (FOI) requests and systematic website searches. Data sources Data were collected via FOI requests to NHS services between 13 February 2015 and 31 March 2015, and searches conducted on NHS apps library websites between 26 March 2015 and 2 November 2015. Data collection/extraction methods Data were compiled from responses to: (1) FOI requests sent to all Improving Access to Psychological Therapies (IAPT) services and NHS Mental Health Trusts in England and (2) NHS apps library search results. Results A total of 61 (54.95%) out of the then 111 IAPT service providers responded, accounting for 191 IAPT services, and all 51 of the then NHS Mental Health Trusts responded. The results were that 13 different web apps and 35 different smartphone apps for depression, anxiety or stress were available through either referral services or the online NHS Apps Libraries. The apps used and recommended vary by area and by point of access (online library/IAPT/trust). Conclusions Future research is required to establish the evidence base for the apps that are being used in the NHS in England. There is a need for service provision to be based on evidence and established guidelines. PMID:28115336

  12. An investigation into the move towards electronic journals: a case study of NHS libraries in Kent, Surrey and Sussex.

    PubMed

    England, Rebecca

    2013-09-01

    Electronic journals are so embedded into practice in academic libraries that it is easy to forget that this is not the case everywhere. In NHS libraries, for example, the staff face a particular set of issues. This article is based on Rebecca England's dissertation on this topic, completed as part of the MSc Econ course in Information and Library studies at Aberystwyth University. Rebecca is E-resources Librarian at the Maidstone and Tunbridge Wells NHS Trust. She investigated the momentum towards electronic journals in NHS libraries in the Kent, Surrey and Sussex region and the potential for a regional purchasing consortium.

  13. Healthcare scandals in the NHS: crime and punishment.

    PubMed

    Alghrani, Amel; Brazier, Margaret; Farrell, Anne-Maree; Griffiths, Danielle; Allen, Neil

    2011-04-01

    The Francis Report into failures of care at Mid Staffordshire NHS Foundation Trust Hospital documented a series of 'shocking' systematic failings in healthcare that left patients routinely neglected, humiliated and in pain as the Trust focused on cutting costs and hitting government targets. At present, the criminal law in England plays a limited role in calling healthcare professionals to account for failures in care. Normally, only if a gross error leads to death will a doctor or nurse face the prospect of prosecution. Doctors and nurses caring for patients under the Mental Health Act 1983 and the Mental Capacity Act 2005 may however be prosecuted for wilful neglect of a patient. In the light of the Francis Report, this article considers whether the criminal offence of wilful neglect should be extended to a broader healthcare setting and not confined to mental healthcare.

  14. Customer care in the NHS.

    PubMed

    Ruddick, Fred

    2015-01-20

    Viewing individuals in need of NHS care as customers has the potential to refocus the way their care is delivered. This article highlights some of the benefits of reframing the nurse-patient relationship in terms of customer care, and draws parallels between good customer care and the provision of high quality patient care in the NHS. It explores lessons to be learned from those who have studied the customer experience, which can be adapted to enhance the customer care experience within the health service. Developing professional expertise in the knowledge and skills that underpin good-quality interpersonal encounters is essential to improve the customer experience in health care and should be prioritised alongside the development of more technical skills. Creating a culture where emotional intelligence, caring and compassion are essential requirements for all nursing staff will improve patient satisfaction.

  15. International patients within the NHS: a case of public sector entrepreneurialism.

    PubMed

    Lunt, Neil; Exworthy, Mark; Hanefeld, Johanna; Smith, Richard D

    2015-01-01

    Many public health systems in high- and middle-income countries are under increasing financial pressures as a result of ageing populations, a rise in chronic and non-communicable diseases and shrinking public resources. At the same time the rise in patient mobility and concomitant market in medical tourism provides opportunities for additional income. This is especially the case where public sector hospitals have a reputation as global centres of excellence. Yet, this requires public sector entrepreneurship which, given the unique features of the public sector, means a change to professional culture. This paper examines how and under what conditions public sector entrepreneurship develops, drawing on the example of international patients in the UK NHS. It reports on a subset of data from a wider study of UK medical tourism, and explores inward flows and NHS responses through the lens of public entrepreneurship. Interviews in the English NHS were conducted with managers of Foundation Trusts with interest in international patient work. Data is from seven Foundation Trusts, based on indepth, semi-structured interviews with a range of NHS managers, and three other key stakeholders (n = 16). Interviews were analysed using a framework on entrepreneurship developed from academic literature. Empirical findings showed that Trust managers were actively pursuing a strategy of expanding international patient activity. Respondents emphasised that this was in the context of the current financial climate for the NHS. International patients were seen as a possible route to ameliorating pressure on stretched NHS resources. The analysis of interviews revealed that public entrepreneurial behaviour requires an organisational managerial or political context in order to develop, such as currently in the UK. Public sector workers engaged in this process develop entrepreneurship - melding political, commercial and stakeholder insights - as a coping mechanism to health system constraints.

  16. NHS market liberalisation and the TTIP agreement.

    PubMed

    Regan, Paul; Ball, Elaine

    2016-07-01

    Governments over the past three decades have undermined the founding principles of the NHS through reforms and market liberalisation. With greater involvement of commercial interests in health care, the NHS will become less democratic and transparent. Recent reforms, which were intended to improve productivity, quality and cost efficiency, have left the NHS exposed to the unwieldy model of market liberalisation and the attrition of public health care. The role of community nurses has been particularly destabilised by commissioning, as their work is difficult to measure. The advent of the Transatlantic Trade and Investment Partnership could further undermine the NHS to the benefit of international commercial interests.

  17. The UK National Health Service's 'innovation agenda': lessons on commercialisation and trust.

    PubMed

    Sterckx, Sigrid; Cockbain, Julian

    2014-01-01

    The UK National Health Service (the 'NHS'), encouraged by the 2011 report Innovation Health and Wealth, Accelerating Adoption and Diffusion in the NHS, and empowered by the Health and Social Care Act 2012, is in the process of adopting a new agenda for stimulating innovation in healthcare. For this, the bodies, body materials, and confidential health information of NHS patients may be co-opted. We explain why this brings the NHS into a moral conflict with its basic goal of providing a universal healthcare service. Putting NHS databases at the disposal of industry, without addressing ethical concerns regarding the privacy, autonomy, and moral integrity of patients and without requiring a 'kick-back' to enhance the service that the NHS provides, is inappropriate. As this article shows, with reference to the commercial arena of direct-to-consumer genetic testing, it is crucial that patient and public trust in the NHS is not eroded.

  18. Use staff wisely to save NHS money.

    PubMed

    Moore, Alison

    2015-12-09

    The NHS could save up to £ 2 billion a year by improving workflow and containing workforce costs, according to Labour peer Lord Carter's review of NHS efficiency. Changes in areas such as rostering and management of annual leave must avoid increasing the pressure on staff.

  19. The procurement of NHS dental services--a guide.

    PubMed

    Jones, C L; Rooney, E

    2009-05-23

    This paper gives an overview of the strategic background for procurement of NHS primary care dental services and an outline of the processes involved in procurement. The main aim is to bring procurement to the attention of a wider audience of dental practitioners and provide advice for potential primary care dental service providers. The move towards local procurement of healthcare services, including primary care dental services, has been shaped by a number of strategic Government publications and is supported by law. In line with other public bodies, the NHS is subject to the European Union and international rules regarding procurement and awarding contracts. Primary Care Trust (PCT) Dental Service Commissioners have to ensure that their procurement strategy is transparent and non-discriminatory so that all providers have an equal opportunity to compete for contracts. In order to successfully tender for future service provision contracts, dental practitioners not only need to be aware of the process of procurement and its associated legal requirements. It is also important that they have a grasp of the expectations of PCTs. Commissioning services via procurement is set to become more commonplace and it is likely, in time, that competition for some contracts will increase in intensity. The importance of researching proposals thoroughly and adopting a professional, businesslike approach to tendering cannot be understated as this maximises chance of success in the new commissioning environment.

  20. Can the NHS cope in future?

    PubMed Central

    Harrison, A.; Dixon, J.; New, B.; Judge, K.

    1997-01-01

    Four potential pressures are likely to determine whether the NHS will be able to cope in future: the change in population structure, changes in level of morbidity, introduction of new technologies, and increasing expectations of patients and NHS providers. New technology and changes in expectations are likely to have the biggest effect and are also the most difficult to quantify. Nevertheless, these pressures are to some extent amenable to control. If the growth in funding continues as it has in the past there is no convincing evidence that the NHS will not continue to cope. PMID:9006479

  1. Capacity of English NHS hospitals to monitor quality in infection prevention and control using a new European framework: a multilevel qualitative analysis

    PubMed Central

    Iwami, Michiyo; Ahmad, Raheelah; Castro-Sánchez, Enrique; Birgand, Gabriel; Johnson, Alan P; Holmes, Alison

    2017-01-01

    Objective (1) To assess the extent to which current English national regulations/policies/guidelines and local hospital practices align with indicators suggested by a European review of effective strategies for infection prevention and control (IPC); (2) to examine the capacity of local hospitals to report on the indicators and current use of data to inform IPC management and practice. Design A national and local-level analysis of the 27 indicators was conducted. At the national level, documentary review of regulations/policies/guidelines was conducted. At the local level data collection comprised: (a) review of documentary sources from 14 hospitals, to determine the capacity to report performance against these indicators; (b) qualitative interviews with 3 senior managers from 5 hospitals and direct observation of hospital wards to find out if these indicators are used to improve IPC management and practice. Setting 2 acute English National Health Service (NHS) trusts and 1 NHS foundation trust (14 hospitals). Participants 3 senior managers from 5 hospitals for qualitative interviews. Primary and secondary outcome measures As primary outcome measures, a ‘Red-Amber-Green’ (RAG) rating was developed reflecting how well the indicators were included in national documents or their availability at the local organisational level. The current use of the indicators to inform IPC management and practice was also assessed. The main secondary outcome measure is any inconsistency between national and local RAG rating results. Results National regulations/policies/guidelines largely cover the suggested European indicators. The ability of individual hospitals to report some of the indicators at ward level varies across staff groups, which may mask required improvements. A reactive use of staffing-related indicators was observed rather than the suggested prospective strategic approach for IPC management. Conclusions For effective patient safety and infection prevention in

  2. Practice education facilitator roles and their value to NHS organisations.

    PubMed

    Scott, Betsy; Rapson, Terri; Allibone, Liz; Hamilton, Rozi; Mambanje, Constance S; Pisaneschi, Laura

    2017-02-23

    The role of the practice education facilitator (PEF) was introduced to support the management of large student nurse numbers in clinical areas and to monitor and enhance the quality of placements. While much has been written about the activities and roles undertaken by PEFs, less is known about the value of this type of role to the NHS organisations that employ them. This article explores some of the views of PEFs working in a variety of trusts and organisations in London and surrounding counties. There is no consistent job definition and often insufficient support, leading to some PEFs feeling overwhelmed by the work and isolated within the role. Since its introduction, the role has required post holders to work more strategically within their trusts' education remits. However, it was felt by most post holders that the role remains undervalued and the perception is that these posts are vulnerable to budget cuts. The article considers what effect this could have on pre-registration nurse education. The profile of the role needs to be strengthened through consistent job descriptions and streamlining the number of job titles attached to the role.

  3. Patient's charter. NHS--keeping the customer satisfied.

    PubMed

    Rigge, M

    1997-10-30

    Complaints to the College of Health suggest that the Patient's Charter standards on receiving care on the basis of clinical need, response to complaints, and information-giving are not being met in many cases. Patients must be involved in revising the Patient's Charter. A truly patient-focused service demands patient representatives on health authority and trust boards, spot checks and systematic reviews of health services. Acute trusts should be remodelled to mirror the patient's progress through the hospital and back to the community.

  4. Getting the basics right: choosing paper hand towels for use in one trust.

    PubMed

    Raymond, Paul

    2004-07-01

    Hand towels that are effective and pleasant to use are an important element of a good infection control practice and are purchased in enormous quantities by NHS trusts. A balance between clinical and cost effectiveness was achieved at one trust following the audit and introduction of a new paper towel product.

  5. "Doing Trust".

    PubMed

    Guillemin, Marilys; Gillam, Lynn; Barnard, Emma; Stewart, Paul; Walker, Hannah; Rosenthal, Doreen

    2016-10-01

    Trust in research is important but not well understood. We examine the ways that researchers understand and practice trust in research. Using a qualitative research design, we interviewed 19 researchers, including eight researchers involved in Australian Indigenous research. The project design focused on sensitive research including research involving vulnerable participants and sensitive research topics. Thematic analysis was used to analyze the data. We found that researchers' understanding of trust integrates both the conceptual and concrete; researchers understand trust in terms of how it relates to other similar concepts and how they practice trust in research. This provides a sound basis to better understand trust in research, as well as identifying mechanisms to regain trust when it is lost in research.

  6. Getting more for their dollar: a comparison of the NHS with California's Kaiser Permanente

    PubMed Central

    Feachem, Richard G A; Sekhri, Neelam K; White, Karen L

    2002-01-01

    Objective To compare the costs and performance of the NHS with those of an integrated system for financing and delivery health services (Kaiser Permanente) in California. Methods The adjusted costs of the two systems and their performance were compared with respect to inputs, use, access to services, responsiveness, and limited quality indicators. Results The per capita costs of the two systems, adjusted for differences in benefits, special activities, population characteristics, and the cost environment, were similar to within 10%. Some aspects of performance differed. In particular, Kaiser members experience more comprehensive and convenient primary care services and much more rapid access to specialist services and hospital admissions. Age adjusted rates of use of acute hospital services in Kaiser were one third of those in the NHS. Conclusions The widely held beliefs that the NHS is efficient and that poor performance in certain areas is largely explained by underinvestment are not supported by this analysis. Kaiser achieved better performance at roughly the same cost as the NHS because of integration throughout the system, efficient management of hospital use, the benefits of competition, and greater investment in information technology. What is already known on this topicComparisons of healthcare systems in different countries have to be undertaken with great care but can be instructiveThe overall healthcare system in the United States is more expensive than the NHS and population health outcomes are no betterThe US healthcare system comprises many discrete and unique subsystems, including the health maintenance organisationsWhat this paper addsAn integrated, non-profit health maintenance organisation in California (Kaiser Permanente), with over six million members, costs about the same as the NHS but performs considerably betterKaiser's superior performance is mainly in prompt and appropriate diagnosis and treatmentThese findings challenge the widely held

  7. Rethinking trust.

    PubMed

    Kramer, Roderick M

    2009-06-01

    Will we ever learn? We'd barely recovered from Enron and WorldCom before we faced the subprime mortgage meltdown and more scandals that shook our trust in businesspeople. Which raises the question: Do we trust too much? In this article, Stanford professor and social psychologist Kramer explores the reasons we trust so easily--and, often, so unwisely. He explains that genetics and childhood learning make us predisposed to trust and that it's been a good survival mechanism. That said, our willingness to trust makes us vulnerable. Our sense of trust kicks in on remarkably simple cues, such as when people look like us or are part of our social group. We also rely on third parties to verify the character of others, sometimes to our detriment (as the victims of Bernard Madoff learned). Add in our illusions of invulnerability and our tendencies to see what we want to see and to overestimate our own judgment, and the bottom line is that we're often easily fooled. We need to develop tempered trust. For those who trust too much, that means reading cues better; for the distrustful, it means developing more receptive behaviors. Everyone should start with small acts of trust that encourage reciprocity and build up. Having a hedge against potential abuses also helps. Hollywood scriptwriters, for instance, register their treatments with the Writers Guild of America to prevent their ideas from being stolen by the executives they pitch. To attract the right relationships, people must strongly signal their own honesty, proactively allay concerns, and, if their trust is abused, retaliate. Trusting individuals in certain roles, which essentially means trusting the system that selects and trains them, also works but isn't foolproof. And don't count on due diligence alone for protection; constant vigilance is needed to make sure the landscape hasn't changed.

  8. Empowerment: the right medicine for improving employee commitment and morale in the NHS?

    PubMed

    Cunningham, I; Hyman, J

    1996-01-01

    States that in recent years, empowerment of National Health Service (NHS) Trust employees has been given substantial political and managerial support. Examines the extent to which the commitment and morale of staff in two NHS Trust hospitals has altered following the introduction of a raft of techniques under the empowerment label. The researchers interviewed substantial numbers of staff with managerial responsibilities, personnel specialists and conducted written surveys seeking employee opinion. Reports the findings, which confirm that, under empowerment, the work of both managers and staff has become more intensive, but managers claim that their commitment has risen, while for non-managerial employees, severe problems of commitment to the Trust, declining morale and high stress were exposed. Identifies reasons for these difficulties which were: the salience of budgetary and operational priorities; lack of training; resistance to the implementation of empowerment; and recognition that little real authority was being devolved to employees. Concludes that the limited effects attributable to empowerment could be explained by its association with harder-edged manpower policies introduced to meet financial and competitive pressures. Under favourable contextual conditions, empowerment may exert more positive effects.

  9. Reassuring and managing patients with concerns about swine flu: Qualitative interviews with callers to NHS Direct

    PubMed Central

    2010-01-01

    Background During the early stages of the 2009 swine flu (influenza H1N1) outbreak, the large majority of patients who contacted the health services about the illness did not have it. In the UK, the NHS Direct telephone service was used by many of these patients. We used qualitative interviews to identify the main reasons why people approached NHS Direct with concerns about swine flu and to identify aspects of their contact which were reassuring, using a framework approach. Methods 33 patients participated in semi-structured interviews. All patients had telephoned NHS Direct between 11 and 14 May with concerns about swine flu and had been assessed as being unlikely to have the illness. Results Reasons for seeking advice about swine flu included: the presence of unexpectedly severe flu-like symptoms; uncertainties about how one can catch swine flu; concern about giving it to others; pressure from friends or employers; and seeking 'peace of mind.' Most participants found speaking to NHS Direct reassuring or useful. Helpful aspects included: having swine flu ruled out; receiving an alternative explanation for symptoms; clarification on how swine flu is transmitted; and the perceived credibility of NHS Direct. No-one reported anything that had increased their anxiety and only one participant subsequently sought additional advice about swine flu from elsewhere. Conclusions Future major incidents involving other forms of chemical, biological or radiological hazards may also cause large numbers of unexposed people to seek health advice. Our data suggest that providing telephone triage and information is helpful in such instances, particularly where advice can be given via a trusted, pre-existing service. PMID:20678192

  10. Morality and markets in the NHS.

    PubMed

    Gilbert, Barnabas J; Clarke, Emma; Leaver, Laurence

    2014-12-01

    Since its establishment in 1948, the history of the National Health Service (NHS) has been characterized by organisational turbulence and system reform. At the same time, progress in science, medicine and technology throughout the western world have revolutionized the delivery of healthcare. The NHS has become a much loved, if much critiqued, national treasure. It is against this backdrop that the role of this state-funded health service has been brought into moral question. Certainly, the challenges facing healthcare policy-makers are numerous and complex, but in the wake of the Health and Social Care Act (2012), no issue is more divisive than that of market-based reform. Here we explore the turbulent history of the NHS, from its foundation to the birth of the healthcare marketplace. We explore arguments for and against the healthcare market and resolve that, amid an evolving economic and moral framework, the NHS must ensure that its original tenets of equity and autonomy remain at its core. We propose a values-explicit, systems-based approach to renew focus on both the processes and the outcomes of care.

  11. Morality and markets in the NHS

    PubMed Central

    Gilbert, Barnabas J; Clarke, Emma; Leaver, Laurence

    2014-01-01

    Since its establishment in 1948, the history of the National Health Service (NHS) has been characterized by organisational turbulence and system reform. At the same time, progress in science, medicine and technology throughout the western world have revolutionized the delivery of healthcare. The NHS has become a much loved, if much critiqued, national treasure. It is against this backdrop that the role of this state-funded health service has been brought into moral question. Certainly, the challenges facing healthcare policy-makers are numerous and complex, but in the wake of the Health and Social Care Act (2012), no issue is more divisive than that of market-based reform. Here we explore the turbulent history of the NHS, from its foundation to the birth of the healthcare marketplace. We explore arguments for and against the healthcare market and resolve that, amid an evolving economic and moral framework, the NHS must ensure that its original tenets of equity and autonomy remain at its core. We propose a values-explicit, systems-based approach to renew focus on both the processes and the outcomes of care. PMID:25489594

  12. Responsibility for funding NHS library services.

    PubMed

    Stewart, D

    1992-06-01

    This paper is intended to contribute to discussion and debate on sources of funding for NHS library services which is a complex issue in the present climate of organizational change. Topics covered include the management and organization of services, the users, their requirements and sources of funding. In conclusion a number of specific issues that need addressing are raised.

  13. Developing organizational learning in the NHS.

    PubMed

    Nutley, S M; Davies, H T

    2001-01-01

    Learning has been identified as a central concern for a modernized NHS. Continuing professional development has an important role to play in improving learning but there is also a need to pay more attention to collective (organizational) learning. Such learning is concerned with the way organizations build and organize knowledge. Recent emphasis within the NHS has been on the codification of individual and collective knowledge - for example, guidelines and National Service Frameworks. This needs to be balanced by more personalized knowledge management strategies, especially when dealing with innovative services that rely on tacit knowledge to solve problems. Having robust systems for storing and communicating knowledge is only one part of the challenge. It is also important to consider how such knowledge gets used, and how routines become established within organizations that structure the way in which knowledge is deployed. In many organizations these routines favour the adaptive use of knowledge, which helps organizations to achieve incremental improvements to existing practices. However, the development of organizational learning in the NHS needs to move beyond adaptive (single loop) learning, to foster skills in generative (double loop) learning and meta-learning. Such learning leads to a redefinition of the organization's goals, norms, policies, procedures or even structures. This paper argues that moving the NHS in this direction will require attention to the cultural values and structural mechanisms that facilitate organizational learning.

  14. Investigation of the degree of organisational influence on patient experience scores in acute medical admission units in all acute hospitals in England using multilevel hierarchical regression modelling

    PubMed Central

    Sullivan, Paul

    2017-01-01

    Objectives Previous studies found that hospital and specialty have limited influence on patient experience scores, and patient level factors are more important. This could be due to heterogeneity of experience delivery across subunits within organisations. We aimed to determine whether organisation level factors have greater impact if scores for the same subspecialty microsystem are analysed in each hospital. Setting Acute medical admission units in all NHS Acute Trusts in England. Participants We analysed patient experience data from the English Adult Inpatient Survey which is administered to 850 patients annually in each acute NHS Trusts in England. We selected all 8753 patients who returned the survey and who were emergency medical admissions and stayed in their admission unit for 1–2 nights, so as to isolate the experience delivered during the acute admission process. Primary and secondary outcome measures We used multilevel logistic regression to determine the apportioned influence of host organisation and of organisation level factors (size and teaching status), and patient level factors (demographics, presence of long-term conditions and disabilities). We selected ‘being treated with respect and dignity’ and ‘pain control’ as primary outcome parameters. Other Picker Domain question scores were analysed as secondary parameters. Results The proportion of overall variance attributable at organisational level was small; 0.5% (NS) for respect and dignity, 0.4% (NS) for pain control. Long-standing conditions and consequent disabilities were associated with low scores. Other item scores also showed that most influence was from patient level factors. Conclusions When a single microsystem, the acute medical admission process, is isolated, variance in experience scores is mainly explainable by patient level factors with limited organisational level influence. This has implications for the use of generic patient experience surveys for comparison between

  15. A comparison of service predispositions between NHS nurses and hospitality workers.

    PubMed

    Lee-Ross, D

    1999-01-01

    The following study sought to develop an instrument to elicit the service predispositions of nurses and hospitality foodservice workers. Results of a pilot study suggested that the service predisposition instrument (SPI) was valid and therefore appropriate to investigate the service attitudes of these workers. Service predispositions of nurses from two NHS Trusts were compared with those of hospitality foodservice workers in two large hotels. Overall, both nurses and foodservice workers were found to have similar positive service predispositions. However, significant differences were present between groups for certain service dimensions.

  16. Challenges of commissioning and contracting for integrated care in the National Health Service (NHS) in England.

    PubMed

    Addicott, Rachael

    2016-01-01

    For many years there has been a separation between purchasing and provision of services in the English National Health Service (NHS). Many studies report that this commissioning function has been weak: purchasers have had little impact or power in negotiations with large acute providers, and have had limited strategic control over the delivery of care. Nevertheless, commissioning has become increasingly embedded in the NHS structure since the arrival of Clinical Commissioning Groups (CCGs) in 2012. Recently, some of these CCGs have focused on how they can contract and commission in different ways to stimulate greater collaboration across providers. This paper examines experiences of commissioning and contracting for integrated care in the English NHS, based on a series of national-level interviews and case studies of five health economies that are implementing novel contracting models. The cases illustrated here demonstrate early experiments to drive innovation through contracting in the NHS that have largely relied on the vision of individual teams or leaders, in combination with external legal, procurement and actuarial support. It is unlikely that this approach will be sustainable or replicable across the country or internationally, despite the best intentions of commissioners. Designing and operating novel contractual approaches will require considerable determination, alongside advanced skills in procurement, contract management and commissioning. The cost of developing new contractual approaches is high, and as the process is difficult and resource-intensive, it is likely that dedicated teams or programs will be required to drive significant improvement.

  17. Open Dialogue and its Relevance to the NHS: Opinions of NHS Staff and Service Users.

    PubMed

    Razzaque, Russell; Wood, Lisa

    2015-11-01

    Open Dialogue is a model of mental health services that originated in Finland and has since, been taken up in trial teams worldwide. As this is a relatively unknown approach in the UK, it is important to tentatively explore perspectives of NHS staff and service-users. Sixty-one Open Dialogue conference attendees, both staff and service-users, were recruited for this study. A feedback questionnaire was administered to determine the extent to which they believed the key tenets of Open Dialogue were important to service user care, and the extent to which they existed within current NHS services. Analysis of data demonstrated a strong consensus on the importance of the key principles of Open Dialogue for mental health care and also moderate disagreement that these principles exist within current NHS service provision. The Open Dialogue principles may offer a useful framework in order to develop services in a clinically meaningful way.

  18. Redefining NHS complaint handling--the real challenge.

    PubMed

    Seelos, L; Adamson, C

    1994-01-01

    More and more organizations find that a constructive and open dialogue with their customers can be an effective strategy for building long-term customer relations. In this context, it has been recognized that effective complaint-contact handling can make a significant contribution to organizations' attempts to maximize customer satisfaction and loyalty. Within the NHS, an intellectual awareness exists that effective complaint/contact handling can contribute to making services more efficient and cost-effective by developing customer-oriented improvement initiatives. Recent efforts have focused on redefining NHS complaint-handling procedures to make them more user-friendly and effective for both NHS employees and customers. Discusses the challenges associated with opening up the NHS to customer feedback. Highlights potential weaknesses in the current approach and argues that the real challenge is for NHS managers to facilitate a culture change that moves the NHS away from a long-established defensive complaint handling practice.

  19. Patterning NHS-terminated SAMs on germanium.

    PubMed

    Morris, Carleen J; Shestopalov, Alexander A; Gold, Brian H; Clark, Robert L; Toone, Eric J

    2011-05-17

    Here we report a simple, robust approach to patterning functional SAMs on germanium. The protocol relies on catalytic soft-lithographic pattern transfer from an elastomeric stamp bearing pendant immobilized sulfonic acid moieties to an NHS-functionalized bilayer molecular system comprising a primary ordered alkyl monolayer and a reactive ester secondary overlayer. The catalytic polyurethane-acrylate stamp was used to form micrometer-scale features of chemically distinct SAMs on germanium. The methodology represents the first example of patterned SAMs on germanium, a semiconductor material.

  20. Trust and Influence

    DTIC Science & Technology

    2012-03-05

    DISTRIBUTION A: Approved for public release; distribution is unlimited. Program Trends •Trust in Autonomous Systems •Cross- cultural Trust... Cultural Trust – Identify the antecedents of trust in different cultures •Trust in Autonomous Systems/Autonomy – identify the factors that shape...Trust & trustworthiness are independent (Mayer et al, 1995) •Trust is relational •Humans in cross- cultural interactions •Complex human-machine

  1. Trusted Objects

    SciTech Connect

    CAMPBELL,PHILIP L.; PIERSON,LYNDON G.; WITZKE,EDWARD L.

    1999-10-27

    In the world of computers a trusted object is a collection of possibly-sensitive data and programs that can be allowed to reside and execute on a computer, even on an adversary's machine. Beyond the scope of one computer we believe that network-based agents in high-consequence and highly reliable applications will depend on this approach, and that the basis for such objects is what we call ''faithful execution.''

  2. Never trust a croup…

    PubMed Central

    Nickinson, Andrew; Minhas, Jatinder Singh; Bhalla, Minak; Anwuzia-Iwegbu, Charles; Chapman, John

    2011-01-01

    A 2-year-old girl presented to the James Paget University Hospitals Trust with croup-like symptoms and was later discharged with dexamethasone syrup. The patient re-presented 6 h later following maternal concern with signs of acute respiratory distress. After a period of clinical stability, she acutely decompensated without any prior signs of a life-threatening deterioration. She was managed using nebulised epinephrine and showed signs of clinical improvement. Although improvement persisted, the child showed signs of exhaustion following the preceding events and was later intubed with an endotracheal tube and transferred to the paediatric intensive care unit at Addenbrooke’s University Hospital, Cambridge. Endotracheal aspiration later grew parainfluenza virus, rhinovirus and Staphylococcus aureus and the patient was diagnosed with the exceptionally rare life threatening complications of croup, bacterial tracheitis. The patient was discharged from intensive care 7 days later and has since made a full recovery. PMID:22689599

  3. An evaluation on the effectiveness of Web 2.0 Startpages (Netvibes & Pageflakes) within NHS libraries.

    PubMed

    McCormick, Carol; Pickard, Alison Jane

    2013-06-01

    Carol McCormick was Learning Resources Advisor in the library at James Cook University Hospital, South Teesside when she completed her BSc (Hons) Librarianship (Work Based Learning) degree at Northumbria University. She gained a 1st Class Honours and is now Learning Resources Librarian. Carol's dissertation formed part of a wider action research project into the provision of current awareness services at James Cook University Hospital. This article reports on the evaluation which was conducted after a Web 2.0 Startpage, or portal, had been introduced to improve access to current awareness information for all staff within the Trust. It is the second article in the Dissertations into practice series to examine the use of web-based tools to improve access to information for NHS staff. AM.

  4. The relationship between organizational culture and performance in acute hospitals.

    PubMed

    Jacobs, Rowena; Mannion, Russell; Davies, Huw T O; Harrison, Stephen; Konteh, Fred; Walshe, Kieran

    2013-01-01

    This paper examines the relationship between senior management team culture and organizational performance in English acute hospitals (NHS Trusts) over three time periods between 2001/2002 and 2007/2008. We use a validated culture rating instrument, the Competing Values Framework, to measure senior management team culture. Organizational performance is assessed using a wide range of routinely collected indicators. We examine the associations between organizational culture and performance using ordered probit and multinomial logit models. We find that organizational culture varies across hospitals and over time, and this variation is at least in part associated in consistent and predictable ways with a variety of organizational characteristics and routine measures of performance. Moreover, hospitals are moving towards more competitive culture archetypes which mirror the current policy context, though with a stronger blend of cultures. The study provides evidence for a relationship between culture and performance in hospital settings.

  5. Looking at the extent of fraud within the NHS.

    PubMed

    Griffith, Richard; Tengnah, Cassam

    2011-10-01

    Fraud costs the NHS billions of pounds each year, and takes money away from frontline services. The Fraud Act 2006 has made the offence clearer and therefore easier to bring prosecutions. Offences can range from false representation about qualifications and experience to fraudulent consent forms, and through to bogus invoices and charging ghost patients. In this article, Richard Griffith and Cassam Tengnah outline what constitutes fraud and the measures taken by the NHS to counter fraudulent activity.

  6. From Hippocrates to Commodities: three models of NHS governance: NHS governance, regulation, Mid Staffordshire inquiry, health care as a commodity.

    PubMed

    Newdick, Christopher

    2014-01-01

    A series of inquiries and reports suggest considerable failings in the care provided to some patients in the NHS. Although the Bristol Inquiry report of 2001 led to the creation of many new regulatory bodies to supervise the NHS, they have never enjoyed consistent support from government and the Mid Staffordshire Inquiry in 2013 suggests they made little difference. Why do some parts of the NHS disregard patients' interests and how we should we respond to the challenge? The following discusses the evolution of approaches to NHS governance through the Hippocratic, Managerial and Commercial models, and assesses their risks and benefits. Apart from the ethical imperative, the need for effective governance is driven both by the growth in information available to the public and the resources wasted by ineffective systems of care. Appropriate solutions depend on an understanding of the perverse incentives inherent in each model and the need for greater sensitivity to the voices of patients and the public.

  7. Trust in Social Computing

    DTIC Science & Technology

    2014-04-07

    T. Schlosser, and H. Garcia-Molina. The eigentrust algorithm for reputation management in p2p networks . In Proceedings of the 12th international...demonstrate real-world applications where trust is explicitly used. As a new 1. REPORT DATE (DD-MM-YYYY) 4. TITLE AND SUBTITLE 13. SUPPLEMENTARY NOTES 12...Mining, TrustModeling, Trust Measurements, Trust Applications , Dis-trust REPORT DOCUMENTATION PAGE 11. SPONSOR/MONITOR’S REPORT NUMBER(S) 10

  8. Trust and Influence

    DTIC Science & Technology

    2013-03-06

    how humans establish, maintain, and repair trust of humans and technological systems) and the science of influence (i.e., understanding how to shape...factors that shape reliance in complex human -machine interactions • Cross-Cultural Trust – identify the antecedents of trust in different cultures...actions of others with little ability to monitor their actions (Mayer et al., 1995) Assumptions: •Trust as a human phenomenon •Trust

  9. Marginal-cost contracting in the NHS: results of a preliminary survey.

    PubMed

    Beddow, A J; Cohen, D R

    2001-05-01

    Market disciplines and incentives were expected to improve efficiency in the UK National Health Service following the introduction of an 'internal market' in 1991. An exploratory survey of all Health Authorities and Trusts in the UK was undertaken to investigate whether players in the NHS managed market are behaving as economic theory predicts they should. The focus was on how and to what extent marginal costing has been used in the contracting process and on whether in some instances an inappropriate use of marginal costing may be resulting in inappropriate investment decisions. Twenty of 29 responding Health Authorities (69%) and 16 of 39 Trusts (41%) stated that they had considered purchasing/providing services on a marginal-cost basis and all of these led to contracts. Marginal-cost contracting appears to be fairly commonplace and the process does not appear to be causing insurmountable conflicts between players. Most marginal-cost contracts were specifically to meet waiting-list initiative targets. Overall results suggest that economic principles are not being particularly adhered to, with expansion in output rarely being related to available capacity. As increased responsibility for commissioning passes to primary care teams and local health groups, there are lessons for those involved in this more disaggregated approach to service shaping and service delivery.

  10. Can learning organizations survive in the newer NHS?

    PubMed Central

    Sheaff, Rod; Pilgrim, David

    2006-01-01

    Background This paper outlines the principal characteristics of a learning organisation and the organisational features that define it. It then compares these features with the organisational conditions that currently obtain, or are being created, within the British NHS. The contradictory development of recent British health policy, resulting in the NHS becoming both more marketised and more bureaucratised has correspondingly ambiguous implications for attempts to implement a 'learning organisation' model. Methods Texts that define and debate the characteristics of a learning organisation were found by snowballing references from the founding learning organisation books and published papers, and then by searching a database specifically devised for a literature review on organisational structures and processes in health care. COPAC and ABI-Info databases for subsequent peer-reviewed publications that also appeared relevant to the present study were searched. Results The outcomes of the above search are summarised and mapped onto the current constituent organisations of the NHS to identify the extent to which they achieve or approximate to a learning organisation status. Conclusion Because of the complexity of the NHS and the contradictory processes of marketisation and bureaucratisation characterising it, it cannot, as a whole system, become a learning organisation. However, it is possible that its constituent organisations may achieve this status to varying degrees. Constraints upon NHS managers to speak their minds freely place an ultimate limit on learning organisation development. This limitation suggests that current British health service policy encourages organisational learning-but not too openly and not too much. PMID:17074083

  11. Leadership in the NHS: does the Emperor have any clothes?

    PubMed

    Checkland, Kath

    2014-10-01

    In this essay, I explore the rise of the concept of 'leadership' in the English NHS, highlighting the similarity with a previous shift from (bad, old) 'administration' to (good, new) 'management'. I take a critical look at this discursive shift and highlight some of the overblown claims made for the value of 'clinical leadership'. I argue that, rather than turning all NHS staff into leaders, we should perhaps tone down the level of our rhetoric and instead emphasize the need for a service full of good followers who will maintain a relentless focus on care, quality and efficiency.

  12. Effectiveness of a pressure-relieving mattress in an acute stroke ward.

    PubMed

    Gleeson, Deborah

    2016-11-10

    Between the 10 May and 18 July 2016, St Helens and Knowsley Teaching Hospitals NHS Trust conducted a small, non-controlled evaluation set out to assess the performance of the Apex Pro-care Auto pressure-relieving mattress in an acute stroke ward. Seven patients, assessed as being at medium-to-high risk of developing a pressure ulcer (PU), were recruited into the evaluation; the mean age was 73.1 years. Three patients were bed bound and four had restricted mobility. The average length of time spent on the mattress was 31 days. At the end of the evaluation, none of the patients had developed a PU while using the mattress. These results indicate that, when combined with a robust PU prevention plan inclusive of repositioning, this pressure-relieving mattress is effective in preventing pressure ulceration.

  13. Trust vs. Confidence

    DTIC Science & Technology

    2016-06-07

    both cognitive and affective factors can be implicated in trust judgements. Moreover, unlike confidence judgements (which can occur in many...occurs in situations without risks. A trust judgement, on the other hand, uses a variety of information beyond the merely cognitive , occurs only when...defined. Although there are many different definitions of trust, our definition (Adams and Webb, 2003) is as follows: Trust is a psychological state

  14. Reliable Design Versus Trust

    NASA Technical Reports Server (NTRS)

    Berg, Melanie; LaBel, Kenneth A.

    2016-01-01

    This presentation focuses on reliability and trust for the users portion of the FPGA design flow. It is assumed that the manufacturer prior to hand-off to the user tests FPGA internal components. The objective is to present the challenges of creating reliable and trusted designs. The following will be addressed: What makes a design vulnerable to functional flaws (reliability) or attackers (trust)? What are the challenges for verifying a reliable design versus a trusted design?

  15. Children's Conceptions of Trust.

    ERIC Educational Resources Information Center

    Kahn, Peter H., Jr.; Turiel, Elliot

    Aware that children conceive of different types of trust, a study examined 60 children's conception of trust. The subjects comprised three age groups: 6-7 years old, 8-9 years old, and 10-11 years old. Each subject was interviewed on the basis of three stories. The stories depicted a hypothesized violation of trust in a moral context (lying),…

  16. From NHS Choices to the integrated customer service platform.

    PubMed

    Gann, Bob; Grant, Maria J

    2013-03-01

    In 2013 the NHS Commissioning Board launches its new integrated customer service platform. The new service utilises the full range of channels (web, telephone, apps etc) to provide access to information to support transparency, participation and transactions. Digital health services have proven benefits in informed choice, shared decision making and patient participation.

  17. Goodwill in the NHS is a one-way street.

    PubMed

    Scott, Graham

    2015-03-25

    The NHS runs on goodwill. Every day thousands of nurses, midwives and healthcare support workers work extra hours, skip breaks and go the extra mile to keep the health service running. In return, you may receive a 'thank you' from your manager or expressions of gratitude from patients, but rarely will you see any extra in your pay packet.

  18. The NHS could learn from inspiring leaders like Barack Obama.

    PubMed

    Coghill, Yvonne

    2017-02-01

    I remember November 2008 like it was yesterday. I was the lead for the NHS Leadership Academy's national Breaking Through programme for black and minority ethnic staff, and recall being at our annual conference bursting with pride at the news that Barack Obama had been elected president of the United States.

  19. Validating the Trust in Teams and Trust in Leaders Scales

    DTIC Science & Technology

    2006-01-01

    Work Scale trust scale ( Cook , Hepworth, Wall and Warr , 1981). This scale measures interpersonal trust in the organizational context. The full version...2005) scale .....................................................................30 Table 16: Team Trust Scale and Cook and Wall ...a whole fairly similarly. Another analysis compared the Team Trust Scale with two subscales from the Cook and Wall (1980) Interpersonal Trust at

  20. Personal Trust Increases Cooperation beyond General Trust

    PubMed Central

    Acedo-Carmona, Cristina; Gomila, Antoni

    2014-01-01

    In this paper we present a new methodology which, while allowing for anonymous interaction, it also makes possible to compare decisions of cooperating or defecting when playing games within a group, according to whether or not players personally trust each other. The design thus goes beyond standard approaches to the role of trust in fostering cooperation, which is restricted to general trust. It also allows considering the role of the topology of the social network involved may play in the level of cooperation found. The results of this work support the idea that personal trust promotes cooperation beyond the level of general trust. We also found that this effect carries over to the whole group, making it more cohesive, but that higher levels of cohesion rely on a particular topology. As a conclusion, we hypothesize that personal trust is a psychological mechanism evolved to make human social life possible in the small groups our ancestors lived in, and that this mechanism persists and plays a role in sustaining cooperation and social cohesion. PMID:25144539

  1. Implications of the UK NHS consent policy for nuclear medicine practice.

    PubMed

    Greaves, Claire D; Tindale, Wendy B

    2005-02-01

    To comply with government policy on consent, the Sheffield Teaching Hospitals (STH) National Health Service (NHS) Trust introduced a new consent policy in February 2002. Verbal or written consent (depending on the level of risk) must be obtained prior to each study. The patient must be fully informed and given time to reach a decision. Consideration needs to be given to the following: to whom, when and how to provide such information and obtain consent. Each study type and patient circumstance needs to be classified according to risk. Consideration of the risks resulted in a local policy in which written consent is required for the following: therapeutic procedures, studies on pregnant women, studies in which pregnancy needs to be avoided, research procedures, cardiac stress for myocardial perfusion scintigraphy and intrathecal administration. Patient information leaflets have been updated with new information about the study and any risks. Information is now available for both patients and hospital staff. Compliance with the consent policy in a service department provides logistic challenges, but it is possible to fully inform patients in advance about their treatment, allowing them to give informed consent.

  2. Moral Legitimacy: The Struggle Of Homeopathy in the NHS.

    PubMed

    Crawford, Louise

    2016-02-01

    This article deploys a well-established theoretical model from the accountability literature to the domain of bioethics. Specifically, homeopathy is identified as a controversial industry and the strategic action of advocates to secure moral legitimacy and attract public funding is explored. The Glasgow Homeopathic Hospital (GHH) is used as the location to examine legitimizing strategies, from gaining legitimacy as a National Health Service (NHS) hospital in 1948, followed by maintaining and repairing legitimacy in response to government enquires in 2000 and 2010. An analysis of legitimizing strategies leads to the conclusion that advocates have been unsuccessful in maintaining and repairing moral legitimacy for homeopathy, thus threatening continued public funding for this unscientific medical modality. This is an encouraging development towards open and transparent NHS accountability for targeting limited public resources in pursuit of maximizing society's health and well-being. Policy implications and areas for future research are suggested.

  3. The Dimensionality of Trust

    DTIC Science & Technology

    2016-06-07

    undesired events. Several trust theorists have characterized distrust as that which is feared, and trust as that which is hoped (e.g., Deutsch , 1958...earliest trust theorist, Morton Deutsch (1958, p. 267) defines suspicion (a concept Deutsch has used interchangeably with the distrust concept) as...theorists have conceptualised distrust as a psychological state as well as a choice behaviour. Theorists such as Deutsch (1958) have equated non

  4. Employee engagement within the NHS: a cross-sectional study

    PubMed Central

    Jeve, Yadava Bapurao; Oppenheimer, Christina; Konje, Justin

    2015-01-01

    Background: Employee engagement is the emotional commitment of the employee towards the organisation. We aimed to analyse baseline work engagement using Utrecht Work Engagement Scale (UWES) at a teaching hospital. Methods: We have conducted a cross-sectional study within the National Health Service (NHS) Teaching Hospital in the UK. All participants were working age population from both genders directly employed by the hospital. UWES has three constituting dimensions of work engagement as vigor, dedication, and absorption. We conducted the study using UWES-9 tool. Outcome measures were mean score for each dimension of work engagement (vigor, dedication, absorption) and total score compared with control score from test manual. Results: We found that the score for vigor and dedication is significantly lower than comparison group (P< 0.0001 for both). The score for absorption was significantly higher than comparison group (P< 0.0001). However, total score is not significantly different. Conclusion: The study shows that work engagement level is below average within the NHS employees. Vigor and dedication are significantly lower, these are characterised by energy, mental resilience, the willingness to invest one’s effort, and persistence as well as a sense of significance, enthusiasm, inspiration, pride, and challenge. The NHS employees are immersed in work. Urgent need to explore strategies to improve work engagement as it is vital for improving productivity, safety and patient experience PMID:25674571

  5. Trust in interprofessional collaboration

    PubMed Central

    Gregory, Paul A. M.; Austin, Zubin

    2016-01-01

    Background: Trust is integral to effective interprofessional collaboration. There has been scant literature characterizing how trust between practitioners is formed, maintained or lost. The objective of this study was to characterize the cognitive model of trust that exists between pharmacists and family physicians working in collaborative primary care settings. Methods: Pharmacists and family physicians who work collaboratively in primary care were participants in this study. Family health teams were excluded from this study because of the distinct nature of these settings. Through a snowball convenience sampling method, a total of 11 pharmacists and 8 family physicians were recruited. A semistructured interview guide was used to guide discussion around trust, relationships and collaboration. Constant-comparative coding was used to identify themes emerging from these data. Results: Pharmacists and family physicians demonstrate different cognitive models of trust in primary care collaboration. For pharmacists, trust appears to be conferred on physicians based on title, degree, status and positional authority. For family physicians, trust appears to be earned based on competency and performance. These differences may lead to interprofessional tension when expectations of reciprocal trust are not met. Conclusions: Further work in characterizing how trust is developed in interprofessional relationships is needed to support effective team formation and functioning. PMID:27540406

  6. In regulation we trust.

    PubMed

    Wiig, Siri; Tharaldsen, Jorunn Elise

    2012-01-01

    The role of trust has been argued to play an increasingly important role in modern, complex, and ambivalent risk societies. Trust within organizational research is anticipated to have a general strategic impact on aspects such as organizational performance, communication and knowledge exchange, and learning from accidents. Trust is also an important aspect related to regulation of risk. Diverse regulatory regimes, their contexts and risks influence regulators use of trust and distrust in regulatory practice. The aim of this paper is to discuss the relationship between risk regulation and trust across diverse risk regulation regimes. By drawing from studies of risk regulation, risk perception, and trust the purpose is to discuss how regulation and trust are linked and used in practice to control risk across system levels in socio-technical systems in high risk industries. This paper provides new knowledge on 1) how functional and dysfunctional trust and distrust are grounded in the empirical realities of high risk industries, 2) how different perspectives on trust and distrust act together and bring new knowledge on how society control risk.

  7. Evidence-based commissioning in the English NHS: who uses which sources of evidence? A survey 2010/2011

    PubMed Central

    Clarke, Aileen; Taylor-Phillips, Sian; Swan, Jacky; Gkeredakis, Emmanouil; Mills, Penny; Powell, John; Nicolini, Davide; Roginski, Claudia; Scarbrough, Harry; Grove, Amy

    2013-01-01

    Objectives To investigate types of evidence used by healthcare commissioners when making decisions and whether decisions were influenced by commissioners’ experience, personal characteristics or role at work. Design Cross-sectional survey of 345 National Health Service (NHS) staff members. Setting The study was conducted across 11 English Primary Care Trusts between 2010 and 2011. Participants A total of 440 staff involved in commissioning decisions and employed at NHS band 7 or above were invited to participate in the study. Of those, 345 (78%) completed all or a part of the survey. Main outcome measures Participants were asked to rate how important different sources of evidence (empirical or practical) were in a recent decision that had been made. Backwards stepwise logistic regression analyses were undertaken to assess the contributions of age, gender and professional background, as well as the years of experience in NHS commissioning, pay grade and work role. Results The extent to which empirical evidence was used for commissioning decisions in the NHS varied according to the professional background. Only 50% of respondents stated that clinical guidelines and cost-effectiveness evidence were important for healthcare decisions. Respondents were more likely to report use of empirical evidence if they worked in Public Health in comparison to other departments (p<0.0005, commissioning and contracts OR   0.32, 95%CI   0.18 to 0.57, finance OR  0.19, 95%CI 0.05 to 0.78, other departments OR 0.35, 95%CI 0.17 to 0.71) or if they were female (OR 1.8 95% CI 1.01 to 3.1) rather than male. Respondents were more likely to report use of practical evidence if they were more senior within the organisation (pay grade 8b or higher OR 2.7, 95%CI 1.4 to 5.3, p=0.004 in comparison to lower pay grades). Conclusions Those trained in Public Health appeared more likely to use external empirical evidence while those at higher pay scales were more likely to use practical

  8. The trust formula: Trust = fairness + leadership

    SciTech Connect

    Lovenheim, R.

    1995-11-01

    Many state and compact LLW siting processes have been characterized by slippage and failure. The paper focuses on two major {open_quotes}lessons learned{close_quotes} regarding public interaction and trust, and how these lessons are being applied to current siting efforts. The relationship of environmental idealism and trust will be explored further in this paper. Supreme Court Justice Stephen Breyer concludes his 1994 book, Breaking the Vicious Circle by stating: {open_quotes}Finally, this book also reflects a belief that trust in institutions arises not simply as a result of openness in government, responses to local interest groups, or priorities emphasized in the press -- though these attitudes and actions play an important role -- but also from those institutions doing a difficult job well.{close_quotes}

  9. Dimensionality of Organizational Trust

    ERIC Educational Resources Information Center

    Adams, Samuel H.; Wiswell, Albert K.

    2007-01-01

    Trust facilitates individual and organizational learning, and is often misunderstood by organizations although they must continuously learn in order to attain organizational goals and survive. Leaders of organizations often view trust defensively and their reactions may impede organizational learning This paper builds on prior research concerning…

  10. National Education Trust Fund

    ERIC Educational Resources Information Center

    Shapp, Milton J.

    1975-01-01

    A proposal from the governor of Pennsylvania for financing all levels of education through a National Education Trust Fund (NETF) that would operate as the present Federal Highway Trust Fund does on a revolving, self-liquidating basis with the cost of an individual's education repaid through a progressive education tax on income. (JT)

  11. Trust, trustworthiness and health.

    PubMed

    Dawson, Angus

    2015-01-01

    Trust is an essential component of good healthcare. If patients trust their physicians, then the relationship between them can be a richer and more meaningful one. The patient is more likely to feel confident and able to disclose symptoms, helping diagnosis and future care. If public health and community workers are trusted, not only is it likely that their work will be easier, in that their actions will be respected and accepted, but their advice will also be sought spontaneously. Trust, can, therefore, be thought of as something that is of benefit to all: healthcare workers, individuals and communities. Trust is, generally, something to be prized and we need to do anything we can to strengthen it.

  12. Commissioning through competition and cooperation in the English NHS under the Health and Social Care Act 2012: evidence from a qualitative study of four clinical commissioning groups

    PubMed Central

    Allen, Pauline; Osipovič, Dorota; Shepherd, Elizabeth; Coleman, Anna; Perkins, Neil; Garnett, Emma; Williams, Lorraine

    2017-01-01

    Objective The Health and Social Care Act 2012 (‘HSCA 2012’) introduced a new, statutory, form of regulation of competition into the National Health Service (NHS), while at the same time recognising that cooperation was necessary. NHS England's policy document, The Five Year Forward View (‘5YFV’) of 2014 placed less emphasis on competition without altering the legislation. We explored how commissioners and providers understand the complex regulatory framework, and how they behave in relation to competition and cooperation. Design We carried out detailed case studies in four clinical commissioning groups, using interviews and documentary analysis to explore the commissioners’ and providers’ understanding and experience of competition and cooperation. Setting/participants We conducted 42 interviews with senior managers in commissioning organisations and senior managers in NHS and independent provider organisations (acute and community services). Results Neither commissioners nor providers fully understand the regulatory regime in respect of competition in the NHS, and have not found that the regulatory authorities have provided adequate guidance. Despite the HSCA 2012 promoting competition, commissioners chose mainly to use collaborative strategies to effect major service reconfigurations, which is endorsed as a suitable approach by providers. Nevertheless, commissioners are using competitive tendering in respect of more peripheral services in order to improve quality of care and value for money. Conclusions Commissioners regard the use of competition and cooperation as appropriate in the NHS currently, although collaborative strategies appear more helpful in respect of large-scale changes. However, the current regulatory framework contained in the HSCA 2012, particularly since the publication of the 5YFV, is not clear. Better guidance should be issued by the regulatory authorities. PMID:28183806

  13. Whom should we trust? Trust yourselves!

    SciTech Connect

    Fentiman, A.W.; Mancl, K.M.; Hajek, B.K.

    1995-11-01

    Members of the public, and their elected officials, often feel at a disadvantage when faced with decisions on technical issues such as those related to low-level radioactive waste management. Many have little or no knowledge of the underlying scientific concepts and often lack a clear understanding of the problems or possible solutions. In the case of controversial, highly emotional topics, facts presented by opposing groups often appear contradictory. People ask, {open_quotes}Whom should we trust?{close_quotes} While advocates of various positions shout, {open_quotes}Trust us!{close_quotes} members of the Ohio State University (OSU) Statewide Low-Level Radioactive Waste Education Program are saying, {open_quotes}Trust yourselves!{close_quotes} The goal of the OSU program is to provide Ohio`s citizens and their elected officials with accurate, easy-to-understand, unbiased information they need to prepare themselves to participate in discussions and decisions related to low-level waste. The faculty members on the project team want to encourage people to learn enough about the topic to feel confident in making their own decisions. For such a program to be successful, however, people must first trust the educational materials they are given. Over the past three years, the OSU team has developed materials that have won wide acceptance. Several factors that appear to have contributed to the acceptance are outlined.

  14. Slow Poisoning? Interests, Emotions, and the Strength of the English NHS

    PubMed Central

    Greer, Scott L.

    2015-01-01

    Martin Powell makes the point that the death of the National Health Service (NHS) is constantly asserted without criteria. This article suggests that the NHS is many things, which makes criteria unstable. The alignment of interests in the structure of the NHS enables both overheated rhetoric and political strength, and that pluralization of provision might actually undermine that alignment over time10.15171/ijhpm.2015.72 PMID:26673183

  15. Wasting your assets--how to make better use of the NHS estate.

    PubMed

    Locke, J

    1994-05-01

    The impact of the health reforms together with other developments will mean that the 24 billion pounds NHS estate will undergo the most fundamental change since the days of Florence Nightingale. Against this background it is more important than ever that the utilisation of the estate is improved and that the NHS learns how to make the best use of private sector investment, says John Locke, Chief Executive of NHS Estates.

  16. Autonomy, Trust, and Respect

    PubMed Central

    Nys, Thomas

    2016-01-01

    This article seeks to explore and analyze the relationship between autonomy and trust, and to show how these findings could be relevant to medical ethics. First, I will argue that the way in which so-called “relational autonomy theories” tie the notions of autonomy and trust together is not entirely satisfying Then, I will introduce the so-called Encapsulated Interest Account as developed by Russell Hardin. This will bring out the importance of the reasons for trust. What good reasons do we have for trusting someone? I will criticize Hardin’s business model as insufficiently robust, especially in the context of health care, and then turn to another source of trust, namely, love. It may seem that trust-through-love is much better suited for the vulnerability that is often involved in health care, but I will also show that it has its own deficiencies. Good health care should therefore pay attention to both models of trust, and I will offer some tentative remarks on how to do this. PMID:26668168

  17. Autonomy, Trust, and Respect.

    PubMed

    Nys, Thomas

    2016-02-01

    This article seeks to explore and analyze the relationship between autonomy and trust, and to show how these findings could be relevant to medical ethics. First, I will argue that the way in which so-called "relational autonomy theories" tie the notions of autonomy and trust together is not entirely satisfying Then, I will introduce the so-called Encapsulated Interest Account as developed by Russell Hardin. This will bring out the importance of the reasons for trust. What good reasons do we have for trusting someone? I will criticize Hardin's business model as insufficiently robust, especially in the context of health care, and then turn to another source of trust, namely, love. It may seem that trust-through-love is much better suited for the vulnerability that is often involved in health care, but I will also show that it has its own deficiencies. Good health care should therefore pay attention to both models of trust, and I will offer some tentative remarks on how to do this.

  18. Deconstructing the toolkit: creativity and risk in the NHS workforce.

    PubMed

    Allen, Von; Brodzinski, Emma

    2009-12-01

    Deconstructing the Toolkit explores the current desire for toolkits that promise failsafe structures to facilitate creative success. The paper examines this cultural phenomenon within the context of the risk-averse workplace-with particular focus on the NHS. The writers draw on Derrida and deconstructionism to reflect upon the principles of creativity and the possibilities for being creative within the workplace. Through reference to The Extra Mile project facilitated by Open Art, the paper examines the importance of engaging with an aesthetic of creativity and embracing a more holistic approach to the problems and potential of the creative process.

  19. A personal journey towards any qualified provider in the NHS.

    PubMed

    Hampton, Sylvie

    2012-09-01

    Any Qualified Provider (AQP) is a new and exciting way of organising health care that offers patient choice and cost-effective care. But there are many rumours and 'Chinese whispers' that are causing concern among healthcare workers throughout the UK. Although not all the rumours are false, there is a general misunderstanding of what AQP can provide and its potential to raise standards and lower costs throughout the NHS. This paper asks: can its promises be achieved? It also shows how AQP may work, through a personal experience of commissioning.

  20. NHS internal market 1991-2: towards a balance sheet.

    PubMed Central

    Petchey, R

    1993-01-01

    The first year of the internal market in the NHS has been claimed to have resulted in increased efficiency. These claims, however, are hard to substantiate because the systems for operating the market are not fully in place. Examination of data on tax relief for private health insurance premiums for over 60s, general practice fundholding, and implementation and transaction costs suggest that much of the increased efficiency is not due to the reforms but to increased funding. Furthermore, some of the changes seem to be decreasing market forces and reducing efficiency. Images p700-a PMID:8471927

  1. The NHS Redress Act 2006 (UK): background and analysis.

    PubMed

    Munro, Howard

    2009-08-01

    The NHS Redress Act 2006 (UK) is an example of a legislated compensation scheme for adverse health care incidents that aims to supplement the tort-based system of compensation, without going all the way to adopting a no-fault compensation system. It proposes an administrative method of providing speedier and more efficient and responsive remedies to adverse health care incidents than traditional legal proceedings. This article examines the detail of the United Kingdom policy arguments both prior to and since the passage of the legislation, as well as providing a detailed analysis of the original Bill, the parliamentary debates and the subsequent Act.

  2. Trusting Crowdsourced Geospatial Semantics

    NASA Astrophysics Data System (ADS)

    Goodhue, P.; McNair, H.; Reitsma, F.

    2015-08-01

    The degree of trust one can place in information is one of the foremost limitations of crowdsourced geospatial information. As with the development of web technologies, the increased prevalence of semantics associated with geospatial information has increased accessibility and functionality. Semantics also provides an opportunity to extend indicators of trust for crowdsourced geospatial information that have largely focused on spatio-temporal and social aspects of that information. Comparing a feature's intrinsic and extrinsic properties to associated ontologies provides a means of semantically assessing the trustworthiness of crowdsourced geospatial information. The application of this approach to unconstrained semantic submissions then allows for a detailed assessment of the trust of these features whilst maintaining the descriptive thoroughness this mode of information submission affords. The resulting trust rating then becomes an attribute of the feature, providing not only an indication as to the trustworthiness of a specific feature but is able to be aggregated across multiple features to illustrate the overall trustworthiness of a dataset.

  3. Trust and Fertility Dynamics

    PubMed Central

    Billari, Francesco C.; Pessin, Léa

    2016-01-01

    We argue that the divergence in fertility trends in advanced societies is influenced by the interaction of long-standing differences in generalized trust with the increase in women’s educational attainment. Our argument builds on the idea that trust enhances individuals’ and couples’ willingness to outsource childcare to outside their extended family. This becomes critically important as women’s increased education enhances the demand for combining work and family life. We test our hypothesis using data from the World Values Survey and European Values Study on 36 industrialized countries between the years 1981 and 2009. Multilevel statistical analyses reveal that the interaction between national-level generalized trust and cohort-level women’s education is positively associated with completed fertility. As education among women expands, high levels of generalized trust moderate fertility decline. PMID:28003707

  4. Trusting Beliefs: A Functional Measurement Study

    ERIC Educational Resources Information Center

    Vidotto, Giulio; Massidda, Davide; Noventa, Stefano; Vicentini, Marco

    2012-01-01

    Trust is a fundamental aspect of everyday life. Several authors define trust as the wish to depend on another entity and split the concept of trust into several interconnected components such as trusting beliefs (e.g., benevolence, competence, honesty, and predictability), trusting intentions, trusting behaviors, disposition to trust, and…

  5. Review of calls to NHS Direct related to attendance in the paediatric emergency department

    PubMed Central

    Stewart, B; Fairhurst, R; Markland, J; Marzouk, O

    2006-01-01

    Objective To examine the outcomes of calls to NHS Direct (NHS‐D) in relation to attendance at the accident and emergency (A&E) department. Design A prospective collection of data about consecutive calls to NHS‐D North West Coast was matched with attendances at the A&E department over a period of 3 months. Setting NHS‐D Regional Trust and a large urban paediatric A&E department. Patients Children and young adults aged <16 years living in local postal code areas. Main outcome measures To examine (1) whether advice given by NHS‐D was followed and (2) the differences in disease severity and necessity of attendance of patients referred by NHS‐D and those referred by general practitioners and self‐presenters. Results The relationship between the advice given and subsequent action is complex. Only 70% of calls advised to attend the A&E department did so. A further 1% (176) were advised not to attend the A&E department did in fact attend the department. Patients referred by NHS‐D represented only 3.2% of department attendances. There was little difference in the triage categories of the presenting groups, but there were significantly less admissions (p<0.01) in the NHS‐D group. Conclusions Delivering telephone advice about illness severity in children is difficult as visual clues are so important. More collaborative prospective studies are needed, including with primary care, to understand families' choices, and to refine and assess NHS‐D's ability to discriminate those requiring further clinical assessment. PMID:17130596

  6. Impact of signals and experience on trust and trusting behavior.

    PubMed

    Chen, Ying-Hueih; Chien, Shu-Hua; Wu, Jyh-Jeng; Tsai, Pei-Yin

    2010-10-01

    Trust is an essential factor that drives virtual interaction and transactions on the Internet. Researchers have investigated the trust development process, and identified several important factors that form the basis for trust. This research combines the signal perspective and trust theory to examine the impact of market signals and past experience on trust formation and trusting behavior. Three market signals, including brand image, Web-site investment, and privacy policies, are identified and empirically tested to determine their impact on consumer trust. Based on 322 active Web users, the quantitative results suggest that brand image, Web-site investment, privacy policies, and past experience all positively impact trust formation. Furthermore, trust shows a positive effect on Web-site stickiness. Both theoretical and practical implications of the results are also offered.

  7. Trusted Computing Technologies, Intel Trusted Execution Technology.

    SciTech Connect

    Guise, Max Joseph; Wendt, Jeremy Daniel

    2011-01-01

    We describe the current state-of-the-art in Trusted Computing Technologies - focusing mainly on Intel's Trusted Execution Technology (TXT). This document is based on existing documentation and tests of two existing TXT-based systems: Intel's Trusted Boot and Invisible Things Lab's Qubes OS. We describe what features are lacking in current implementations, describe what a mature system could provide, and present a list of developments to watch. Critical systems perform operation-critical computations on high importance data. In such systems, the inputs, computation steps, and outputs may be highly sensitive. Sensitive components must be protected from both unauthorized release, and unauthorized alteration: Unauthorized users should not access the sensitive input and sensitive output data, nor be able to alter them; the computation contains intermediate data with the same requirements, and executes algorithms that the unauthorized should not be able to know or alter. Due to various system requirements, such critical systems are frequently built from commercial hardware, employ commercial software, and require network access. These hardware, software, and network system components increase the risk that sensitive input data, computation, and output data may be compromised.

  8. The problem of obesity in the NHS all comes down to cost.

    PubMed

    Salter, Catherine

    2014-09-09

    Well done to NHS England chief executive Simon Stevens for speaking up about the sensitive issue of obese nurses and the need for NHS staff to be healthy advocates (Analysis August 13, Editorial and Letters August 20 and Wright Angle August 27).

  9. Join us on streets to demand our say in decisions on NHS reforms.

    PubMed

    Hillyer, Sami

    2016-06-01

    The government knows we have an NHS staffing shortage - that is something we can all agree on. It is also their selling point for the removal of NHS bursaries. If we introduce a loan system, they say, it will give us an additional 10,000 training places for nurses, midwives and allied health professionals.

  10. Evidence to the Royal Commission on the NHS

    PubMed Central

    1977-01-01

    1. It is the right of everyone in the UK to have access to personal and continuing primary health care of a high standard (para. 4.1). 2. The primary health care service should be built on general practice (paras 2.3 to 2.10, 4.1 to 4.3). 3. The nature of the most important health problems today means inevitably that the main burden of care will fall on the primary health service (paras 3.2 to 3.7). 4. It follows that the NHS must be reorientated around primary health care; the functions and size of the hospital service will then depend on the responsibilities of the primary health care sector (para. 4.2). 5. It also follows that primary health care must attract a higher priority in the allocation of resources (paras 4.4, 5.2 to 5.8). 6. Setting standards of performance is a high priority for all the health professions and the NHS itself (paras 3.6, 3.7). 7. In medicine, professional standards will not improve unless medical education is radically reshaped by the implementation of the recommendations of the Committee of Enquiry into the Regulation of the Medical Profession (para. 5.4). 8. Inadequate care by some general practitioners today is acknowledged (paras 2.12, 2.13); the main causes are examined (para. 2.15) and remedies are suggested (paras 4.4, 5.4 to 5.6). 9. The special problems of primary care in parts of conurbations are described (paras 2.14 to 2.17); a proposal to deal with this exceptional situation is made (para. 5.7). 10. Primary health care should be provided normally by functionally integrated teams of general practitioners, nurses, health visitors and, where appropriate, social workers, supported by receptionists and secretarial staff (paras 2.4, 2.10). 11. Within the primary health care team ultimate responsibility must rest with general practitioners (para. 4.1). 12. To provide good primary health care we need: i) Appropriate manpower (para. 5.2). ii) Adequate premises (para. 5.3). iii) Effective education (paras 5.4, 5.5). iv) A modern

  11. Trust Transitivity in Social Networks

    PubMed Central

    Richters, Oliver; Peixoto, Tiago P.

    2011-01-01

    Non-centralized recommendation-based decision making is a central feature of several social and technological processes, such as market dynamics, peer-to-peer file-sharing and the web of trust of digital certification. We investigate the properties of trust propagation on networks, based on a simple metric of trust transitivity. We investigate analytically the percolation properties of trust transitivity in random networks with arbitrary in/out-degree distributions, and compare with numerical realizations. We find that the existence of a non-zero fraction of absolute trust (i.e. entirely confident trust) is a requirement for the viability of global trust propagation in large systems: The average pair-wise trust is marked by a discontinuous transition at a specific fraction of absolute trust, below which it vanishes. Furthermore, we perform an extensive analysis of the Pretty Good Privacy (PGP) web of trust, in view of the concepts introduced. We compare different scenarios of trust distribution: community- and authority-centered. We find that these scenarios lead to sharply different patterns of trust propagation, due to the segregation of authority hubs and densely-connected communities. While the authority-centered scenario is more efficient, and leads to higher average trust values, it favours weakly-connected “fringe” nodes, which are directly trusted by authorities. The community-centered scheme, on the other hand, favours nodes with intermediate in/out-degrees, in detriment of the authorities and its “fringe” peers. PMID:21483683

  12. Reengineering NHS Hospitals in Greece: Redistribution Leads to Rational Mergers

    PubMed Central

    Nikolentzos, Athanasios; Kontodimopoulos, Nick; Polyzos, Nikolaos; Thireos, Eleftherios; Tountas, Yannis

    2015-01-01

    The purpose of this study was to record and evaluate existing public hospital infrastructure of the National Health System (NHS), in terms of clinics and laboratories, as well as the healthcare workforce in each of these units and in every health region in Greece, in an attempt to optimize the allocation of these resources. An extensive analysis of raw data according to supply and performance indicators was performed to serve as a solid and objective scientific baseline for the proposed reengineering of the Greek public hospitals. Suggestions for “reshuffling” clinics and diagnostic laboratories, and their personnel, were made by using a best versus worst outcome indicator approach at a regional and national level. This study is expected to contribute to the academic debate about the gap between theory and evidence based decision-making in health policy. PMID:26156925

  13. Developing network-based services in the NHS.

    PubMed

    Conner, M

    2001-01-01

    Networks, based upon informal relationships, have ensured that care was delivered to patients for many years. This informal organisation of care, based upon personal relationships, ensures that where the bureaucratic organisation fails the patient, health professionals' work together to network the resources the patient needs. Networks are not new. Formalising networks and recognising their potential to deliver seamless care is new. The NHS must ensure that networks are developed, allowing them freedom from bureaucracy to reach their potential. The Northern and Yorkshire Learning Alliance (NYLA) was established as part of the Northern and Yorkshire health community's efforts to radically improve care. The NYLA operates as a network with a small team of change experts working to develop change management and service improvement capacity across 10,000 square miles. As a network based organisation the team has learned many lessons, which may inform the development of clinical networks in England.

  14. Trusted Translation Services

    NASA Astrophysics Data System (ADS)

    Atif, Yacine; Serhani, Mohamed Adel; Campbell, Piers; Mathew, Sujith Samuel

    Administering multilingual Web sites and applications reliably, involves interconnected and multipart tasks, where trust in the involved parties and content translation sources is paramount. Published Web sites may reflect content from databases, content management systems and other repositories to manage related Web content. But a Web site mirrored wholly or selectively onto a target language version requires streamlined trusted processes. Traditionally, files are translated and transferred via FTP, e-mail, or other communication means. Similarly, translation instructions are communicated between involved parties through verbal instruction, e-mail, and instruction files lead to a variety of inconsistencies and lack of trust in the translation process. This paper proposes a Web service approach to streamline the translation processes and an integration of trust properties in the proposed translation Web services. Web Services have been instrumental in handling problems inherent to systems integration, allowing web-based systems to converse and communicate data automatically. The OASIS Translation Web Services Technical Committee has released a standard way for Web Services to serve the translation and localization business. This article proposes a framework to centralize translation services at a reputable source providing a workflow and a mechanism to quantify service trust. An implementation of the framework is also described in the context of a localization case study.

  15. Zoning: focused support: a trust wide implementation project.

    PubMed

    Gamble, C; Dodd, G; Grellier, J; Hever, M; O'Conner, C; Clarke, T; Chipere, R; Mellor, M; Ness, M

    2010-02-01

    Applying pragmatic risk management procedures to facilitate the sharing of clinical knowledge in and across mental health teams. Abstract Zoning: focused support is pragmatic risk management support procedure that enhances adherence to operational policies, provides a forum in which staff can receive support and visually facilitates the sharing of clinical knowledge. This paper presents a 3-year multi-method management project that sought to introduce zoning principles into all teams of an inner city Mental Health NHS Trust. By changing the language and culture of the organization findings indicate that there has been a positive attitudinal shift in how the approach is perceived. It is considered to be of value to staff, service users and their families and 73% of teams are now using it routinely.

  16. Trust Development in Small Teams

    DTIC Science & Technology

    2016-06-07

    distinction between trust as a psychological state and as choice behaviour appears to be waning somewhat in favour of trust being conceptualised as a... psychological state. A recent review, for example, selectively excluded articles that focused on trust as only a behaviour in favour of those that involved...the conceptualisation of trust as both a psychological state and a behaviour (Dirks and Ferrin, 2002). This shift will perhaps accommodate some of

  17. Four Essential Practices for Building Trust

    ERIC Educational Resources Information Center

    Combs, Julie Peterson; Harris, Sandra; Edmonson, Stacey

    2015-01-01

    The presence of trust can enhance an organization's efforts to fulfill its mission, and the lack of trust can constrict those efforts. The authors offer four essential guidelines to help school leaders communicate in a way that builds trust. Build trust by understanding trust. Trusted leaders demonstrate care, character, and competence in their…

  18. Trust It or Trash It?

    MedlinePlus

    Trust It or Trash It? About | Contact | Español Tab 1 Tab 2 What is Trust It or Trash It? This is a tool to help you think ... here for the developer version. Home Who Said It? Who wrote it? Think about TRUSTING IT if: ...

  19. Trust Development in Outdoor Leadership

    ERIC Educational Resources Information Center

    Shooter, Wynn; Paisley, Karen; Sibthorp, Jim

    2010-01-01

    Establishing trusting relationships between leaders and participants is one way that outdoor leaders can create an emotionally safe and productive milieu that supports the attainment of desirable outcomes. Multidisciplinary literature offers considerable insight into leader trust development and the outcomes that are linked to trust in a leader.…

  20. Why Teachers Trust School Leaders

    ERIC Educational Resources Information Center

    Handford, Victoria; Leithwood, Kenneth

    2013-01-01

    Purpose: Trust among teachers in schools is significantly related to student achievement and trust in school leaders is an important influence on such trust. The purpose of this study is to identify leadership practices which teachers interpret as signs of trustworthiness on the part of their principals. Design/methodology/approach: Evidence for…

  1. Short-term and long-term effects of acute kidney injury in chronic kidney disease patients: A longitudinal analysis.

    PubMed

    Asar, Özgür; Ritchie, James; Kalra, Philip A; Diggle, Peter J

    2016-11-01

    We use data from an ongoing cohort study of chronic kidney patients at Salford Royal NHS Foundation Trust, Greater Manchester, United Kingdom, to investigate the influence of acute kidney injury (AKI) on the subsequent rate of change of kidney function amongst patients already diagnosed with chronic kidney disease (CKD). We use a linear mixed effects modelling framework to enable estimation of both acute and chronic effects of AKI events on kidney function. We model the fixed effects by a piece-wise linear function with three change-points to capture the acute changes in kidney function that characterise an AKI event, and the random effects by the sum of three components: a random intercept, a stationary stochastic process with Matérn correlation structure, and measurement error. We consider both multivariate Normal and multivariate t versions of the random effects. For either specification, we estimate model parameters by maximum likelihood and evaluate the plug-in predictive distributions of the random effects given the data. We find that following an AKI event the average long-term rate of decline in kidney function is almost doubled, regardless of the severity of the event. We also identify and present examples of individual patients whose kidney function trajectories diverge substantially from the population-average.

  2. Human Trust in Networks

    DTIC Science & Technology

    2009-06-01

    Robert and Bertrand David (Eds.):  Proceedings of the 18th International Conference of the Association Francophone d’Interaction Homme ‐ Machine ...provides us with an avenue of approach; that is, to understand how trust is mediated by technology interfaces and connections. Salamacha and

  3. Towards a new health care paradigm. Patient-focused care. The case of Kingston Hospital Trust.

    PubMed

    Newman, K

    1997-01-01

    Patient-focused care (PFC) and business process re-engineering (BPR) have been advocated in the academic literature as techniques to improve both quality of service and reduce costs. Seeks to separate and delineate the components of PFC and BPR and, using the case study method, describe the adoption and implementation process of PFC in medicine and maternity by one London NHS Trust Hospital. Reports the impact of this innovation on service delivery, staff reconfiguration and multi-skilling. Identifies preconditions and key success factors and indicates lessons for the future.

  4. Homo economicus belief inhibits trust.

    PubMed

    Xin, Ziqiang; Liu, Guofang

    2013-01-01

    As a foundational concept in economics, the homo economicus assumption regards humans as rational and self-interested actors. In contrast, trust requires individuals to believe partners' benevolence and unselfishness. Thus, the homo economicus belief may inhibit trust. The present three experiments demonstrated that the direct exposure to homo economicus belief can weaken trust. And economic situations like profit calculation can also activate individuals' homo economicus belief and inhibit their trust. It seems that people's increasing homo economicus belief may serve as one cause of the worldwide decline of trust.

  5. Healthcare reforms: implications for the education and training of acute and critical care nurses

    PubMed Central

    Glen, S

    2004-01-01

    This paper offers a wide ranging analysis of the drivers that resulted in scrutiny of medical, nursing, and healthcare professional roles. It suggests that what is needed is a coherent vision of the future shape of the health workforce. This requires moving beyond the presumption that reforming working practices primarily involves "delegating doctors" responsibilities to nurses. The paper argues that it is self evident that the implications of changes in healthcare roles and the ability of existing professionals to function effectively in the future will require education, training, and human resource investment supportive of the changes. It suggests a clear definition of competence and a national standard to practice is essential for nurses working in acute and acute critical settings. There should therefore be a correlation between levels of practice, levels of education, and remuneration. Furthermore, education programmes for senior nurses should sit coherently alongside the education programmes required by Modernising Medical Careers. Finally, the realisation of the government's service and modernisation agenda will require a culture change within higher education institutions, postgraduate deaneries, professional organisations, workforce development confederations, and NHS trusts. PMID:15579609

  6. Implementing a Portable Trusted Environment

    NASA Astrophysics Data System (ADS)

    Zic, John; Nepal, Surya

    The development of trusted systems, as envisaged by the Trusted Computing Group, assumed that the computing environments are uniform in terms of their operational environment, including hardware configuration, execution of a standard set of applications, operating system and facilities and procedures that allow the issue, revocation and maintenance of critical encryption keys and authorization certificates. These assumptions may be applicable to a single managed enterprise infrastructure. However, in situations where the users are mobile, or the computing environment is heterogeneous and the Internet provides the connectivity, the management of trust between enterprises becomes overwhelmingly difficult, if not impossible. As a result, deployment and uptake of trusted secure systems based on Trusted Platform Module have not been as successful as first envisaged. In this paper, we report on our experiences in designing and implementing a prototype personal trusted device called the Trust Extension Device, or TED, that provides users with a portable trustworthy environment for conducting transactions on any Internet connected computer.

  7. Social Trust of Virtual Identities

    NASA Astrophysics Data System (ADS)

    Seigneur, Jean-Marc

    Most other chapters of this book discuss computational models of trust in broader terms, giving definitions of trust, explaining how trust should evolve over time, surveying the different facets of trust .On the other hand, this chapter has a clear focus on the important element of identity in computational trust mechanisms. Trust and reputation are easier to form in face-to-face situations than in situations involving the use of computers and networks because the identity of the trustee is more difficult to verify. In this chapter, the different means to recognise virtual identities are surveyed. Next, their integration into computational trust engines is discussed, especially according to four main requirements: Adaptability, Security, Usability and Privacy (ASUP).

  8. Evaluation of NHS Carbamates as a Potent and Selective Class of Endocannabinoid Hydrolase Inhibitors

    PubMed Central

    2013-01-01

    Monoacylglycerol lipase (MAGL) is a principal metabolic enzyme responsible for hydrolyzing the endogenous cannabinoid (endocannabinoid) 2-arachidonoylglycerol (2-AG). Selective inhibitors of MAGL offer valuable probes to further understand the enzyme’s function in biological systems and may lead to drugs for treating a variety of diseases, including psychiatric disorders, neuroinflammation, and pain. N-Hydroxysuccinimidyl (NHS) carbamates have recently been identified as a promising class of serine hydrolase inhibitors that shows minimal cross-reactivity with other proteins in the proteome. Here, we explore NHS carbamates more broadly and demonstrate their potential as inhibitors of endocannabinoid hydrolases and additional enzymes from the serine hydrolase class. We extensively characterize an NHS carbamate 1a (MJN110) as a potent, selective, and in-vivo-active MAGL inhibitor. Finally, we demonstrate that MJN110 alleviates mechanical allodynia in a rat model of diabetic neuropathy, marking NHS carbamates as a promising class of MAGL inhibitors. PMID:23731016

  9. Can NHS politics, power and conflict ever be a good thing for nurses?

    PubMed

    Lees, Carolyn

    2016-07-14

    This article explores how organisational politics, power and conflict have a positive role to play for nurses in NHS organisational change and improvement, rather than always leading to disagreement and dispute.

  10. The Condition for Generous Trust

    PubMed Central

    Shinya, Obayashi; Yusuke, Inagaki; Hiroki, Takikawa

    2016-01-01

    Trust has been considered the “cement” of a society and is much studied in sociology and other social sciences. Most studies, however, have neglected one important aspect of trust: it involves an act of forgiving and showing tolerance toward another’s failure. In this study, we refer to this concept as “generous trust” and examine the conditions under which generous trust becomes a more viable option when compared to other types of trust. We investigate two settings. First, we introduce two types of uncertainties: uncertainty as to whether trustees have the intention to cooperate, and uncertainty as to whether trustees have enough competence to accomplish the entrusted tasks. Second, we examine the manner in which trust functions in a broader social context, one that involves matching and commitment processes. Since we expect generosity or forgiveness to work differently in the matching and commitment processes, we must differentiate trust strategies into generous trust in the matching process and that in the commitment process. Our analytical strategy is two-fold. First, we analyze the “modified” trust game that incorporates the two types of uncertainties without the matching process. This simplified setting enables us to derive mathematical results using game theory, thereby giving basic insight into the trust mechanism. Second, we investigate socially embedded trust relationships in contexts involving the matching and commitment processes, using agent-based simulation. Results show that uncertainty about partner’s intention and competence makes generous trust a viable option. In contrast, too much uncertainty undermines the possibility of generous trust. Furthermore, a strategy that is too generous cannot stand alone. Generosity should be accompanied with moderate punishment. As for socially embedded trust relationships, generosity functions differently in the matching process versus the commitment process. Indeed, these two types of generous

  11. Interregional Patient Mobility in the Italian NHS: A Case of Badly-Managed Decentralization Comment on "Regional Incentives and Patient Cross-Border Mobility: Evidence From the Italian Experience".

    PubMed

    Neri, Stefano

    2015-08-25

    The article by Brenna and Spandonaro on interregional mobility for acute hospital care in Italy raises important issues concerning social and territorial equity in a healthcare system. Based on Regions and private providers' strategic behavior, the hypothesis adopted to explain patient cross-border mobility (CBM), demonstrated by statistical analysis, may be further explored using qualitative methods. In order to reduce CBM, the central government needs to play a more active role in coordination, even in a highly decentralized National Health Service (NHS).

  12. Analysis of consultants' NHS and private incomes in England in 2003/4

    PubMed Central

    Morris, Stephen; Elliott, Bob; Ma, Ada; McConnachie, Alex; Rice, Nigel; Skåtun, Diane; Sutton, Matt

    2008-01-01

    Summary Objective Consultants employed by the NHS in England are allowed to undertake private practice to supplement their NHS income. Until the introduction of a new contract from October 2003, those employed on full-time contracts were allowed to earn private incomes no greater than 10% of their NHS income. In this paper we investigate the magnitude and determinants of consultants' NHS and private incomes. Design Quantitative analysis of financial data. Setting A unique, anonymized, non-disclosive dataset derived from tax returns for a sample of 24,407 consultants (92.3% of the total) in England for the financial year 2003/4. Main outcome methods The conditional mean total, NHS and private incomes earned by age group, type of contract, specialty and region of place of work. Results The mean annual total, NHS and private incomes across all consultants in 2003/4 were £110,773, £76,628 and £34,144, respectively. Incomes varied by age, type of contract, specialty and region of place of work. The ratio of mean private to NHS income for consultants employed on a full-time contract was 0.26. The mean private income across specialties ranged from £5,144 (for paediatric neurology) to £142,723 (plastic surgery). There was a positive association between mean private income and NHS waiting lists across specialties. Conclusions Consultants employed on full-time contracts on average exceeded the limits on private income stipulated by the 10% rule. Specialty is a more important determinant of income than the region in which the consultant works. Further work is required to explore the association between mean private income and waiting lists. PMID:18591691

  13. Specialty location decisions in the reformed NHS: a case study.

    PubMed

    Hindle, T; Roberts, E; Worthington, D

    1998-08-01

    A soft systems approach, largely based on soft systems methodology, was used to steer a study (completed in 1996) of the National Health Service contracting process. It led to action research projects on a number of related issues. One such area that emerged very strongly concerns service rationalization and service planning, and in particular the location of 'small' specialties. A Trust-based study involving patient flow modelling demonstrates the form these problems can take within the internal market and highlights the challenge they make to the contracting process or the new primary care group based commissioning process if they are to be resolved in a rational manner.

  14. Clinical nurse specialists: essential resource for an effective NHS.

    PubMed

    Vidall, Cheryl; Barlow, Helen; Crowe, Maggie; Harrison, Isabel; Young, Annie

    Despite emerging evidence for the clinical and financial efficacy of the clinical nurse specialist (CNS), the provision of this role is patchy across the country. There is also a risk that incumbent CNS' may be redirected to less specialist work in trusts that do not appreciate the full value of the service that these nurses provide. Optimal and equitable patient access to CNS care will require the development of a strong evidence base showing that specialist nurses not only deliver patient-focused care, but that they can also help to meet healthcare managers' objectives of streamlined, cost-effective clinical services.

  15. Unmeasured improvement work: the lack of routinely collected, service-related data in NHS endoscopy units in England involved in "modernisation"

    PubMed Central

    Thorne, Kymberley; Hutchings, Hayley A; Elwyn, Glyn

    2008-01-01

    Background The availability of routinely collected service-related endoscopy data from NHS endoscopy units has never been quantified. Methods This retrospective observational study asked 19 endoscopy units to submit copies of all in-house, service-related endoscopy data that had been routinely collected by the unit – Referral numbers, Activity, Number of patients waiting and Number of lost slots. Nine of the endoscopy units had previously participated in the Modernising Endoscopy Services (MES) project during 2003 to redesign their endoscopy services. These MES sites had access to additional funding and data collection software. The other ten (Control sites) had modernised independently. All data was requested in two phases and corresponded to eight specific time points between January 2003 and April 2006. Results Only eight of 19 endoscopy units submitted routinely collected, service-related data. Another site's data was collected specifically for the study. A further two units claimed to routinely collect service-related data but did not submit any to the study. The remaining eight did not collect any service-related endoscopy data routinely and liaised with their Trust for data. Of the eight sites submitting service-related data, only three were MES project sites. Of these three, the data variables collected were limited and none collected the complete set of endoscopy data variables requested. Of the other five sites, two collected all four endoscopy data types. Data for the three MES project sites went back as far as January 2003, whilst the five Control sites were only able to submit data from December 2003 onwards. Conclusion There was a lack of service-related endoscopy data routinely collected by the study sites, especially those who had participated in the MES project. Without this data, NHS endoscopy services cannot have a true understanding of their services, cannot identify problems and cannot measure the impact of any changes. With the increasing

  16. Guidance for commissioning NHS England dental conscious sedation services: a framework tool.

    PubMed

    Howlett, Paul

    2014-01-01

    Conscious sedation is an integral part of modern day dental care and should be delivered through a high quality, effective and evidence-based approach. Commissioning of NHS dental services in England is currently under review by NHS England and the National Dental Commissioning Group. This group has identified the management of vulnerable people including anxious patients, as one of its priorities. The Society for the Advancement of Anaesthesia in Dentistry (SAAD) believes this provides an opportunity to influence the commissioning of NHS conscious sedation services. With this aim in mind,"Guidance for Commissioning NHS England Dental Conscious Sedation Services: A Framework Tool" was developed. This guidance proposes a common approach to the organisation of NHS dental conscious sedation services in England, advocating the provision of Tier 1 and Tier 2 services in all regions. Its ethos is a"hub and spoke" model of service delivery with patient assessment delivered by experienced and well trained dental sedationists at its core. In line with the recent Francis Report fundamental standards for all aspects of dental conscious sedation practice are outlined, supported by a robust and predictable quality assurance process. This work has been shared with key stakeholders in NHS England including the Chief Dental Officer and the Head of Primary Care Commissioning.

  17. Has NHS reorganisation saved lives? A CuSum study using 65 years of data

    PubMed Central

    Lale, Alice S

    2016-01-01

    Objectives To determine if NHS reforms affect population mortality. Design Retrospective study using routinely published data. Setting & participants Resident population of England and Wales 1948 to 2012 Main outcome measure All cause age sex directly standardised mortality England and Wales 1948 to 2012. Methods Using the CuSum technique and Change-Point Analysis to identify sustained changes in the improving age-standardised mortality rates for the period 1948-2012, and comparing the time of these changes with periods of NHS reform. Where observed changes did not fit with NHS reform, changes external to the NHS were sought as a possible explanation of changes observed. Results CuSum plotting and CPA showed no significant changes in female mortality trend between 1948 and 2012. However, this analysis identified a sustained improvement in the male mortality trend, occurring in the mid-1970s. A further change in the rate of male mortality decline was found around the Millennium. Conclusion The 1974 NHS reorganisation, changing service arrangements predominantly for women and children, is considered an unlikely explanation of the improved rate of male mortality decline. Thus, centrally led NHS reorganisation has never had any detectable effect on either male or female mortality and must be considered ineffective for this purpose. But some evidence supporting the view that increased funding improves outcomes is found. PMID:26432817

  18. The immunocytokine NHS-IL12 as a potential cancer therapeutic

    PubMed Central

    Kradjian, Giorgio; Guzman, Wilson; Bernhardt, Anna; Neuteboom, Berend; Lan, Yan; Sabzevari, Helen; Schlom, Jeffrey; Greiner, John W.

    2014-01-01

    Targeted delivery of IL-12 might turn this cytokine into a safer, more effective cancer therapeutic. Here we describe a novel immunocytokine, NHS-IL12, consisting of two molecules of IL-12 fused to a tumor necrosis-targeting human IgG1 (NHS76). The addition of the human IgG1 moiety resulted in a longer plasma half-life of NHS-IL12 than recombinant IL-12, and a selective targeting to murine tumors in vivo. Data from both in vitro assays using human PBMCs and in vivo primate studies showed that IFN-gamma production by immune cells is attenuated following treatment with the immunocytokine, suggesting an improved toxicity profile than seen with recombinant IL-12 alone. NHS-IL12 was superior to recombinant IL-12 when evaluated as an anti-tumor agent in three murine tumor models. Mechanistic studies utilizing immune cell subset-depleting antibodies, flow cytometric methods, and in vitro cytotoxicity and ELISA assays all indicated that the anti-tumor effects of NHS-IL12 were primarily CD8+ T cell-dependent and likely IL-12-mediated. Combining NHS-IL12 treatment with a cancer vaccine, radiation, or chemotherapy resulted in greater anti-tumor effects than each individual therapy alone. These preclinical findings provide a rationale for the clinical testing of this immunocytokine, both as a single agent and in combination with vaccines, radiation and chemotherapy. PMID:24681847

  19. A clean bill of health? The efficacy of an NHS commissioned outsourced police custody healthcare service.

    PubMed

    de Viggiani, Nick

    2013-08-01

    Police custody healthcare services for detainees in the UK are most commonly outsourced to independent healthcare providers who employ custody nurses and forensic physicians to deliver forensic healthcare services. A pilot was introduced in 2008 by the Department of Health to explore the efficacy of commissioning custody healthcare via the NHS, in the wake of the 2005-2006 shift of prison healthcare to the NHS. The objective was to improve quality and accountability through NHS commissioning and the introduction of NHS governance to the management and delivery of custody healthcare. This article discusses key themes that arose from the project evaluation, which focused on the commissioning relationship between the police, the NHS commissioner and the private healthcare provider. The evaluation observed an evolving relationship between the police, the local NHS and the front-line nurses, which was complicated by the quite distinctive professional values and ideologies operating, with their contrasting organisational imperatives and discordant values and principles. A key challenge for commissioners is to develop synergy between operational and strategically located stakeholders so that they can work effectively towards common goals. Government policy appears to remain focused on creating safe, supportive and humane custody environments that balance criminal justice and health imperatives and support the rights and needs of detainees, victims, professionals and the public. This remains an ambitious agenda and presents a major challenge for new criminal justice health partnerships.

  20. Market--what market? A review of Health Authority purchasing in the NHS internal market.

    PubMed

    West, P A

    1998-05-01

    This paper argues that the British NHS Reforms (the 'Reforms') set out in Working for Patients [1] largely failed to create a market, to achieve the changes that market forces might have been expected to achieve or to meet the objectives set for the NHS in Working for Patients. It draws on the available literature and the author's experience of work with the NHS during the 6 years after Working for Patients. It is hampered, as are all such reviews of the UK Reforms, by the lack of a detailed and systematic research appraisal of the internal market. Many small changes, resulting from market mechanisms, may have occurred throughout the NHS without being publicized or well documented. But overall, there is little convincing evidence that the Reforms have achieved their goals or met the objectives of the politicians who initiated them. The argument here is necessarily limited by the space available (but see [2] for a detailed analysis of the NHS Reforms). The initial sections of the paper examine the characteristics of markets and market power and the extent to which the NHS Reforms created a market, with health authorities and fund-holders as its buyers. The paper concentrates in particular on health authorities. Later sections then examine the extent to which the Reforms met the objectives set out in Working for Patients.

  1. The funding and organization of infection control in NHS hospital trusts: a study of infection control professionals' views.

    PubMed

    Croxson, B; Allen, P; Roberts, J A; Archibald, K; Crawshaw, S; Taylor, L

    2003-05-01

    The problems associated with hospital-acquired infection have been causing increasing concern in England in recent years. This paper reports the results of a nationwide survey of hospital infection control professionals' views concerning the organizational structures used to manage and obtain funding for control of infection. A complex picture with significant variation between hospitals emerges. Although government policy dictates that specific funding for hospital infection control is formally made available, it is not always the case that infection control professionals have adequate resources to undertake their roles. In some cases this reflects the failure of hospitals' infection control budgetary mechanisms; in others it reflects the effects of decentralizing budgets to directorate or ward level. Some use was made of informal mechanisms either to supplement or to substitute for the formal ones. But almost all infection control professionals still believed they were constrained in their ability to protect the hospital population from the risk of infectious disease. It is clear that recent government announcements that increased effort will be made to support local structures and thereby improve the control of hospital acquired infection are to be welcomed.

  2. Technology, Intelligence, and TRUST

    DTIC Science & Technology

    2007-01-01

    single email or message. The collections team does not have to make an either/or decision about whom to send its intercept or interrogation report...International security studies at the George C. Marshall Center for european security studies in Garmisch- Partenkirchen, Germany. he is a career ... career as an intelligence officer, I was told on numerous occasions, “Trust us, when the balloon goes up, you’ll get all the intelligence you need

  3. Optimal Distinctiveness Signals Membership Trust.

    PubMed

    Leonardelli, Geoffrey J; Loyd, Denise Lewin

    2016-07-01

    According to optimal distinctiveness theory, sufficiently small minority groups are associated with greater membership trust, even among members otherwise unknown, because the groups are seen as optimally distinctive. This article elaborates on the prediction's motivational and cognitive processes and tests whether sufficiently small minorities (defined by relative size; for example, 20%) are associated with greater membership trust relative to mere minorities (45%), and whether such trust is a function of optimal distinctiveness. Two experiments, examining observers' perceptions of minority and majority groups and using minimal groups and (in Experiment 2) a trust game, revealed greater membership trust in minorities than majorities. In Experiment 2, participants also preferred joining minorities over more powerful majorities. Both effects occurred only when minorities were 20% rather than 45%. In both studies, perceptions of optimal distinctiveness mediated effects. Discussion focuses on the value of relative size and optimal distinctiveness, and when membership trust manifests.

  4. Towards a politics of trust.

    PubMed

    Gilbert, T

    1998-05-01

    This paper draws upon sociological theory to demonstrate that the manufacture and deployment of trust is an integral part of the function of complex systems such as health care. The discussion begins by identifying the error within the nursing literature which arises from a rather technical conceptualization of trust. This tends to limit the dimensions to trust which is established, and fails to recognize that trust may be subject to competition and conflict. The paper continues by drawing upon the work of two theorists, Niklas Luhmann and Susan P. Shapiro, to demonstrate how trust functions within systems such as health care and the mechanisms through which it is controlled. The title of this paper, 'Towards a politics of trust', identifies that this is merely the first stage in the analysis. Further stages are necessary which analyse the ways in which power is exercised in the conflict for control within discrete elements of the system.

  5. A Requisite for Employee Trust: Leadership.

    ERIC Educational Resources Information Center

    Hart, Kerry Marshall

    1988-01-01

    Provides background on organizational trust as product of need satisfaction and presents framework for understanding organizational trust with regard to theoretical differentiation of personal trust and system trust. Defines three factors of organizational trust: openness/congruity, shared values, and autonomy/feedback. Discusses how supervisors…

  6. Capturing Young American Trust in National Databases

    ERIC Educational Resources Information Center

    Menard, Lauren A.

    2011-01-01

    A pattern of decreasing trusting proportions in each consecutive decade and increasing trusting proportions with age was revealed in data. Although trust levels were lower in younger adults and the 2000s, findings did not support hypotheses of more rapidly falling trust levels or a college degree procuring less trust in the 2000s. A hypothesis of…

  7. epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England.

    PubMed

    Loveday, H P; Wilson, J A; Pratt, R J; Golsorkhi, M; Tingle, A; Bak, A; Browne, J; Prieto, J; Wilcox, M; UK Department of Health

    2014-01-01

    National evidence-based guidelines for preventing healthcare-associated infections (HCAI) in National Health Service (NHS) hospitals in England were originally commissioned by the Department of Health and developed during 1998-2000 by a nurse-led multi-professional team of researchers and specialist clinicians. Following extensive consultation, they were first published in January 2001(1) and updated in 2007.(2) A cardinal feature of evidence-based guidelines is that they are subject to timely review in order that new research evidence and technological advances can be identified, appraised and, if shown to be effective for the prevention of HCAI, incorporated into amended guidelines. Periodically updating the evidence base and guideline recommendations is essential in order to maintain their validity and authority. The Department of Health commissioned a review of new evidence and we have updated the evidence base for making infection prevention and control recommendations. A critical assessment of the updated evidence indicated that the epic2 guidelines published in 2007 remain robust, relevant and appropriate, but some guideline recommendations required adjustments to enhance clarity and a number of new recommendations were required. These have been clearly identified in the text. In addition, the synopses of evidence underpinning the guideline recommendations have been updated. These guidelines (epic3) provide comprehensive recommendations for preventing HCAI in hospital and other acute care settings based on the best currently available evidence. National evidence-based guidelines are broad principles of best practice that need to be integrated into local practice guidelines and audited to reduce variation in practice and maintain patient safety. Clinically effective infection prevention and control practice is an essential feature of patient protection. By incorporating these guidelines into routine daily clinical practice, patient safety can be enhanced and

  8. Building and Understanding Trust Relationships

    DTIC Science & Technology

    2012-03-17

    interdependence. To meet these challenges, senior military leaders must understand and build internal and external trust. The Ken Blanchard Company, one...Military Review: The Profession of Arms, September 30, 2011, 16. 2 The Ken Blanchard Company, “Building Trust,” 2010,pdf, http...www.kenblanchard.com/img/pub/ Blanchard -Building-Trust.pdf (accessed November 27, 2011). 3 Richard H. Kohn, “The Early Retirement of Gen. Ronald Fogleman, Chief of

  9. The Need to Trust and to Trust More Wisely in Academe

    ERIC Educational Resources Information Center

    Bowman, Richard F.

    2012-01-01

    Where trust is an issue, there is no trust. Trust in diverse organizations has never been lower. A shadow of doubt stalks one's every decision to trust collegially and institutionally. Still, colleagues sense intuitively that institutions cannot function optimally without a bedrock level of trust. In academic life, trust is a form of social…

  10. Use of the NHS Choices website for primary care consultations: results from online and general practice surveys

    PubMed Central

    Murray, Joanna; Majeed, Azeem; Khan, Muhammad Saleem; Lee, John Tayu; Nelson, Paul

    2011-01-01

    Objectives To determine the effect of using the NHS Choices website on primary care consultations in England and Wales. We examined the hypothesis that using NHS Choices may reduce the frequency of primary care consultations among young, healthy users. Design Two cross-sectional surveys of NHS Choices users. Setting Survey of NHS Choices users using an online pop-up questionnaire on the NHS Choices website and a snapshot survey of patients in six general practices in London. Participants NHS Choices website users and general practice patients. Main outcome measures For both surveys, we measured the proportion of people using NHS Choices when considering whether to consult their GP practice and on subsequent frequency of primary care consultations. Results Around 59% (n = 1559) of online and 8% (n = 125) of general practice survey respondents reported using NHS Choices in relation to their use of primary care services. Among these, 33% (n = 515) of online and 18% (n = 23) of general practice respondents reported reduced primary care consultations as a result of using NHS Choices. We estimated the equivalent capacity savings in primary care from reduced consultations as a result of using NHS Choices to be approximately £94 million per year. Conclusions NHS Choices has been shown to alter healthcare-seeking behaviour, attitudes and knowledge among its users. Using NHS Choices results in reduced demand for primary care consultations among young, healthy users for whom reduced health service use is likely to be appropriate. Reducing potentially avoidable consultations can result in considerable capacity savings in UK primary care. PMID:21847438

  11. The barriers to and enablers of providing reasonably adjusted health services to people with intellectual disabilities in acute hospitals: evidence from a mixed-methods study

    PubMed Central

    Tuffrey-Wijne, Irene; Goulding, Lucy; Giatras, Nikoletta; Abraham, Elisabeth; Gillard, Steve; White, Sarah; Edwards, Christine; Hollins, Sheila

    2014-01-01

    Objective To identify the factors that promote and compromise the implementation of reasonably adjusted healthcare services for patients with intellectual disabilities in acute National Health Service (NHS) hospitals. Design A mixed-methods study involving interviews, questionnaires and participant observation (July 2011–March 2013). Setting Six acute NHS hospital trusts in England. Methods Reasonable adjustments for people with intellectual disabilities were identified through the literature. Data were collected on implementation and staff understanding of these adjustments. Results Data collected included staff questionnaires (n=990), staff interviews (n=68), interviews with adults with intellectual disabilities (n=33), questionnaires (n=88) and interviews (n=37) with carers of patients with intellectual disabilities, and expert panel discussions (n=42). Hospital strategies that supported implementation of reasonable adjustments did not reliably translate into consistent provision of such adjustments. Good practice often depended on the knowledge, understanding and flexibility of individual staff and teams, leading to the delivery of reasonable adjustments being haphazard throughout the organisation. Major barriers included: lack of effective systems for identifying and flagging patients with intellectual disabilities, lack of staff understanding of the reasonable adjustments that may be needed, lack of clear lines of responsibility and accountability for implementing reasonable adjustments, and lack of allocation of additional funding and resources. Key enablers were the Intellectual Disability Liaison Nurse and the ward manager. Conclusions The evidence suggests that ward culture, staff attitudes and staff knowledge are crucial in ensuring that hospital services are accessible to vulnerable patients. The authors suggest that flagging the need for specific reasonable adjustments, rather than the vulnerable condition itself, may address some of the barriers

  12. Generalized Trust and Trust in Institutions in Confucian Asia

    ERIC Educational Resources Information Center

    Tan, Soo Jiuan; Tambyah, Siok Kuan

    2011-01-01

    This study examines generalized trust and trust in institutions in Confucian Asia, covering six countries namely, China, Japan, Singapore, South Korea, Taiwan and Vietnam, and one dependent region, Hong Kong. Using data from the 2006 AsiaBarometer Survey, our study affirms the reliability and validity of using a two-item scale to measure…

  13. 'Searching for the people in charge': appraising the 1983 Griffiths NHS management inquiry.

    PubMed

    Gorsky, Martin

    2013-01-01

    This is the first of two related articles in the present volume which examine the recent history of health services management using the case of the British National Health Service (NHS). In the historiography of the NHS the 1980s is widely seen as a watershed, when public policy first sought to introduce market disciplines into its operation. Administrative and managerial reforms were central to this process, and their origins and impact have been the subject of continuing debate. This article examines and evaluates one of the key events in this history, the Griffiths NHS Inquiry of 1983, which put in place the principles of 'general management' in the NHS. Drawing on both documentary records and oral evidence it offers fresh perspectives on the reasons why the Conservative government embarked on this reform, on the workings of the inquiry team under the leadership of the businessman Roy Griffiths, and on the uneven course of the implementation of his recommendations. While its initial impact arguably did not meet the expectations of its supporters, it is suggested that several of Griffiths' key concerns have grown, not diminished, in importance as aspects of subsequent health politics. These include: the need for clinician involvement in NHS management and financing; the conundrum of how to depoliticise the central direction of the service while retaining political accountability; the desirability of measuring and improving performance; and the question of how best to incorporate the wishes of patients and public in the decision-making arena.

  14. Improving the acute care of COPD patients across Gloucestershire: a quality improvement project.

    PubMed

    Miller, Craig; Cushley, Claire; Redler, Kasey; Mitchell, Claire; Aynsley Day, Elizabeth; Mansfield, Helen; Nye, Abigail

    2015-01-01

    Admissions for exacerbations of chronic obstructive pulmonary disease (COPD) present a significant proportion of patients in the acute medical take. The British Thoracic Society (BTS) provides guidelines for time specific interventions, that should be delivered to those with an acute exacerbation of COPD through the admission care bundle. These include correct diagnosis, correct assessment of oxygenation, early administration of treatment, recognition of respiratory failure, and specialist review. Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) chose improvement in acute COPD care to be a local Commissioning for Quality and Innovation (CQUIN) scheme, which enables commissioners to reward excellence by linking a proportion of English healthcare providers' income to the achievement of local quality improvement goals. The effects of initiatives put in place by senior clinicians had waned, and further improvements were required to meet the CQUIN target. The aim of the scheme was to improve compliance with the BTS guidelines and CQUIN scheme for patients admitted with an exacerbation of COPD. Specific bundle paperwork to be used for all patients admitted to the Trust with an exacerbation of COPD was introduced to the Trust in June 2014, with training and education of medical staff at that time. This had improved compliance rates from 10% to 63% by September 2014. Compliance with each intervention was audited through the examination of notes of patients admitted with an exacerbation of COPD. Compliance rates had plateaued over the last three months, and so a focus group involving junior medical staff met in September 2014 to try to increase awareness further, in order to drive greater improvements in care, and meet the CQUIN requirements. Their strategies were implemented, and then compliance with the CQUIN requirements was reaudited as described above. The December 2014 audit results showed a further improvement in overall COPD care, with 73% of patients

  15. Improving the acute care of COPD patients across Gloucestershire: a quality improvement project.

    PubMed Central

    Miller, Craig; Cushley, Claire; Redler, Kasey; Mitchell, Claire; Aynsley Day, Elizabeth; Mansfield, Helen; Nye, Abigail

    2015-01-01

    Admissions for exacerbations of chronic obstructive pulmonary disease (COPD) present a significant proportion of patients in the acute medical take. The British Thoracic Society (BTS) provides guidelines for time specific interventions, that should be delivered to those with an acute exacerbation of COPD through the admission care bundle. These include correct diagnosis, correct assessment of oxygenation, early administration of treatment, recognition of respiratory failure, and specialist review. Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) chose improvement in acute COPD care to be a local Commissioning for Quality and Innovation (CQUIN) scheme, which enables commissioners to reward excellence by linking a proportion of English healthcare providers’ income to the achievement of local quality improvement goals. The effects of initiatives put in place by senior clinicians had waned, and further improvements were required to meet the CQUIN target. The aim of the scheme was to improve compliance with the BTS guidelines and CQUIN scheme for patients admitted with an exacerbation of COPD. Specific bundle paperwork to be used for all patients admitted to the Trust with an exacerbation of COPD was introduced to the Trust in June 2014, with training and education of medical staff at that time. This had improved compliance rates from 10% to 63% by September 2014. Compliance with each intervention was audited through the examination of notes of patients admitted with an exacerbation of COPD. Compliance rates had plateaued over the last three months, and so a focus group involving junior medical staff met in September 2014 to try to increase awareness further, in order to drive greater improvements in care, and meet the CQUIN requirements. Their strategies were implemented, and then compliance with the CQUIN requirements was reaudited as described above. The December 2014 audit results showed a further improvement in overall COPD care, with 73% of patients

  16. A standardised storage solution for venepuncture/cannulation equipment could save an NHS hospital the equivalent of a whole junior doctor

    PubMed Central

    Lindley, Steven; Robertson, Ian

    2014-01-01

    Junior doctors, nursing staff, and phlebotomists spend a large proportion of their time taking blood samples and siting (venous) cannulae. Approximately 350 blood samples are taken daily across 25 wards at the Royal United Hospital Bath NHS Trust. There is no standard storage solution for venepuncture or cannulation equipment. On-call junior doctors cover most of the hospital's wards. Time is wasted locating essential equipment on unfamiliar wards and nurses are frequently interrupted to assist. These delays can compromise patient safety in emergencies as well as contributing to a source of daily inefficiency. Junior doctors were timed collecting equipment needed for venepuncture and cannulation on unfamiliar wards. Initial results suggested large variation between timings on different wards. The medical admissions unit (MAU), which organises items for venepuncture and cannulation on a single trolley, was 4 times quicker than the mean of all other wards. MAU mean time 21.0s vs. Non-standardised wards mean time 103.0s (p<0.0001). Estimates suggest approximately 47 hours per week (the equivalent of a fulltime doctor) could be saved by implementing a standard trust-wide storage solution. We set out to introduce the MAU trolley format to all adult inpatient wards. All ward managers agreed to implement the trolley. 18 wards (72% of adult inpatient wards) already possessed the ‘MAU style’ trolley, which we standardised using an easy-to-follow inventory and laminated draw inlays. Feedback was very positive from doctors and ward staff alike. We repeated timings to validate the change and successfully presented a business case to senior management for a further 10 trolleys (£3623.78) for full adult inpatient ward coverage. As junior doctors, we identified a common problem, tested solutions, and made early simple affordable changes. Initial work helped us present a compelling case for patient safety and efficiency improvements, releasing money to implement modest trust

  17. Trusted computing strengthens cloud authentication.

    PubMed

    Ghazizadeh, Eghbal; Zamani, Mazdak; Ab Manan, Jamalul-lail; Alizadeh, Mojtaba

    2014-01-01

    Cloud computing is a new generation of technology which is designed to provide the commercial necessities, solve the IT management issues, and run the appropriate applications. Another entry on the list of cloud functions which has been handled internally is Identity Access Management (IAM). Companies encounter IAM as security challenges while adopting more technologies became apparent. Trust Multi-tenancy and trusted computing based on a Trusted Platform Module (TPM) are great technologies for solving the trust and security concerns in the cloud identity environment. Single sign-on (SSO) and OpenID have been released to solve security and privacy problems for cloud identity. This paper proposes the use of trusted computing, Federated Identity Management, and OpenID Web SSO to solve identity theft in the cloud. Besides, this proposed model has been simulated in .Net environment. Security analyzing, simulation, and BLP confidential model are three ways to evaluate and analyze our proposed model.

  18. Trusted Computing Strengthens Cloud Authentication

    PubMed Central

    2014-01-01

    Cloud computing is a new generation of technology which is designed to provide the commercial necessities, solve the IT management issues, and run the appropriate applications. Another entry on the list of cloud functions which has been handled internally is Identity Access Management (IAM). Companies encounter IAM as security challenges while adopting more technologies became apparent. Trust Multi-tenancy and trusted computing based on a Trusted Platform Module (TPM) are great technologies for solving the trust and security concerns in the cloud identity environment. Single sign-on (SSO) and OpenID have been released to solve security and privacy problems for cloud identity. This paper proposes the use of trusted computing, Federated Identity Management, and OpenID Web SSO to solve identity theft in the cloud. Besides, this proposed model has been simulated in .Net environment. Security analyzing, simulation, and BLP confidential model are three ways to evaluate and analyze our proposed model. PMID:24701149

  19. Annual appraisal and liege homage: why the British NHS is fundamentally a feudal organisation.

    PubMed

    Tyler, Len; Evans, Ann

    2003-01-01

    A study of the past can help us understand present-day management structures. Strong parallels can be seen between the present-day British National Health Service (NHS) and English feudal society in the early Middle Ages. Both systems are hierarchical, both show limited mobility between layers in the hierarchies and in both there is a strong element of central control coexisting with significant day-to-day delegation of responsibility. Ceremony plays a key role in relationships, such as through the swearing of liege homage in feudal society and through formal assessment and appraisal in the modern NHS. Although the NHS clearly does not show parallels for every element of feudal society, it is possible to draw practical lessons from the comparison, particularly relating to the ownership of problems, team-working and appraisal.

  20. The fallacy of choice in the common law and NHS policy.

    PubMed

    Whiteman, Ingrid

    2013-06-01

    Neither the English courts nor the National Health Service (NHS) have been immune to the modern mantra of patient choice. This article examines whether beneath the rhetoric any form of real choice is endorsed either in law or in NHS policy. I explore the case law on 'consent', look at choice within the NHS and highlight the dilemmas that a mismatch of language and practice poses for clinicians. Given the variance in interpretation and lack of consistency for the individual patient I argue for a semantic change that obviates the use of 'choice', focussing instead on the options for treatment that are available and accessible, with due acknowledgement of individual patient preferences, without raising unfettered and false expectations.

  1. The direct cost of intravenous insulin infusions to the NHS in England and Wales.

    PubMed

    Rajendran, Rajesh; Scott, Anne; Rayman, Gerry

    2015-08-01

    The cost of intravenous insulin infusion to the NHS is unknown. The aim of this study was to estimate the direct cost of insulin infusions to the NHS in England and Wales in the first 24-hour period of infusion. Data from the National Inpatient Diabetes Audit 2013 in the UK were used to estimate the number of insulin infusions in use across England and Wales. Costs were calculated for six models for setting up and maintenance of insulin infusions, depending on the extent of involvement of different healthcare professionals in the UK. In this study, the direct costs of intravenous insulin infusions to the NHS in England and Wales have been estimated to vary from £6.4-8.5 million in the first 24-hour period on infusion. More appropriate use of these infusions could result in substantial cost savings.

  2. Volunteering and overseas placements in the NHS: a survey of current activity

    PubMed Central

    Chatwin, John; Ackers, Louise

    2016-01-01

    Objective The study aimed to establish current levels of overseas volunteering and placement activity across all staff grades within the National Health Service (NHS) in the North West of England. Design Cross-sectional survey. Instrument Descriptive statistics. Setting 4 main regional hospitals in the North West of England, and additional NHS staff training events. Participants Convenience sample of NHS staff (n=911). Results 911 NHS staff took part in the survey. The medical and dental staff group returned the highest number of responses (32.1%). 42% of staff reported some form of overseas volunteering or placement experience. Most staff took an international placement as students (33.6% men; 40.6% women). Medium-term placements were undertaken by 46.7% of men, and 52.5% of women. Settlement stays (ie, over 1 year) were reported by 7.6% men, and 8.3% women). The majority of respondents engaged in international placement were from the age groups incorporating ‘below 25’ to ‘41–50’ (74%). Multiple placement experiences were uncommon: 2.5% of respondents reported three periods of overseas activity, and 1.5% reported four. All those with multiple placement experience came from the staff groups incorporating midwife/nurse/health visitor, and medical and dental. Conclusions This survey captured a snapshot of current levels of volunteering and overseas placement activity across NHS staff grades in the North West. Owing to relatively homogenous organisational structures, findings are likely to broadly represent the position across the organisation as a whole. Although some degree of overseas placement activity is undertaken by a relatively high proportion of NHS staff, such activity is currently heavily skewed towards higher clinical staff grades. Significant numbers of allied health professionals and equivalent non-clinical cadres also report overseas experience, and we anticipate that the numbers will continue to rise if current policy initiatives gain

  3. The NHS Health Check in England: an evaluation of the first 4 years

    PubMed Central

    Robson, John; Dostal, Isabel; Sheikh, Aziz; Eldridge, Sandra; Madurasinghe, Vichithranie; Griffiths, Chris; Coupland, Carol; Hippisley-Cox, Julia

    2016-01-01

    Objectives To describe implementation of a new national preventive programme to reduce cardiovascular morbidity. Design Observational study over 4 years (April 2009—March 2013). Setting 655 general practices across England from the QResearch database. Participants Eligible adults aged 40–74 years including attendees at a National Health Service (NHS) Health Check. Intervention NHS Health Check: routine structured cardiovascular check with support for behavioural change and in those at highest risk, treatment of risk factors and newly identified comorbidity. Results Of 1.68 million people eligible for an NHS Health Check, 214 295 attended in the period 2009–12. Attendance quadrupled as the programme progressed; 5.8% in 2010 to 30.1% in 2012. Attendance was relatively higher among older people, of whom 19.6% of those eligible at age 60–74 years attended and 9.0% at age 40–59 years. Attendance by population groups at higher cardiovascular disease (CVD) risk, such as the more socially disadvantaged 14.9%, was higher than that of the more affluent 12.3%. Among attendees 7844 new cases of hypertension (38/1000 Checks), 1934 new cases of type 2 diabetes (9/1000 Checks) and 807 new cases of chronic kidney disease (4/1000 Checks) were identified. Of the 27 624 people found to be at high CVD risk (20% or more 10-year risk) when attending an NHS Health Check, 19.3% (5325) were newly prescribed statins and 8.8% (2438) were newly prescribed antihypertensive therapy. Conclusions NHS Health Check coverage was lower than expected but showed year-on-year improvement. Newly identified comorbidities were an important feature of the NHS Health Checks. Statin treatment at national scale for 1 in 5 attendees at highest CVD risk is likely to have contributed to important reductions in their CVD events. PMID:26762161

  4. NHS health checks: an update on the debate and program implementation in England.

    PubMed

    Abdalrahman, Bayad; Soljak, Michael

    2015-01-01

    Cardiovascular disease is the leading cause of mortality and morbidity worldwide. In England, the government has adopted a population-wide prevention program for cardiovascular disease, the NHS Health Check program. The program has sparked controversies over the evidence base and feasibility of implementation. We aim to provide an update on the debate and program implementation. In conclusion, the evidence base for the NHS Health Check program has a number of uncertainties and program delivery has been suboptimal. It is important to continue monitoring and evaluating the program to provide the evidence base for future policy direction.

  5. Climate change, health and sustainability: a brief survey of primary care trusts in the south west of England.

    PubMed

    Nichols, Andrew; Richardson, Janet

    2011-03-01

    With climate change threatening to present real challenges to public health, the relevant UK organizations, such as the NHS, have produced guidelines and action plans to encourage primary care trusts (PCTs) to reduce their carbon emissions and generally function in a more sustainable way. This paper presents the results of a survey designed to assess how successful this initiative has been in one part of the UK, the south west of England. While the results are promising, the PCTs surveyed are aware that commitment and leadership must come from a higher level.

  6. The Business of Trust.

    PubMed

    Frisse, Mark E

    2016-04-01

    New mobile devices, social networks, analytics, and communications technologies are emerging at an unparalleled rate. As a result, academic health centers will face both new opportunities and formidable challenges. Unlike previous transitions from paper-based systems to networked computer systems, these new technologies are the product of new entrepreneurial and commercial interests driven by consumers. As these new commercial products and services are more widely adopted, the likelihood grows that data will be used in unanticipated ways inconsistent with societal norms. Academic health centers will have to understand the implications of these technologies and engage more actively in processes governing the collection, aggregation, and use of health data produced in a new era of consumer-driven health care technology. Maintaining public trust should be a paramount concern.

  7. Trust in performance indicators?

    PubMed Central

    Davies, H. T.; Lampel, J.

    1998-01-01

    The 1980s and 90s have seen the proliferation of all forms of performance indicators as part of attempts to command and control health services. The latest area to receive attention is health outcomes. Published league tables of mortality and other health outcomes have been available in the United States for some time and in Scotland since the early 1990s; they have now been developed for England and Wales. Publication of these data has proceeded despite warnings as to their limited meaningfulness and usefulness. The time has come to ask whether the remedy is worse than the malady: are published health outcomes contributing to quality efforts or subverting more constructive approaches? This paper argues that attempts to force improvements through publishing health outcomes can be counterproductive, and outlines an alternative approach which involves fostering greater trust in professionalism as a basis for quality enhancements. PMID:10185142

  8. Trust, Respect, and Reciprocity

    PubMed Central

    Phong, Tran Viet; Nhan, Le Nguyen Thanh; Dung, Nguyen Thanh; Ngan, Ta Thi Dieu; Kinh, Nguyen Van; Parker, Michael; Bull, Susan

    2015-01-01

    International science funders and publishers are driving a growing trend in data sharing. There is mounting pressure on researchers in low- and middle-income settings to conform to new sharing policies, despite minimal empirically grounded accounts of the ethical challenges of implementing the policies in these settings. This study used in-depth interviews and focus group discussions with 48 stakeholders in Vietnam to explore the experiences, attitudes, and expectations that inform ethical and effective approaches to sharing clinical research data. Distinct views on the role of trust, respect, and reciprocity were among those that emerged to inform culturally appropriate best practices. We conclude by discussing the challenges that authors of data-sharing policies should consider in this unique context. PMID:26297747

  9. Improving the quality of antibiotic prescribing in the NHS by developing a new Antimicrobial Stewardship Programme: Start Smart--Then Focus.

    PubMed

    Ashiru-Oredope, Diane; Sharland, Mike; Charani, Esmita; McNulty, Cliodna; Cooke, Jonathan

    2012-07-01

    There has been dramatic change in antibiotic use in English hospitals. Data from 2004 and 2009 show that the focus on reducing fluoroquinolone and second- and third-generation cephalosporin use seems to have been heeded in NHS secondary care, and has been associated with a substantial decline in hospital Clostridium difficile rates. However, there has been a substantial increase in use of co-amoxiclav, carbapenems and piperacillin/tazobactam. In primary care, antibiotic prescribing fell markedly from 1995 to 2000, but has since risen steadily to levels seen in the early 1990s. There remains a 2-fold variation in antimicrobial prescribing among English General Practices. In 2010, the NHS Atlas of Variation documented a 3-fold variation in the prescription of quinolones and an 18-fold variation in cephalosporins by Primary Care Trusts across England. There is a clear need to improve antimicrobial prescribing. This paper describes the development of new antimicrobial stewardship programmes for primary care and hospitals by the Department of Health's Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection: Antimicrobial Stewardship in Primary Care Initiative. The secondary care programme promotes the rapid prescription of the right antibiotic at the right dose at the right time, followed by active review for all patients still on antibiotics 48 h after admission. The five options available are to stop, switch to oral, continue and review again, change (if possible to a narrower spectrum) or move to outpatient parenteral antibiotic therapy. A range of audit and outcome tools has been developed, but to maintain optimal antimicrobial usage, monitoring of local and national quantitative and qualitative data on prescribing and consumption is required, linked to the development of key performance indicators in primary, secondary and tertiary care.

  10. Why Do Speech and Language Therapists Stay in, Leave and (Sometimes) Return to the National Health Service (NHS)?

    ERIC Educational Resources Information Center

    Loan-Clarke, John; Arnold, John; Coombs, Crispin; Bosley, Sara; Martin, Caroline

    2009-01-01

    Background: Research into recruitment, retention and return of speech and language therapists in the National Health Service (NHS) is relatively limited, particularly in respect of understanding the factors that drive employment choice decisions. Aims: To identify what factors influence speech and language therapists working in the NHS to stay,…

  11. Trust and Dialogue in the Army Profession

    DTIC Science & Technology

    2008-05-22

    foundational concept, trust, from an organizational perspective, facilitates the lasting commitment to meet strategic aims. Trust involves the expectation...core of the professional military ethi As a foundational concept, trust, from an organizational perspective, facilitates the lasting commitment to meet...forms the core of the professional military ethic. As a foundational concept, trust, from an organizational perspective, facilitates the lasting

  12. Trust, Behavior, and High School Outcomes

    ERIC Educational Resources Information Center

    Romero, Lisa S.

    2015-01-01

    Purpose: The purpose of this paper is to contribute to the literature on student trust and to examine the relationship between student trust, behavior, and academic outcomes in high school. It asks, first, does trust have a positive effect on high school outcomes? Second, does trust influence student behavior, exerting an indirect effect on…

  13. 43 CFR 426.7 - Trusts.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Trusts. 426.7 Section 426.7 Public Lands... LIMITATION RULES AND REGULATIONS § 426.7 Trusts. (a) Definitions for purposes of this section: Grantor revocable trust means a trust that holds irrigable land or irrigation land that may be revoked at...

  14. 12 CFR 7.2022 - Voting trusts.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 1 2010-01-01 2010-01-01 false Voting trusts. 7.2022 Section 7.2022 Banks and... Practices § 7.2022 Voting trusts. The shareholders of a national bank may establish a voting trust under the applicable law of a state selected by the participants and designated in the trust agreement, provided...

  15. 7 CFR 1400.100 - Revocable trust.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Revocable trust. 1400.100 Section 1400.100... AND SUBSEQUENT CROP, PROGRAM, OR FISCAL YEARS Payment Limitation § 1400.100 Revocable trust. A revocable trust and the grantor of the trust will be considered to be the same person....

  16. TRUST: TDRSS Resource User Support Tool

    NASA Technical Reports Server (NTRS)

    Sparn, Thomas P.; Gablehouse, R. Daniel

    1991-01-01

    TRUST-TDRSS (Tracking Data and Relay Satellite System) Resource User Support Tool is presented in the form of the viewgraphs. The following subject areas are covered: TRUST development cycle; the TRUST system; scheduling window; ODM/GCMR window; TRUST architecture; surpass; and summary.

  17. 14 CFR 47.8 - Voting trusts.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Voting trusts. 47.8 Section 47.8... REGISTRATION General § 47.8 Voting trusts. (a) If a voting trust is used to qualify a domestic corporation as a... the fully executed voting trust agreement, which must identify each voting interest of the...

  18. Fiscal decentralization in the Italian NHS: what happens to interregional redistribution?

    PubMed

    Ferrario, Caterina; Zanardi, Alberto

    2011-04-01

    This paper explores how pressures for an increased decentralization of taxing powers to sub-national governments may affect the degree of income redistribution across regional territories accomplished by the Italian NHS. In Italy, political responsibilities for health care are decentralized to regional governments, but the central government retains a critical role in ensuring all citizens uniform access to health services. To this end the central government runs an expenditure needs equalizing system to top up regional governments own resources. However, this system is currently put under question by strong political pressures calling for a weakening of central government involvement. Applying a well developed econometric approach we find that the NHS currently reduces interregional differences in per-capita income by about 7% of GDP. A reform of the NHS in terms of a reduction of expenditure standards produces a weakening of redistribution across jurisdictions, the size of which crucially depends on the financing arrangements of health care that will be actually adopted. We conclude that the decentralization of the NHS would give rise to relevant policy issues concerning in particular the different health care spending possibilities across regions and the impact on the interregional mobility of patients.

  19. Partial progress: governing the pharmaceutical industry and the NHS, 1948-2008.

    PubMed

    Abraham, John

    2009-12-01

    Coinciding with sixty years of the U.K. National Health Service (NHS), this article reviews the neglected area of the governance of the pharmaceutical industry and the NHS. It traces the relationships between the pharmaceutical industry, the state, and the NHS from the creation of the health service to the present, as they have grappled with the overlapping challenges of pharmaceutical safety, efficacy, cost-effectiveness, pricing, promotion, and advertising. The article draws on the concepts of "corporate bias" and "regulatory capture" from political theory, and "counter-vailing powers" and "clinical autonomy" in medical sociology, while also introducing the new concepts of "assimilated allies" and "pharmaceuticalization" in order to synthesize a theoretical framework capable of longitudinal empirical analysis of pharmaceutical governance. The analysis identifies areas in which the governance of pharmaceuticals and the NHS has contributed to progress in health care since 1948. However, it is argued that that progress has been slow, restricted, and vulnerable to misdirection due to the enormous and unrivaled influence afforded to the pharmaceutical industry in policy developments. Countervailing influences against such corporate bias have often been limited and subject to destabilization by the industry's assimilated allies either within the state or in the embrace of pharmaceuticalization and consumerism.

  20. Large scale implementation of a medicines reconciliation care bundle in NHS GGC GP practices

    PubMed Central

    Bruce, Rachel

    2016-01-01

    Medicines reconciliation (MR) is an essential process for patient safety, promoting safer use of medicines with effective communication at the interface, particularly when patients are admitted and discharged from hospital. Much of the work on MR has been focussed in secondary care, however, the principles are equally important in primary care. The aim of the work was to test the Scottish Patient Safety in Primary Care (SPSP-PC) MR care bundle and consider scale up and spread across all NHS Greater Glasgow and Clyde (NHS GGC) GP practices. Care bundles are a quality improvement tool which can drive improvement by standardising processes to deliver optimum care. Pilot work and testing began with 5 GP practices in 2011 and was spread to over 200 practices by 2015/16. A care bundle compliance process measure was measured monthly, with practices sampling 10 patients per month. Practices could view their run charts in real time and identify which measures resulted in “non-compliance” and PDSA cycles were promoted to test and implement improvements. Data was collated at NHS GGC level with an aim of 95% compliance with the care bundle by March 2016. MR care bundle compliance started at 40% (5 practices reporting) in 2011 with final data in March 2016 demonstrating 92% compliance (192 practices reporting). A sustained “reliability” of 92-93% across >200 practices has been observed since January 2015. In conclusion, the bundle was implemented by 97% of NHS GGC GP practices and resulted in process improvements. PMID:27933147

  1. How are policy makers using evidence? Models of research utilisation and local NHS policy making

    PubMed Central

    Elliott, H.; Popay, J.

    2000-01-01

    STUDY OBJECTIVE—This paper is based on a qualitative study that aimed to identify factors that facilitate or impede evidence-based policy making at a local level in the UK National Health Service (NHS). It considers how models of research utilisation drawn from the social sciences map onto empirical evidence from this study.
DESIGN—A literature review and case studies of social research projects that were initiated by NHS health authority managers or GP fundholders in one region of the NHS. In depth interviews and document analysis were used.
SETTING—One NHS region in England.
PARTICIPANTS—Policy makers, GPs and researchers working on each of the social research projects selected as case studies.
MAIN RESULTS—The direct influence of research evidence on decision making was tempered by factors such as financial constraints, shifting timescales and decision makers' own experiential knowledge. Research was more likely to impact on policy in indirect ways, including shaping policy debate and mediating dialogue between service providers and users.
CONCLUSIONS—The study highlights the role of sustained dialogue between researchers and the users of research in improving the utilisation of research-based evidence in the policy process.


Keywords: evidence-based policy making; research/policy interface; research utilisation PMID:10818123

  2. Management Development in the NHS: Nurses and Managers, Discourses and Identities

    ERIC Educational Resources Information Center

    Sambrook, Sally

    2006-01-01

    Purpose: Aims to provide a brief discussion of discourses of HRD, then a brief review of HRD within the NHS, including stakeholders in HRD, and particularly management development. To explore some of the different discourses used by different managers, particularly those with a nursing background and those without, and the possible reasons for the…

  3. A Survey of Food Projects in the English NHS Regions and Health Action Zones in 2001

    ERIC Educational Resources Information Center

    Caraher, Martin; Cowburn, Gill

    2004-01-01

    Background and Objective: This article sets out the findings from an analysis of food projects, with a particular emphasis on fruit and vegetables, from the 26 Health Action Zones (HAZs) in England and those taking place within the former NHS regional areas in 2001. The objective was to gather information on the existing practice to inform future…

  4. What does it mean to involve consumers successfully in NHS research? A consensus study

    PubMed Central

    Telford, Rosemary; Boote, Jonathan D.; Cooper, Cindy L.

    2004-01-01

    Abstract Objective  To obtain consensus on the principles and indicators of successful consumer involvement in NHS research. Design  Consensus methods were used. An expert workshop, employing the nominal group technique was used to generate potential principles and indicators. A two‐round postal Delphi process was used to obtain consensus on the principles and indicators. Setting and participants  Participants were drawn from health, social care, universities and consumer organizations. A purposive sampling strategy was used to identify people who had experience and/or knowledge of consumer involvement in NHS research. Six researchers and seven consumers participated in an expert workshop. Ninety‐six people completed both rounds of the Delphi process. Main outcome measures  Consensus on principles and indicators of successful consumer involvement in NHS research. Results  Eight principles were developed through an expert workshop and Delphi process, and rated as both clear and valid. Consensus was reached on at least one clear and valid indicator by which to measure each principle. Conclusions  Consensus has been obtained on eight principles of successful consumer involvement in NHS research. They may help commissioners, researchers and consumers to deepen their understanding of this issue, and can be used to guide good practice. PMID:15327460

  5. Control and accountability in the NHS market: a practical proposition or logical impossibility?

    PubMed

    Glynn, J J; Perkins, D

    1998-01-01

    Before the imposition of the NHS internal market, systems of accountability and control were far from adequate and could be criticized on a number of grounds. The market was offered as a panacea to address these inadequacies. However, in practice there have only been partial improvements which could have been achieved without the imposition of the market. The market also creates new problems and a number of crises and scandals seem to be addressed at the political level by pleas to utilize resources more effectively. These pleas mean that more and more the focus is turning back to central planning in the provision of care and further away from so-called market mechanisms. The NHS "managed" market has been imperfect and will continue to be so. Argues that there is no alternative but to return to the planned provision of health care in order to improve on accountability and control in the NHS. Hopefully the adverse impact of the market on clinicians and others will force a more rational reappraisal of the fundamental raison d'être of the NHS and the need for those involved in the delivery of services, at all levels, to be more openly accountable.

  6. Healthcare reform. Is the NHS ready for US business guru's strategy?

    PubMed

    Cavendish, Will; Edwards, Nigel; Swindells, Matthew; Henke, Nicolaus; Robinson, Edna; Smith, Richard

    2006-12-07

    The central argument of the new book by renowned US academics Michael Porter and Elizabeth Olmsted Teisberg is that the US health system is broken because rather than improving quality and efficiency, it focuses on budgetary battles. HSJ gathered together six leading healthcare insiders to discuss whether his diagnosis is applicable to the NHS. Nick Edwards was there.

  7. Experiences of patients and healthcare professionals of NHS cardiovascular health checks: a qualitative study

    PubMed Central

    Riley, R.; Coghill, N.; Montgomery, A.; Feder, G.; Horwood, J.

    2016-01-01

    Background NHS Health Checks are a national cardiovascular risk assessment and management programme in England and Wales. We examined the experiences of patients attending and healthcare professionals (HCPs) conducting NHS Health Checks. Methods Interviews were conducted with a purposive sample of 28 patients and 16 HCPs recruited from eight general practices across a range of socio-economic localities. Interviews were audio recorded, transcribed, anonymized and analysed thematically. Results Patients were motivated to attend an NHS Health Check because of health beliefs, the perceived value of the programme, a family history of cardiovascular and other diseases and expectations of receiving a general health assessment. Some patients reported benefits including reassurance and reinforcement of healthy lifestyles. Others experienced confusion and frustration about how results and advice were communicated, some having a poor understanding of the implications of their results. HCPs raised concerns about the skill set of some staff to competently communicate risk and lifestyle information. Conclusions To improve the satisfaction of patients attending and improve facilitation of lifestyle change, HCPs conducting the NHS Health Checks require sufficient training to equip them with appropriate skills and knowledge to deliver the service effectively. PMID:26408822

  8. Trust and Privacy in Healthcare

    NASA Astrophysics Data System (ADS)

    Singleton, Peter; Kalra, Dipak

    This paper considers issues of trust and privacy in healthcare around increased data-sharing through Electronic Health Records (EHRs). It uses a model structured around different aspects of trust in the healthcare organisation’s reasons for greater data-sharing and their ability to execute EHR projects, particularly any associated confidentiality controls. It reflects the individual’s personal circumstances and attitude to use of health records.

  9. Trust and Online Reputation Systems

    NASA Astrophysics Data System (ADS)

    Kwan, Ming; Ramachandran, Deepak

    Web 2.0 technologies provide organizations with unprecedented opportunities to expand and solidify relationships with their customers, partners, and employees—while empowering firms to define entirely new business models focused on sharing information in online collaborative environments. Yet, in and of themselves, these technologies cannot ensure productive online interactions. Leading enterprises that are experimenting with social networks and online communities are already discovering this fact and along with it, the importance of establishing trust as the foundation for online collaboration and transactions. Just as today's consumers must feel secure to bank, exchange personal information and purchase products and services online; participants in Web 2.0 initiatives will only accept the higher levels of risk and exposure inherent in e-commerce and Web collaboration in an environment of trust. Indeed, only by attending to the need to cultivate online trust with customers, partners and employees will enterprises ever fully exploit the expanded business potential posed by Web 2.0. But developing online trust is no easy feat. While various preliminary attempts have occurred, no definitive model for establishing or measuring it has yet been established. To that end, nGenera has identified three, distinct dimensions of online trust: reputation (quantitative-based); relationship (qualitative-based) and process (system-based). When considered together, they form a valuable model for understanding online trust and a toolbox for cultivating it to support Web 2.0 initiatives.

  10. Greek NHS capacity constraints regarding intravenous treatment for rheumatoid arthritis patients.

    PubMed

    Athanasakis, Kostas; Detsis, Marios; Souliotis, Kyriakos; Golna, Christina; Kyriopoulos, John

    2012-04-01

    Intravenous (iv) infusion of biologic agents is a highly effective therapeutic option for active rheumatoid arthritis (RA). In Greece, it is mandatory that all infusions are administered in a hospital setting; therefore, they are strongly correlated with the system's capacity in terms of resources. The objective of this paper was to assess the capacity of the Greek National Health System (NHS) hospitals to meet current/projected demand for iv treatment of RA patients. Semi-qualitative interviews on the basis of a strictly structured questionnaire were conducted with the Heads of all NHS RA infusion sites to record available resources, service utilization and ability to meet current/projected demand. Out of 31 NHS infusion sites, 28 responded (90.3%). On average, 41.6% of Greek NHS RA patients are treated with a biologic agent and 61.5% of respondents stated that available resources are insufficient to meet current demand. The most important constraints in selection order were as follows: space (93%), staff (89.5%), equipment (61.5%) and working hours (57%). Fifty-six percent of respondents stated that they may decline treatment to patients due to constraints. Overall, respondents estimated that the number of iv patients could be increased by 104%, were there no capacity constraints. An important proportion of the estimated 40.000 RA patients in Greece, for whom iv biologic treatment in the hospital setting is essential for disease control, may be declined treatment due to constraints in RA-specific resources. Rationalization and reallocation of NHS resources is required to ensure equity in access to effective treatment for all RA patients.

  11. Addressing current and future challenges for the NHS: the role of good leadership.

    PubMed

    Elton, Lotte

    2016-10-03

    Purpose This paper aims to describe and analyse some of the ways in which good leadership can enable those working within the National Health Service (NHS) to weather the changes and difficulties likely to arise in the coming years, and takes the format of an essay written by the prize-winner of the Faculty of Medical Leadership and Management's Student Prize. The Faculty of Medical Leadership and Management ran its inaugural Student Prize in 2015-2016, which aimed at medical students with an interest in medical leadership. In running the Prize, the Faculty hoped to foster an enthusiasm for and understanding of the importance of leadership in medicine. Design/methodology/approach The Faculty asked entrants to discuss the role of good leadership in addressing the current and future challenges faced by the NHS, making reference to the Leadership and Management Standards for Medical Professionals published by the Faculty in 2015. These standards were intended to help guide current and future leaders and were grouped into three categories, namely, self, team and corporate responsibility. Findings This paper highlights the political nature of health care in the UK and the increasing impetus on medical professionals to navigate debates on austerity measures and health-care costs, particularly given the projected deficit in NHS funding. It stresses the importance of building organisational cultures prizing transparency to prevent future breaches in standards of care and the value of patient-centred approaches in improving satisfaction for both patients and staff. Identification of opportunities for collaboration and partnership is emphasised as crucial to assuage the burden that lack of appropriate social care places on clinical services. Originality/value This paper offers a novel perspective - that of a medical student - on the complex issues faced by the NHS over the coming years and utilises a well-regarded set of standards in conceptualising the role that health

  12. Plus ça change, plus c'est la même chose: senior NHS managers' narratives of restructuring.

    PubMed

    Macfarlane, Fraser; Exworthy, Mark; Wilmott, Micky; Greenhalgh, Trish

    2011-09-01

    The UK National Health Service (NHS) is regularly restructured. Its smooth operation and organisational memory depends on the insights and capability of managers, especially those with experience of previous transitions. Narrative methods can illuminate complex change from the perspective of key actors. We used an adaptation of Wengraf's biographical narrative life interview method to explore how 20 senior NHS managers (chief executives, directors and assistant directors) had perceived and responded to major transitions since 1974. Data were analysed thematically using insights from phenomenology, neo-institutional theory and critical management studies. Findings were contextualised within a literature review of NHS policy and management 1974-2009. Managers described how experience in different NHS organisations helped build resilience and tacit knowledge, and how a strong commitment to the 'NHS brand' allowed them to weather a succession of policy changes and implement and embed such changes locally. By synthesising these personal and situated micro-narratives, we built a wider picture of macro-level institutional change in the NHS, in which the various visible restructurings in recent years appear to have masked a deeper continuity in terms of enduring values, norms and ways of working. We consider the implications of these findings for the future NHS.

  13. Lack of language skills and knowledge of local culture in international medical graduates: Implications for the NHS.

    PubMed

    Hamarneh, Ashraf

    2015-01-01

    International Medical Graduates (IMGs) form a coherent part of the National Health Service (NHS). Nearly 25% of the doctors working in the NHS are IMGs who obtained their primary medical degree from outside the EU. Moving to a different country that holds a different set of values and belief systems can be very challenging for IMGs, which in turn could have a significant effect on the service provided to NHS patients. This article will address the issue of effective communication skills within the IMG population and will explore the underlying issues behind this problem.

  14. The Slow, Lingering Death of the English NHS: Comment on "Who Killed the English National Health Service?".

    PubMed

    Hunter, David J

    2015-09-09

    The death of the English National Health Service (NHS) may be slow in coming but that does not mean that it is not the Conservative-led UK government's desired end state. The government is displaying tactical cunning in achieving its long-term purpose to remould the British state. Powell seeks greater clarity amidst the confusion but the lack of clarity is a principal weapon in the government's assault on the public realm, including the NHS. Moreover, there is ample supporting evidence to caution against Powell's tendency to complacency concerning the ultimate fate of the NHS.

  15. Views of NHS commissioners on commissioning support provision. Evidence from a qualitative study examining the early development of clinical commissioning groups in England

    PubMed Central

    Petsoulas, Christina; Allen, Pauline; Checkland, Kath; Coleman, Anna; Segar, Julia; Peckham, Stephen; Mcdermott, Imelda

    2014-01-01

    Objective The 2010 healthcare reform in England introduced primary care-led commissioning in the National Health Service (NHS) by establishing clinical commissioning groups (CCGs). A key factor for the success of the reform is the provision of excellent commissioning support services to CCGs. The Government's aim is to create a vibrant market of competing providers of such services (from both for-profit and not-for-profit sectors). Until this market develops, however, commissioning support units (CSUs) have been created from which CCGs are buying commissioning support functions. This study explored the attitudes of CCGs towards outsourcing commissioning support functions during the initial stage of the reform. Design The research took place between September 2011 and June 2012. We used a case study research design in eight CCGs, conducting in-depth interviews, observation of meetings and analysis of policy documents. Setting/participants We conducted 96 interviews and observed 146 meetings (a total of approximately 439 h). Results Many CCGs were reluctant to outsource core commissioning support functions (such as contracting) for fear of losing local knowledge and trusted relationships. Others were disappointed by the absence of choice and saw CSUs as monopolies and a recreation of the abolished PCTs. Many expressed doubts about the expectation that outsourcing of commissioning support functions will result in lower administrative costs. Conclusions Given the nature of healthcare commissioning, outsourcing vital commissioning support functions may not be the preferred option of CCGs. Considerations of high transaction costs, and the risk of fragmentation of services and loss of trusted relationships involved in short-term contracting, may lead most CCGs to decide to form long-term partnerships with commissioning support suppliers in the future. This option, however, limits competition by creating ‘network closure’ and calls into question the Government

  16. The fair factor in matters of trust.

    PubMed

    Williams, Lauren L

    2006-01-01

    Communities are bound together by trust among their members. Trust thrives when a pervasive sense of fairness exists. Evidence suggests that trust has social, professional, and economic value for today's organizations, making it worthy of attention. Matters of trust and justice are important and timely for nurse leaders to consider given the challenge to improve practice settings in a manner that enhances nurse satisfaction. The aim of this article is to make explicit the value in building organizational justice and trust within an organization's nursing community. Nursing leadership strategies are integrated, thus offering practical guidance in creating a culture of justice, making trust explicit, and establishing trustworthiness.

  17. Disaggregating ethnoracial disparities in physician trust.

    PubMed

    Sewell, Abigail A

    2015-11-01

    Past research yields mixed evidence regarding whether ethnoracial minorities trust physicians less than Whites. Using the 2002 and 2006 General Social Surveys, variegated ethnoracial differences in trust in physicians are identified by disaggregating a multidimensional physician trust scale. Compared to Whites, Blacks are less likely to trust the technical judgment and interpersonal competence of doctors. Latinos are less likely than Whites to trust the fiduciary ethic, technical judgment, and interpersonal competence of doctors. Black-Latino differences in physician trust are a function of ethnoracial differences in parental nativity. The ways ethnoracial hierarchies are inscribed into power-imbalanced clinical exchanges are discussed.

  18. 25 CFR 1000.355 - How are trust evaluations conducted?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... EDUCATION ACT Trust Evaluation Review Annual Trust Evaluations § 1000.355 How are trust evaluations... required by § 1000.365. (b) This section describes the general framework for trust reviews. However,...

  19. 25 CFR 1000.355 - How are trust evaluations conducted?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... EDUCATION ACT Trust Evaluation Review Annual Trust Evaluations § 1000.355 How are trust evaluations... required by § 1000.365. (b) This section describes the general framework for trust reviews. However,...

  20. 25 CFR 1000.355 - How are trust evaluations conducted?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... EDUCATION ACT Trust Evaluation Review Annual Trust Evaluations § 1000.355 How are trust evaluations... required by § 1000.365. (b) This section describes the general framework for trust reviews. However,...

  1. 25 CFR 1000.355 - How are trust evaluations conducted?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... EDUCATION ACT Trust Evaluation Review Annual Trust Evaluations § 1000.355 How are trust evaluations... required by § 1000.365. (b) This section describes the general framework for trust reviews. However,...

  2. Auditing senior management communication practices in the NHS: a regional study.

    PubMed

    Hargie, O D; Tourish, D

    1996-11-01

    Increasingly, organizations are being confronted with significant strategic change. This process can only be managed effectively if human resource implications, including how effectively managers and staff communicate with each other, are taken into account. This paper outlines how communication audits provide managers with insights into patterns of communication within their organizations. The nature of communication audits are briefly delineated and explained. An investigation from within the National Health Service (NHS) is offered, which illustrates how a communication audit focusing on relationships between regional, district and local levels of management illuminated patterns of communication between senior managers at these levels. This resulted in the development of an action plan for the improvement of communication practices. The generalizability of these findings to the NHS is discussed.

  3. Success factors for implementation of the balanced scorecard in a NHS multi-agency setting.

    PubMed

    Radnor, Zoe; Lovell, Bill

    2003-01-01

    Even though the balanced scorecard (BSC) has become a highly popular performance management tool, usage in local public sector National Health Service (NHS) organisations is still rare. This paper conditionally outlines some grounds in supporting such usage. In particular underlying conceptual concerns with the BSC system and its implementation pitfalls require full consideration. This paper then outlines some factors to be taken into account for "successful" BSC implementation in a NHS multi-agency setting. These findings emerged from a series of focus groups that took place with contributors drawn from all the key organisations within the Bradford Health Action Zone. Finally, this paper argues that if key criteria are met, successful implementation of the BSC may then proceed. However, "blind" BSC implementation without consideration of these factors may result in potential "failure".

  4. Embedding knowledge management in the NHS south-west: pragmatic first steps for a practical concept.

    PubMed

    Plaice, Caroline; Kitch, Pam

    2003-06-01

    Knowledge management, like clinical governance, is a practical science. Clinical governance, with its emphasis on creating an environment where clinical quality is monitored and acted upon, is one of the foundation stones of the new National Health Service (NHS). Both knowledge management and clinical governance need to share the same criteria in order to operate. Using these two pragmatic concepts and the premise of a practical approach, this article seeks to identify the drivers for knowledge management in the NHS, highlight national initiatives and focus on the steps libraries in the south-west of England have taken to make knowledge management a reality. In so doing, the central role of the library and information service has been reinforced and embedded and librarians have been recognized for their real worth to their organizations.

  5. Knowledge management in the NHS: positioning the healthcare librarian at the knowledge intersection.

    PubMed

    Keeling, C; Lambert, S

    2000-09-01

    This paper defines what is meant by Knowledge Management, investigates how it interlinks with new ways of delivering health care and gives a synopsis of a study that investigated issues around implementation of Knowledge Management across a sample of healthcare librarians. Areas of investigation that are related to Knowledge Management include: HSG(97)47, evidence-based medicine, clinical governance, information and communication technologies, and the changing role of the healthcare librarian. A diagram is included in this paper which illustrates how the healthcare librarian interacts with resources, staff and practices, so contributing to the knowledge base of health care. The paper concludes that Government policy, new technologies and the push towards the practice of information age medicine are forcing changes throughout the NHS. Recognition of Knowledge Management is still in its infancy in the NHS--it calls for major change in organizational thinking and acceptance by the librarian that their service must also be subject to continuous improvement.

  6. Patient Choice for Older People in English NHS Primary Care: Theory and Practice

    PubMed Central

    Harding, Andrew J. E.; Sanders, Frances; Lara, Antonieta Medina; van Teijlingen, Edwin R.; Wood, Cate; Galpin, Di; Baron, Sue; Crowe, Sam; Sharma, Sheetal

    2014-01-01

    In the English National Health Service (NHS), patients are now expected to choose the time and place of treatment and even choose the actual treatment. However, the theory on which patient choice is based and the implementation of patient choice are controversial. There is evidence to indicate that attitudes and abilities to make choices are relatively sophisticated and not as straightforward as policy developments suggest. In addition, and surprisingly, there is little research on whether making individual choices about care is regarded as a priority by the largest NHS patient group and the single largest group for most GPs—older people. This conceptual paper examines the theory of patient choice concerning accessing and engaging with healthcare provision and reviews existing evidence on older people and patient choice in primary care. PMID:24967329

  7. Picture, archiving and communication system in the Italian NHS: a primer on diffusion and evaluation analysis.

    PubMed

    Buccoliero, Luca; Calciolari, Stefano; Marsilio, Marta; Mattavelli, Elisa

    2009-03-01

    This contribution focuses on picture archiving and communication systems (PACS) in the Italian National Healthcare System (NHS). It finally aims to test the Chiefs Radiology Department's perceptions about PACS along the main evaluation dimensions emerging from the literature. First, a brief review of the main literature concerning PACS evaluation leads the authors to classify the different approaches undertaken and highlight the main variables of investigation. Second, the evidence emerging from a survey is presented and discussed in the light of the literature review. The survey aims to: (a) map out the degree of PACSs diffusion and their main features in the Italian NHS; (b) verify whether and how PACS impact the dimensions analyzed in many evaluation studies carried out to date; (c) test the relationship between some measured impacts and specific PACS features.

  8. Multidisciplinary team working, clinical networks, and chambers; opportunities to work differently in the NHS.

    PubMed

    Carter, S; Garside, P; Black, A

    2003-12-01

    Recently in the United Kingdom some new organisational structures for clinicians have been discussed. So far little has changed, but the intensity of interest suggests this may be an opportunity to link change in working practices with improvements in quality. Multidisciplinary team working is developing within the National Health Service (NHS) and some groups are expanding their roles across traditional institutional boundaries to form complex clinical networks. It would require little to make these functional networks autonomous from current NHS structures. Other models of working without traditional institutional boundaries have been discussed, including the formation of "chambers" for doctors and other professionals. We describe the first tentative steps of one group as an example and suggest that further experimentation with evaluation is required.

  9. Colonizing the new world of NHS management: the shifting power of professionals.

    PubMed

    Thorne, Marie L

    2002-02-01

    This paper explores the changing patterns of professional power and the struggle for control between doctors and managers in the UK NHS, by examining the role of clinical directors. Located at the nexus of managerial and professional power, clinical directors represent and embody the challenges to medicine through increased managerialism and the profession's response to it. An analysis of the role of clinical directors reveals the changes in power and jurisdiction that have been created through clinical management. A medical model of professional power illustrates how structural and ideological changes threaten medical dominance. However, clinical directors respond to the changes by creating new forms of expertise through managerial assimilation, to extend their jurisdiction and domain within the organization and in the market. This re-professionalization, rather than de-professionalization, by doctors raises questions about the shifting power balance between doctors and managers in the NHS and between doctors within the medical profession.

  10. NHS-ester functionalized poly(PEGMA) brushes on silicon surface for covalent protein immobilization.

    PubMed

    Yao, Yang; Ma, Yong-Zheng; Qin, Ming; Ma, Xiao-Jing; Wang, Chen; Feng, Xi-Zeng

    2008-10-15

    Poly(PEGMA) homopolymer brushes were developed by atom transfer radical polymerization (ATRP) on the initiator-modified silicon surface (Si-initiator). Through covalent binding, protein immobilization on the poly(PEGMA) films was enabled by further NHS-ester functionalization of the poly(PEGMA) chain ends. The formation of polymer brushes was confirmed by assessing the surface composition (XPS) and morphology (atomic force microscopy (AFM), scanning electronic microscopy (SEM)) of the modified silicon wafer. The binding performance of the NHS-ester functionalized surfaces with two proteins horseradish peroxidase (HRP) and chicken immunoglobulin (IgG) was monitored by direct observation. These results suggest that this method which incorporates the properties of polymer brush onto the binding surfaces may be a good strategy suitable for covalent protein immobilization.

  11. Adequate trust avails, mistaken trust matters: on the moral responsibility of doctors as proxies for patients' trust in biobank research.

    PubMed

    Johnsson, Linus; Helgesson, Gert; Hansson, Mats G; Eriksson, Stefan

    2013-11-01

    In Sweden, most patients are recruited into biobank research by non-researcher doctors. Patients' trust in doctors may therefore be important to their willingness to participate. We suggest a model of trust that makes sense of such transitions of trust between domains and distinguishes adequate trust from mistaken trust. The unique position of doctors implies, we argue, a Kantian imperfect duty to compensate for patients' mistaken trust. There are at least three kinds of mistaken trust, each of which requires a different set of countermeasures. First, trust is mistaken when necessary competence is lacking; the competence must be developed or the illusion dispelled. Second, trust is irrational whenever the patient is mistaken about his actual reasons for trusting. Care must therefore be taken to support the patient's reasoning and moral agency. Third, some patients inappropriately trust doctors to recommend only research that will benefit them directly. Such trust should be counteracted by nurturing a culture where patients expect to be asked occasionally to contribute to the common good.

  12. A Trusted Portable Computing Device

    NASA Astrophysics Data System (ADS)

    Ming-wei, Fang; Jun-jun, Wu; Peng-fei, Yu; Xin-fang, Zhang

    A trusted portable computing device and its security mechanism were presented to solve the security issues, such as the attack of virus and Trojan horse, the lost and stolen of storage device, in mobile office. It used smart card to build a trusted portable security base, virtualization to create a secure virtual execution environment, two-factor authentication mechanism to identify legitimate users, and dynamic encryption to protect data privacy. The security environment described in this paper is characteristic of portability, security and reliability. It can meet the security requirement of mobile office.

  13. Managing integration work in an NHS electronic patient record (EPR) project.

    PubMed

    Martin, David; Mariani, John; Rouncefield, Mark

    2007-03-01

    This article uses an ethnographic study of the design and deployment of an electronic patient record (EPR) system in the UK NHS to document some of the difficulties of integrating new IT systems with existing and developing practices, technologies and regulatory requirements. It highlights that 'integration' in this situation produces a variety of different but connected and potentially competing requirements that create difficulties in achieving artful and successful system deployment.

  14. Psychoanalysis and analytic psychotherapy in the NHS--a problem for medical ethics.

    PubMed Central

    Wilkinson, G

    1986-01-01

    I question the place of psychoanalysis and psychoanalytically oriented psychotherapy in the National Health Service (NHS), with reference to published material; and, particularly, in relation to primary care, health economics and medical ethics. I argue that there are pressing clinical, research, economic, and ethical reasons in support of the contention that an urgent review of the extent and impact of psychoanalytic practices in the health service is called for. PMID:3735363

  15. Exceptionally good? Positive experiences of NHS care and treatment surprises lymphoma patients: a qualitative interview study

    PubMed Central

    Ziebland, Sue; Evans, Julie; Toynbee, Polly

    2010-01-01

    Abstract Objective  Initial analysis of an interview study with patients about their experiences of lymphoma identified a strong emergent theme suggesting people were surprised to receive good care in the UK National Health Service. This qualitative analysis helps illuminate the disparity between public perceptions of NHS care and individual experiences. Participants and setting  Forty‐one women and men with lymphoma were interviewed at home by an academic social scientist; nine who had had all their treatment before 1997 were excluded from this analysis. Design  Initial qualitative thematic analysis used constant comparison and axial coding. Using narrative analytic methods, we explored how the accounts of positive experiences were structured and framed as well as what was said. Results  Every person we interviewed described positive experiences of the NHS. These included the skills and humanity of the specialist staff involved in their care, the team work, the organization of care and communication and information. However, these positive experiences were often framed as personal good fortune rather than an indication that a high standard might be expected of NHS cancer care. Participants’ accounts also suggest a discrepancy through the use of framing devices that imply that less professional, kind and caring treatment might be expected. Conclusion  People may be able to maintain the apparently contradictory opinions that the NHS is not very good, even if their own experience of care is excellent, if they construct their own experience as ‘lucky’. Health professionals could help by reassuring patients with a more positive, realistic expectation of specialist care. PMID:20579116

  16. A Unified Theory of Trust and Collaboration

    NASA Astrophysics Data System (ADS)

    Cai, Guoray; Squicciarini, Anna

    We consider a type of applications where collaboration and trust are tightly coupled with the need to protect sensitive information. Existing trust management technologies have been limited to offering generic mechanisms for enforcing access control policies based on exchanged credentials, and rarely deal with the situated meaning of trust in a specific collaborative context. Towards trust management for highly dynamic and collaborative activities, this paper describes a theory of trust intention and semantics that makes explicit connections between collaborative activities and trust. The model supports inferring trust state based on knowledge about state of collaborative activity. It is the first step towards a unified approach for computer-mediated trust communication in the context of collaborative work.

  17. Building trusting relationships in online health communities.

    PubMed

    Zhao, Jing; Ha, Sejin; Widdows, Richard

    2013-09-01

    This study investigates consumers' use of online health communities (OHCs) for healthcare from a relationship building perspective based on the commitment-trust theory of relationships. The study proposes that perspective taking, empathic concern, self-efficacy, and network density affect the development of both cognitive and affective trust, which together determine OHC members' membership continuance intention (MCI) and knowledge contribution. Data collected from eight existing OHCs (N=255) were utilized to test the hypothesized model. Results show that perspective taking and self-efficacy can increase cognitive trust and affective trust, respectively. Network density contributes to cognitive and affective trust. Both cognitive trust and affective trust influence MCI, while only affective trust impacts members' knowledge contribution behaviors.

  18. Applying Machine Trust Models to Forensic Investigations

    NASA Astrophysics Data System (ADS)

    Wojcik, Marika; Venter, Hein; Eloff, Jan; Olivier, Martin

    Digital forensics involves the identification, preservation, analysis and presentation of electronic evidence for use in legal proceedings. In the presence of contradictory evidence, forensic investigators need a means to determine which evidence can be trusted. This is particularly true in a trust model environment where computerised agents may make trust-based decisions that influence interactions within the system. This paper focuses on the analysis of evidence in trust-based environments and the determination of the degree to which evidence can be trusted. The trust model proposed in this work may be implemented in a tool for conducting trust-based forensic investigations. The model takes into account the trust environment and parameters that influence interactions in a computer network being investigated. Also, it allows for crimes to be reenacted to create more substantial evidentiary proof.

  19. 77 FR 5065 - Preservation Trust Advisors, LLC and Northern Lights Fund Trust; Notice of Application

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-01

    ... From the Federal Register Online via the Government Publishing Office SECURITIES AND EXCHANGE COMMISSION Preservation Trust Advisors, LLC and Northern Lights Fund Trust; Notice of Application January 26...'') and Northern Lights Fund Trust (the ``Trust''). FILING DATES: The application was filed on...

  20. An Investigation of Children's Peer Trust across Culture: Is the Composition of Peer Trust Universal?

    ERIC Educational Resources Information Center

    Betts, Lucy R.; Rotenberg, Ken J.; Petrocchi, Serena; Lecciso, Flavia; Sakai, Atsushi; Maeshiro, Kazumi; Judson, Helen

    2014-01-01

    The components of children's trust in same-gender peers (trust beliefs, ascribed trustworthiness, and dyadic reciprocal trust) were examined in samples of 8-11-year-olds from the UK, Italy, and Japan. Trust was assessed by children's ratings of the extent to which same-gender classmates kept promises and kept secrets. Social relations analyses…

  1. Trust or Consequences: The Relationship between Faculty Trust and Faculty Learning Communities in Higher Education

    ERIC Educational Resources Information Center

    Wilson, Gaye R.

    2011-01-01

    The purpose of this study was to investigate relationships between FLC membership and faculty trust in higher education colleagues and faculty trust in higher education administration in public and private universities in the United States. This quantitative study examines trust in colleagues and trust in administration in higher education, two…

  2. Exploring equity in uptake of the NHS Health Check and a nested physical activity intervention trial

    PubMed Central

    Attwood, S.; Morton, K.; Sutton, S.

    2016-01-01

    Background Socio-demographic factors characterizing disadvantage may influence uptake of preventative health interventions such as the NHS Health Check and research trials informing their content. Methods A cross-sectional study examining socio-demographic characteristics of participants and non-participants to the NHS Health Check and a nested trial of very brief physical activity interventions within this context. Age, gender, Index of Multiple Deprivation (IMD) and ethnicity were extracted from patient records of four General Practices (GP) in England. Results In multivariate analyses controlling for GP surgery, the odds of participation in the Health Check were higher for older patients (OR 1.05, 95% CI 1.04–1.07) and lower from areas of greater deprivation (IMD Quintiles 4 versus 1, OR 0.37, 95% CI 0.18–0.76, 5 versus 1 OR 0.42, 95% CI 0.20–0.88). Older patients were more likely to participate in the physical activity trial (OR 1.04, 95% CI 1.02–1.06). Conclusions Younger patients and those living in areas of greater deprivation may be at risk of non-participation in the NHS Health Check, while younger age also predicted non-participation in a nested research trial. The role that GP-surgery-specific factors play in influencing participation across different socio-demographic groups requires further exploration. PMID:26036701

  3. General practitioner-led commissioning in the NHS: progress, prospects and pitfalls.

    PubMed

    Mannion, Russell

    2011-01-01

    The latest NHS reforms in England will require all general practices to become members of general practitioner (GP) consortia. These organisations will have responsibility for commissioning the majority of health care for their local populations. This article reviews the history and evidence on impact of the previous models of GP commissioning that have been introduced in the NHS with the aim of distilling key lessons for the design, implementation and evaluation of the latest reforms. GP commissioning has the potential to generate a variety of benefits for the NHS and patients, including lowering elective and non-elective referrals, reducing waiting times, improved coordination of primary and community support services and better financial risk management. GP commissioning has also the potential to reduce patient satisfaction, increase inequalities between geographical areas and may generate substantial management and transaction costs. The GP community will need to display strong directive leadership as well as nurture a culture of collaboration and group camaraderie among practices if the GP consortia model of commissioning is to deliver the desired improvements in quality and performance. The implementation of the new GP consortia model of commissioning needs to be monitored and evaluated to ensure that the benefits are maximized and any unintended and dysfunctional effects mitigated.

  4. NHS reforms in the United Kingdom and learning from developing country experience.

    PubMed

    Collins, C D; Green, A T; Hunter, D J

    2000-01-01

    The NHS has been the object of much international interest from its inception and through its periodic reforms. However, UK policy-makers have expressed only limited and selective concern for health sector reforms in other countries. This paper seeks to identify key elements of the present process and content of reforms to the UK NHS and examine the extent to which international learning would be important in developing these reforms. Particular emphasis is placed on learning from developing country experience. The paper therefore considers the policy process in the UK, the focus on primary care, the shift from competitive to collaborative strategies in addition to prioritising and planning. Each is considered in relation to developing country experience and the opportunities for learning. The paper concludes by setting out four areas leading to an international opening in NHS policy processes: developing political space in policy making, developing mechanisms for international exchanges, understanding policy context, and broadening international experience and changing values. The notion of a one-way process in international policy learning is rejected: while the South can learn from the North, so too can the North from the South.

  5. Inferring Trust Based on Similarity with TILLIT

    NASA Astrophysics Data System (ADS)

    Tavakolifard, Mozhgan; Herrmann, Peter; Knapskog, Svein J.

    A network of people having established trust relations and a model for propagation of related trust scores are fundamental building blocks in many of today’s most successful e-commerce and recommendation systems. However, the web of trust is often too sparse to predict trust values between non-familiar people with high accuracy. Trust inferences are transitive associations among users in the context of an underlying social network and may provide additional information to alleviate the consequences of the sparsity and possible cold-start problems. Such approaches are helpful, provided that a complete trust path exists between the two users. An alternative approach to the problem is advocated in this paper. Based on collaborative filtering one can exploit the like-mindedness resp. similarity of individuals to infer trust to yet unknown parties which increases the trust relations in the web. For instance, if one knows that with respect to a specific property, two parties are trusted alike by a large number of different trusters, one can assume that they are similar. Thus, if one has a certain degree of trust to the one party, one can safely assume a very similar trustworthiness of the other one. In an attempt to provide high quality recommendations and proper initial trust values even when no complete trust propagation path or user profile exists, we propose TILLIT — a model based on combination of trust inferences and user similarity. The similarity is derived from the structure of the trust graph and users’ trust behavior as opposed to other collaborative-filtering based approaches which use ratings of items or user’s profile. We describe an algorithm realizing the approach based on a combination of trust inferences and user similarity, and validate the algorithm using a real large-scale data-set.

  6. Setting standards and monitoring quality in the NHS 1999-2013: a classic case of goal conflict.

    PubMed

    Littlejohns, Peter; Knight, Alec; Littlejohns, Anna; Poole, Tara-Lynn; Kieslich, Katharina

    2016-07-19

    2013 saw the National Health Service (NHS) in England severely criticized for providing poor quality despite successive governments in the previous 15 years, establishing a range of new institutions to improve NHS quality. This study seeks to understand the contributions of political and organizational influences in enabling the NHS to deliver high-quality care through exploring the experiences of two of the major new organizations established to set standards and monitor NHS quality. We used a mixed method approach: first a cross-sectional, in-depth qualitative interview study and then the application of principal agent modeling (Waterman and Meier broader framework). Ten themes were identified as influencing the functioning of the NHS regulatory institutions: socio-political environment; governance and accountability; external relationships; clarity of purpose; organizational reputation; leadership and management; organizational stability; resources; organizational methods; and organizational performance. The organizations could be easily mapped onto the framework, and their transience between the different states could be monitored. We concluded that differing policy objectives for NHS quality monitoring resulted in central involvement and organizational change. This had a disruptive effect on the ability of the NHS to monitor quality. Constant professional leadership, both clinical and managerial, and basing decisions on best evidence, both technical and organizational, helped one institution to deliver on its remit, even within a changing political/policy environment. Application of the Waterman-Meier framework enabled an understanding and description of the dynamic relationship between central government and organizations in the NHS and may predict when tensions will arise in the future. © 2016 The Authors. The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd.

  7. Research of trust model in P2P network based on trusted computing

    NASA Astrophysics Data System (ADS)

    Li, Rong; Li, Lei

    2013-03-01

    In order to strengthen the security of P2P networks, it is necessary to build trust relationships between nodes of networks. However, the traditional trust evaluation models can't resist the attacks of Pseudospoofing and Pseudostheft effectively. To resolve the problems, in this paper, the trusted computing method is introduced into P2P networks, and an idea of group trust model based on trusted computing methods is proposed. In the process of trust evaluation, the model can realize the anonymous attestation of the node body, which improves the creditability of trust relationships between nodes and resolves the security problems of P2P networks.

  8. The Role of Trust in Information Science and Technology.

    ERIC Educational Resources Information Center

    Marsh, Stephen; Dibben, Mark R.

    2003-01-01

    Discusses the notion of trust as it relates to information science and technology, specifically user interfaces, autonomous agents, and information systems. Highlights include theoretical meaning of trust; trust and levels of analysis, including organizational trust; electronic commerce, user interfaces, and static trust; dynamic trust; and trust…

  9. The Relationship between Collective Student Trust and Student Achievement

    ERIC Educational Resources Information Center

    Casper, David Carl

    2012-01-01

    The relationship between collective student trust and student achievement was tested in a sample of 1,748 5th grade students in 34 Title I elementary schools in an urban and urban fringe district. Trust was defined, the conditions of trust described, and the facets of trust discussed. Collective trust was distinguished from relational trust and…

  10. 40 CFR 280.102 - Trust fund.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 26 2010-07-01 2010-07-01 false Trust fund. 280.102 Section 280.102...) Financial Responsibility § 280.102 Trust fund. (a) An owner or operator may satisfy the requirements of § 280.93 by establishing a trust fund that conforms to the requirements of this section. The...

  11. 14 CFR 47.8 - Voting trusts.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Voting trusts. 47.8 Section 47.8 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRCRAFT REGISTRATION General § 47.8 Voting trusts. (a) If a voting trust is used to qualify a domestic corporation as...

  12. Trust and Relationship Building in Electronic Commerce.

    ERIC Educational Resources Information Center

    Papadopoulou, Panagiota; Andreou, Andreas; Kanellis, Panagiotis; Martakos, Drakoulis

    2001-01-01

    Discussion of the need for trust in electronic commerce to build customer relationships focuses on a model drawn from established theoretical work on trust and relationship marketing that highlights differences between traditional and electronic commerce. Considers how trust can be built into virtual environments. (Contains 50 references.)…

  13. Trust, Conflict and Performance in Scientific Collaborations.

    ERIC Educational Resources Information Center

    Shrum, Wesley; Chompalov, Ivan; Genuth, Joel

    2001-01-01

    Examines 53 collaborations in physics and related sciences with two unexpected findings: (1) trust is no higher in projects formed through pre-existing relationships than those without such ties; and (2) there is no relationship between trust and performance. Concludes that more important than trust for an understanding of large scientific…

  14. Animal Behaviour: Friendship Enhances Trust in Chimpanzees.

    PubMed

    Silk, Joan

    2016-01-25

    Individuals that participate in exchanges with delayed rewards can be exploited if their partners don't reciprocate. In humans, friendships are built on trust, and trust enhances cooperation. New evidence suggests that close social bonds also enhance trust in chimpanzees.

  15. 46 CFR 67.36 - Trust.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 2 2010-10-01 2010-10-01 false Trust. 67.36 Section 67.36 Shipping COAST GUARD... Citizenship Requirements for Vessel Documentation § 67.36 Trust. (a) For the purpose of obtaining a registry or recreational endorsement, a trust arrangement meets citizenship requirements if: (1) Each of...

  16. Trust as a Teaching Skill

    ERIC Educational Resources Information Center

    Leon-Weil, Anica; Hewitt, Carol

    2008-01-01

    Should I stop the conflict or narrate it? Do I redirect or reassure? Two infant/toddler teachers explain how they use trust as a teaching tool, "teaching" less and involving the toddlers in their classroom in the decisions that affect them. They took to heart the philosophy of Magda Gerber, who urged parents to "observe more, do less." The author…

  17. Taxability of Educational Benefits Trusts

    ERIC Educational Resources Information Center

    Temple Law Quarterly, 1976

    1976-01-01

    Corporations have found the promise of providing a college education to the children of employees--without the recognition of income to the parent-employee--to be a popular fringe benefit. The Internal Revenue Service has attacked educational benefit trusts in Revenue Ruling 75-448. Implications are discussed. (LBH)

  18. Education and the National Trust.

    ERIC Educational Resources Information Center

    Binns, Gareth

    1995-01-01

    Defines the British National Trust as it marks its centenary. Known for its work in protecting historic buildings and places of natural beauty, a major focus is now education. Schoolchildren may attend curriculum-based special programs when visiting historic houses and the countryside. Others use open-space sites with no specific education…

  19. The Sutton Trust: Mobility Manifesto

    ERIC Educational Resources Information Center

    Sutton Trust, 2014

    2014-01-01

    Ahead of the party conference season, the Sutton Trust is urging fairer admissions to comprehensives, grammar schools and independent schools as part of a 10-point Mobility Manifesto setting out ten practical policy steps designed to put social mobility at the heart of the 2015 election campaign. The manifesto urges greater use of ballots (random…

  20. 25 CFR 1000.360 - Is the trust evaluation standard or process different when the trust asset is held in trust for...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 25 Indians 2 2013-04-01 2013-04-01 false Is the trust evaluation standard or process different... EDUCATION ACT Trust Evaluation Review Annual Trust Evaluations § 1000.360 Is the trust evaluation standard... allottee? No, Tribes/Consortia are under the same obligation as the Secretary to perform trust...

  1. 25 CFR 1000.360 - Is the trust evaluation standard or process different when the trust asset is held in trust for...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 25 Indians 2 2014-04-01 2014-04-01 false Is the trust evaluation standard or process different... EDUCATION ACT Trust Evaluation Review Annual Trust Evaluations § 1000.360 Is the trust evaluation standard... allottee? No, Tribes/Consortia are under the same obligation as the Secretary to perform trust...

  2. 25 CFR 1000.360 - Is the trust evaluation standard or process different when the trust asset is held in trust for...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 25 Indians 2 2012-04-01 2012-04-01 false Is the trust evaluation standard or process different... EDUCATION ACT Trust Evaluation Review Annual Trust Evaluations § 1000.360 Is the trust evaluation standard... allottee? No, Tribes/Consortia are under the same obligation as the Secretary to perform trust...

  3. 25 CFR 1000.360 - Is the trust evaluation standard or process different when the trust asset is held in trust for...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 25 Indians 2 2011-04-01 2011-04-01 false Is the trust evaluation standard or process different... EDUCATION ACT Trust Evaluation Review Annual Trust Evaluations § 1000.360 Is the trust evaluation standard... allottee? No, Tribes/Consortia are under the same obligation as the Secretary to perform trust...

  4. Predators and the public trust.

    PubMed

    Treves, Adrian; Chapron, Guillaume; López-Bao, Jose V; Shoemaker, Chase; Goeckner, Apollonia R; Bruskotter, Jeremy T

    2017-02-01

    Many democratic governments recognize a duty to conserve environmental resources, including wild animals, as a public trust for current and future citizens. These public trust principles have informed two centuries of U.S.A. Supreme Court decisions and environmental laws worldwide. Nevertheless numerous populations of large-bodied, mammalian carnivores (predators) were eradicated in the 20th century. Environmental movements and strict legal protections have fostered predator recoveries across the U.S.A. and Europe since the 1970s. Now subnational jurisdictions are regaining management authority from central governments for their predator subpopulations. Will the history of local eradication repeat or will these jurisdictions adopt public trust thinking and their obligation to broad public interests over narrower ones? We review the role of public trust principles in the restoration and preservation of controversial species. In so doing we argue for the essential roles of scientists from many disciplines concerned with biological diversity and its conservation. We look beyond species endangerment to future generations' interests in sustainability, particularly non-consumptive uses. Although our conclusions apply to all wild organisms, we focus on predators because of the particular challenges they pose for government trustees, trust managers, and society. Gray wolves Canis lupus L. deserve particular attention, because detailed information and abundant policy debates across regions have exposed four important challenges for preserving predators in the face of interest group hostility. One challenge is uncertainty and varied interpretations about public trustees' responsibilities for wildlife, which have created a mosaic of policies across jurisdictions. We explore how such mosaics have merits and drawbacks for biodiversity. The other three challenges to conserving wildlife as public trust assets are illuminated by the biology of predators and the interacting

  5. Sinking slowly: Diversity in propensity to trust predicts downward trust spirals in small groups.

    PubMed

    Ferguson, Amanda J; Peterson, Randall S

    2015-07-01

    This paper examines the phenomenon of trust spirals in small groups. Drawing on literature on the spiral reinforcement of trust, we theorize that diversity in propensity to trust has affective and cognitive consequences related to trust (i.e., feelings of frustration and perceptions of low similarity), reducing the level of experienced intragroup trust early in a group's development. Reduced experienced trust then fuels relationship conflict and lowers trust even further over time, ultimately having a negative effect on group performance. These ideas are tested using a sample of MBA student groups surveyed at 3 time periods over 4 months. Results confirm our hypothesis that diversity in propensity to trust is sufficient to trigger a downward trust spiral and poor performance in small groups.

  6. Water law - Public Trust Doctrine

    SciTech Connect

    Casey, E.S.

    1984-07-01

    In a case involving California's Mono Lake, the State Supreme Court held that infringement of the values protected by the Public Trust Doctrine is a separate ground for challenging water appropriations, and that the continuing nature of the state's duty as trustee prevents the acquisition of a vested right to appropriations that injure navigation, commerce, and fisheries. The author summarizes the history and the competing claims of the Doctrine and the California Appropriative Water Rights System. The National Audubon suit now makes it possible for any member of the public to challenge any surface water diversion as injurious to the public trust, but it also offers the California courts an opportunity to redirect the state's water policies. 130 references.

  7. 25 CFR 1000.360 - Is the trust evaluation standard or process different when the trust asset is held in trust for...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... EDUCATION ACT Trust Evaluation Review Annual Trust Evaluations § 1000.360 Is the trust evaluation standard... 1000.360 Indians OFFICE OF THE ASSISTANT SECRETARY, INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR...

  8. Clinical decision making by dentists working in the NHS General Dental Services since April 2006.

    PubMed

    Davies, B J B; Macfarlane, F

    2010-11-27

    In April 2006 a new contract was introduced that governed how NHS General Dental Practitioners would be funded for the services they provide. This study looks at the impact that the contract has had in the three years since its introduction, evaluating its influence on the clinical care that patients receive and the clinical decisions that dentists are making. This qualitative service evaluation involved interviewing 12 dentists representative of a range of NHS dentists involved with the new NHS dental contract using a semi-structured approach. We found evidence that the new contract has led to dentists making different decisions in their daily practice and sometimes altering their treatment plans and referral patterns to ensure that their business is not disadvantaged. Access to care for some patients without a regular dentist can be compromised by the new contract as it can be financially challenging for a dentist to accept to care for a new patient who has an unknown and potentially large need for treatment. Cherry-picking of potentially more profitable patients may be common. The incentive is to watch borderline problems rather than to treat if a treatment band threshold has already been crossed and treatment may be delayed until a later course of treatment for the same reason. Dentists often feel that complex treatments (for example, endodontic treatments) are financially unviable. Some dentists are referring difficult cases that might previously have been treated 'in house', such as extractions, to another provider, as this enables offloading of costs while potentially retaining full fees. Younger and less experienced dentists may be further pressured.

  9. Retention of young general practitioners entering the NHS from 1991-1992.

    PubMed Central

    Taylor, D H; Quayle, J A; Roberts, C

    1999-01-01

    BACKGROUND: The supply of general practitioners (GPs) in the National Health Service (NHS) is dynamic and there are fears that there will be an inadequate number of doctors to meet the needs of the NHS. There are particular concerns about changes in the career trajectory of young GPs and what they mean for overall supply. AIM: To identify predictors of retention among young, new entrant GPs entering the NHS between 1 October 1991 and 1 October 1992. METHOD: Two-year retention rates of young (35 years of age or less) new entrant GPs have been modelled using a multilevel logit model. Retention is defined as young, new entrant GPs remaining in their initial health authority for two years or more. RESULTS: Two hundred and fifty-two (13.0%) members of the study group left general practice within two years of entry (i.e. were not retained). Sex (females had lower retention [95% CI = 0.43-0.75]), practice size (young GPs in larger practices had higher retention [95% CI = 1.10-1.29]), and belonging to a practice in one of 16 Greater London Health Authorities (which had lower retention [95% CI = 0.39-0.82]) were identified as major predictors of retention. Deprivation, measured at the individual GP patient list level, had a very slight association with retention (P = 0.097; 95% CI = 1.00-1.02). Deprivation measured at the health authority level (95% CI = 0.99-1.01) was not found to be a statistically significant predictor of retention (P = 0.83). CONCLUSION: None of the statistically significant predictors of retention suggest any policy panacea to end this phenomenon. The challenge for policy is to learn to deal with the dynamic nature of the GP workforce with a non-crisis mentality. PMID:10736904

  10. Calibration of Trust and Distrust

    DTIC Science & Technology

    2016-06-07

    entrenched beliefs and behaviours, regardless of whether they are positive or negative ( Deutsch , 1973). Any proclivity toward either an exaggerated...Trust in Organizations: Frontiers of Theory and Research (pp. 246-260). Thousand Oaks, CA: Sage Publications. DEUTSCH , M. (1973). The...Bunker, B., & Rubin, J. (Eds.). Conflict, cooperation, and justice: Essays inspired by the work of Morton Deutsch . (pp.133-173). San Francisco, CA, US

  11. Money and trust among strangers.

    PubMed

    Camera, Gabriele; Casari, Marco; Bigoni, Maria

    2013-09-10

    What makes money essential for the functioning of modern society? Through an experiment, we present evidence for the existence of a relevant behavioral dimension in addition to the standard theoretical arguments. Subjects faced repeated opportunities to help an anonymous counterpart who changed over time. Cooperation required trusting that help given to a stranger today would be returned by a stranger in the future. Cooperation levels declined when going from small to large groups of strangers, even if monitoring and payoffs from cooperation were invariant to group size. We then introduced intrinsically worthless tokens. Tokens endogenously became money: subjects took to reward help with a token and to demand a token in exchange for help. Subjects trusted that strangers would return help for a token. Cooperation levels remained stable as the groups grew larger. In all conditions, full cooperation was possible through a social norm of decentralized enforcement, without using tokens. This turned out to be especially demanding in large groups. Lack of trust among strangers thus made money behaviorally essential. To explain these results, we developed an evolutionary model. When behavior in society is heterogeneous, cooperation collapses without tokens. In contrast, the use of tokens makes cooperation evolutionarily stable.

  12. Social Collaborative Filtering by Trust.

    PubMed

    Yang, Bo; Lei, Yu; Liu, Jiming; Li, Wenjie

    2016-09-01

    Recommender systems are used to accurately and actively provide users with potentially interesting information or services. Collaborative filtering is a widely adopted approach to recommendation, but sparse data and cold-start users are often barriers to providing high quality recommendations. To address such issues, we propose a novel method that works to improve the performance of collaborative filtering recommendations by integrating sparse rating data given by users and sparse social trust network among these same users. This is a model-based method that adopts matrix factorization technique that maps users into low-dimensional latent feature spaces in terms of their trust relationship, and aims to more accurately reflect the users reciprocal influence on the formation of their own opinions and to learn better preferential patterns of users for high-quality recommendations. We use four large-scale datasets to show that the proposed method performs much better, especially for cold start users, than state-of-the-art recommendation algorithms for social collaborative filtering based on trust.

  13. The drive to refer more NHS 111 callers to community nursing teams.

    PubMed

    Duffin, Christian

    2014-05-01

    Cutting emergency department admission rates has been a health service priority. The NHS 111 free telephone-based service was created for people who require urgent care or advice for conditions that are not life threatening. Callers may be given advice on self-management or directed to a GP, walk-in centre or pharmacist. However, some policy experts argue that opportunities to divert large numbers of patients who call community nursing teams are being missed. Two senior nurses in London community services with higher referral rates explain how they achieve these by using integrated pathways.

  14. An economic analysis of the limits of market based reforms in the English NHS

    PubMed Central

    2013-01-01

    Background Over the past three decades, a limited range of market like mechanisms have been introduced into the hierarchically structured English National Health Service (‘NHS’), which is a nationally tax funded, budget limited healthcare system, with access to care for all, producing structures known as a quasi market. Recently, the Health and Social Care Act 2012 (‘HSCA’) has been enacted, introducing further market elements. The paper examines the theory and effects of these market mechanisms. Methods Using neo-classical economics as a primary theoretical framework, as well as new institutional economics and socio-legal theory, the paper first examines the fundamental elements of markets, comparing these with the operation of authority and resource allocation employed in hierarchical structures. Second, the paper examines the application of market concepts to the delivery of healthcare, drawing out the problems which economic and socio-legal theories predict are likely to be encountered. Third, the paper discusses the research evidence concerning the operation of the quasi market in the English NHS. This evidence is provided by research conducted in the UK which uses economic and socio-legal logic to investigate the operation of the economic aspects of the NHS quasi market. Fourth, the paper provides an analysis of the salient elements of the quasi market regime amended by the HSCA 2012. Results It is not possible to construct a market conforming to classical economic principles in respect of healthcare. Moreover, it is not desirable to do so, as goals which markets cannot deliver (such as fairness of access) are crucial in England. Most of the evidence shows that the quasi market mechanisms used in the English NHS do not appear to be effective either. This finding should be seen in the light of the fact that the operation of these mechanisms has been significantly affected by the national political (i.e. continuingly hierarchical) and budgetary context

  15. A discussion: the future role of homeopathy in the National Health Service (NHS).

    PubMed

    Ng, Daniel Yu-Hin

    2011-07-01

    Homeopathy has been provided by the National Health Service in the UK for over 60 years, funded largely by taxpayer's money. However, in recent years, its provision has come under much criticism questioning its true value. Taking a neutral stance, arguments both for and against the provision of homeopathy on the NHS is presented. It includes issues such as the evidence and safety profile of homeopathy, but also takes into account costs and benefits of homeopathy in a wider perspective. Overall, the provision of homeopathy is justified as long as there is a need within the population, occupying a complementary role alongside conventional medicine.

  16. Targets and prioritization: the case of cancer in the English NHS.

    PubMed

    Harrison, Anthony J; Foot, Catherine S

    2012-01-01

    From 1999 onwards, patients judged by their general practitioners (GPs) to require urgent access to care for suspected cancer have been referred under the so-called two-week wait rule, or fast track, which guaranteed that they would be seen in a hospital clinic within that period. The two-week wait was introduced in the belief that England's relatively poor cancer outcomes were due, at least in part, to delays in accessing care. This paper assesses the impact of the two-week wait against a number of criteria. Although the NHS has largely succeeded in meeting this target, there is little evidence that it has improved outcomes.

  17. Complementary therapy use by patients and parents of children with asthma and the implications for NHS care: a qualitative study

    PubMed Central

    Shaw, Alison; Thompson, Elizabeth A; Sharp, Debbie

    2006-01-01

    Background Patients are increasingly using complementary therapies, often for chronic conditions. Asthma is the most common chronic condition in the UK. Previous research indicates that some asthma patients experience gaps in their NHS care. However, little attention has been given to how and why patients and parents of children with asthma use complementary therapies and the implications for NHS care. Methods Qualitative study, comprising 50 semi-structured interviews with a purposeful sample of 22 adults and 28 children with asthma (plus a parent), recruited from a range of NHS and non-NHS settings in Bristol, England. Data analysis was thematic, drawing on the principles of constant comparison. Results A range of complementary therapies were being used for asthma, most commonly Buteyko breathing and homeopathy. Most use took place outside of the NHS, comprising either self-treatment or consultation with private complementary therapists. Complementary therapies were usually used alongside not instead of conventional asthma treatment. A spectrum of complementary therapy users emerged, including "committed", "pragmatic" and "last resort" users. Motivating factors for complementary therapy use included concerns about conventional NHS care ("push factors") and attractive aspects of complementary therapies ("pull factors"). While participants were often uncertain whether therapies had directly helped their asthma, breathing techniques such as the Buteyko Method were most notably reported to enhance symptom control and enable reduction in medication. Across the range of therapies, the process of seeking and using complementary therapies seemed to help patients in two broad ways: it empowered them to take greater personal control over their condition rather than feel dependant on medication, and enabled exploration of a broader range of possible causes of their asthma than commonly discussed within NHS settings. Conclusion Complementary therapy use reflects patients

  18. Defining the Pharmacodynamic Profile and Therapeutic Index of NHS-IL12 Immunocytokine in Dogs with Malignant Melanoma

    PubMed Central

    Paoloni, Melissa; Mazcko, Christina; Selting, Kimberly; Lana, Susan; Barber, Lisa; Phillips, Jeffrey; Skorupski, Katherine; Vail, David; Wilson, Heather; Biller, Barbara; Avery, Anne; Kiupel, Matti; LeBlanc, Amy; Bernhardt, Anna; Brunkhorst, Beatrice; Tighe, Robert; Khanna, Chand

    2015-01-01

    Background Interleukin (IL)-12 is a pro-inflammatory cytokine that mediates T-helper type 1 responses and cytotoxic T-cell activation, contributing to its utility as anti-cancer agent. Systemic administration of IL-12 often results in unacceptable toxicity; therefore, strategies to direct delivery of IL-12 to tumors are under investigation. The objective of this study was to assist the preclinical development of NHS-IL12, an immunocytokine consisting of an antibody, which targets necrotic tumor regions, linked to IL-12. Specifically this study sought to evaluate the safety, serum pharmacokinetics, anti-tumor activity, and immune modulation of NHS-IL12 in dogs with naturally occurring cancers. Methodology/Principal Findings A rapid dose-escalation study of NHS-IL12 administered subcutaneously to dogs with melanoma was conducted through the Comparative Oncology Trials Consortium (COTC). Eleven dogs were enrolled in four dose-escalation cohorts; thereafter, an additional seven dogs were treated at the defined tolerable dose of 0.8 mg/m2. The expanded cohort at this fixed dose (ten dogs in total) was accrued for further pharmacokinetics and pharmacodynamics assessment. NHS-IL12 levels, serum cytokine concentrations, and peripheral blood mononuclear cell characterization (post-treatment) and draining lymph node immune profiling, and tumor biopsies (pre- and post-treatment) were collected. Adverse events included thrombocytopenia, liver enzymopathies, fever, and vasculitis. Correlation between interferon (IFN)-γ induction, adverse events, and NHS-IL12 exposure (maximum concentration and area under the concentration-time curve) were dose-dependent. Serum IL-10 levels and intratumoral CD8+ populations increased after treatment. Partial responses, according to Response Evaluation Criteria in Solid Tumors (RECIST) criteria, were observed in two dogs treated with NHS-IL12 0.8 mg/m2 and 1.6 mg/m2. Conclusions/Significance NHS-IL12 was administered safely to dogs with melanoma

  19. In-gel NHS-propionate derivatization for histone post-translational modifications analysis in Arabidopsis thaliana.

    PubMed

    Chen, Jiajia; Gao, Jun; Peng, Maolin; Wang, Yi; Yu, Yanyan; Yang, Pengyuan; Jin, Hong

    2015-07-30

    Post-translational modifications (PTMs) on histone are highly correlated with genetic and epigenetic regulation of gene expression from chromatin. Mass spectrometry (MS) has developed to be an optimal tool for the identification and quantification of histone PTMs. Derivatization of histones with chemicals such as propionic anhydride, N-hydroxysuccinimide ester (NHS-propionate) has been widely used in histone PTMs analysis in bottom-up MS strategy, which requires high purity for histone samples. However, biological samples are not always prepared with high purity, containing detergents or other interferences in most cases. As an alternative approach, an adaptation of in gel derivatization method, termed In-gel NHS, is utilized for a broader application in histone PTMs analysis and it is shown to be a more time-saving preparation method. The proposed method was optimized for a better derivatization efficiency and displayed high reproducibility, indicating quantification of histone PTMs based on In-gel NHS was achievable. Without any traditional fussy histone purification procedures, we succeeded to quantitatively profile the histone PTMs from Arabidopsis with selective knock down of CLF (clf-29) and the original parental (col) with In-gel NHS method in a rapid way, which indicated the high specificity of CLF on H3K27me3 in Arabidopsis. In-gel NHS quantification results also suggest distinctive histone modification patterns in plants, which is invaluable foundation for future studies on histone modifications in plants.

  20. Stabilization of collagen with EDC/NHS in the presence of L-lysine: a comprehensive study.

    PubMed

    Usha, R; Sreeram, K J; Rajaram, A

    2012-02-01

    This paper reports the effect of L-lysine on the conformational, rheological, and thermal properties of 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide (EDC) and N-hydroxysuccinimide (NHS) cross linked collagen and investigates the influence of l-lysine on the self assembly processes of collagen. In the absence of L-lysine, the rheological characterization of collagen cross linked with EDC/NHS showed an increase in shearing stress with shearing speed indicating that the collagen chains become rigid and the molecules are reluctant to flow. On the other hand, the increase in shearing stress with shearing speed is comparatively much less in the presence of L-lysine indicating a greater flexibility of the collagen molecules. The self assembly processes of collagen treated with EDC/NHS in the absence and presence of L-lysine were characterized using powder XRD, FT-IR, polarizing optical microscopy and kinetic studies. XRD studies show an increase in peak intensity and sharpness in the presence of L-lysine indicating the enhancement of crystallinity of collagen nano-fibrils. FT-IR results suggest that the incorporation of L-lysine in the EDC/NHS cross linking favors the molecular stability of collagen. From the present study, it is possible to conclude that the pre-treatment of collagen with L-lysine enhances EDC/NHS cross linking and can be used for biomaterial applications.

  1. Trust me, I'm a researcher!: The role of trust in biomedical research.

    PubMed

    Kerasidou, Angeliki

    2017-03-01

    In biomedical research lack of trust is seen as a great threat that can severely jeopardise the whole biomedical research enterprise. Practices, such as informed consent, and also the administrative and regulatory oversight of research in the form of research ethics committees and Institutional Review Boards, are established to ensure the protection of future research subjects and, at the same time, restore public trust in biomedical research. Empirical research also testifies to the role of trust as one of the decisive factors in research participation and lack of trust as a barrier for consenting to research. However, what is often missing is a clear definition of trust. This paper seeks to address this gap. It starts with a conceptual analysis of the term trust. It compares trust with two other related terms, those of reliance and trustworthiness, and offers a defence of Baier's attribute of 'good will' a basic characteristic of trust. It, then, proceeds to consider trust in the context of biomedical research by examining two questions: First, is trust necessary in biomedical research?; and second, do increases in regulatory oversight of biomedical research also increase trust in the field? This paper argues that regulatory oversight is important for increasing reliance in biomedical research, but it does not improve trust, which remains important for biomedical research. It finishes by pointing at professional integrity as a way of promoting trust and trustworthiness in this field.

  2. From the general to the specific: How social trust motivates relational trust.

    PubMed

    Robbins, Blaine G

    2016-01-01

    When people form beliefs about the trustworthiness of others with respect to particular matters (i.e., when individuals trust), theory suggests that they rely on preexistent cognitive schemas regarding the general cooperativeness of individuals and organizations (i.e., social trust). In spite of prior work, the impact of social trust on relational trust-or what Russell Hardin (2002) calls trust as a three-part relation where actor A trusts actor B with reference to matter Y-is not well established. Four vignette experiments were administered to Amazon.com Mechanical Turk workers (N = 1388 and N = 1419) and to public university undergraduate students (N = 995 and N = 956) in order to investigate the relationship between social trust and relational trust. Measures of general social trust and particular social trust produced statistically equivalent effects that were positively associated with relational trust. Political trust, however, was statistically unrelated to relational trust. These results support the idea that people rely on schemas and stereotypes concerned with the general cooperativeness and helpfulness of others when forming beliefs about another person's trustworthiness with respect to a particular matter at hand.

  3. The Value of Trust to Nursing.

    PubMed

    Rutherford, Marcella M

    2014-01-01

    Trust, one of nursing's intangible assets, impacts nurses' ability to form meaningful relationships with patients and this connection positively impacts health outcomes. Linking trust to the fabric of nursing and investing in its measurement will become essential to nursing's valuation and the resulting investment in nursing. Trust, as nursing's core value, should be fostered by nurse educators as they prepare the next generation of nurses. Nurse administrators should connect the trust a patient has for his or her nurse and patient cooperation and honest transparent communication between providers and the patient. Banking trust as a valuable nursing asset will substantiate nursing's marketing and support its worth. Nursing's trustworthiness is an intangible asset that warrants protection, as trust once lost is hard to recapture.

  4. Social information influences trust behaviour in adolescents.

    PubMed

    Lee, Nikki C; Jolles, Jelle; Krabbendam, Lydia

    2016-01-01

    Trust plays an integral role in daily interactions within adolescents' social environment. Using a trust game paradigm, this study investigated the modulating influence of social information about three interaction partners on trust behaviour in adolescents aged 12-18 (N = 845). After receiving information about their interaction partners prior to the task, participants were most likely to share with a 'good' partner and rate this partner as most trustworthy. Over the course of the task all interaction partners showed similar levels of trustworthy behaviour, but overall participants continued to trust and view the good partner as more trustworthy than 'bad' and 'neutral' partners throughout the game. However, with age the ability to overcome prior social information and adapt trust behaviour improved: middle and late adolescents showed a larger decrease in trust of the good partner than early adolescents, and late adolescents were more likely to reward trustworthy behaviour from the negative partner.

  5. 17 CFR 240.16a-8 - Trusts.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 17 Commodity and Securities Exchanges 3 2010-04-01 2010-04-01 false Trusts. 240.16a-8 Section 240...-8 Trusts. (a) Persons subject to section 16—(1) Trusts. A trust shall be subject to section 16 of the Act with respect to securities of the issuer if the trust is a beneficial owner, pursuant to §...

  6. Trust-Building in Electronic Markets: Relative Importance and Interaction Effects of Trust-Building Mechanisms

    NASA Astrophysics Data System (ADS)

    Tams, Stefan

    We examine the relative and complementary effectiveness of trust-building strategies in online environments. While prior research has examined various antecedents to trust, we investigated two trust-building mechanisms more in depth: Web site trust and vendor reputation. We tried to understand the relative effectiveness of these two important mechanisms to provide online businesses with a clear recommendation of how to establish trust in an effective and efficient manner. Drawing from the literature on trust, we proposed vendor reputation to be more effective than Web site trust. Moreover, we examined a potential complementary effect of these mechanisms so as to provide online businesses with a deeper understanding of how to derive superior trust. We hypothesize a small such effect. The study proposes a laboratory experiment to test the model.

  7. Representing Trust in Cognitive Social Simulations

    NASA Astrophysics Data System (ADS)

    Pollock, Shawn S.; Alt, Jonathan K.; Darken, Christian J.

    Trust plays a critical role in communications, strength of relationships, and information processing at the individual and group level. Cognitive social simulations show promise in providing an experimental platform for the examination of social phenomena such as trust formation. This paper describes the initial attempts at representation of trust in a cognitive social simulation using reinforcement learning algorithms centered around a cooperative Public Commodity game within a dynamic social network.

  8. Exploring a Dynamic Model of Trust Management

    DTIC Science & Technology

    2014-06-01

    factors affecting different trust indicators during trust development and acquisition is limited. The goal of this research is to provide a broad view on...how these factors affect trust. The overall goal of the larger research study is to evaluate the relative strength of Mayer’s trustworthiness...distribution unlimited. 88ABW-2014-4087; Cleared 29 August 2014 4.4.6. Positive Affect Negative Affect Scale (PANAS) The 20-item self- report , PANAS

  9. The meanings of 'culture' in health and social care: a case study of the combined Trust in Somerset.

    PubMed

    Peck, E; Towell, D; Gulliver, P

    2001-11-01

    On the 1st of April 1999 Somerset Health Authority and Somerset County Council established a Joint Commissioning Board (JCB) to commission mental health services. Simultaneously, the Somerset Partnerships Health and Social Care NHS Trust was set-up as a combined health and social care services provider; for the first time in England, the majority of social services mental health staff transferred their employment to this Trust. The JCB commissioned an evaluation of the impact of these innovations on users and carers, staff and senior officers and members in the organisations concerned. In the course of the research, one concept frequently recurred as a source of both optimism and concern: 'culture'. However, the meanings attributed to this term varied significantly between stakeholders. After summarising the methodology and the results to date of the evaluation, this paper briefly reviews the conceptions of culture in the literature on organisations, and introduces a taxonomy for discussing culture. That taxonomy is then deployed to explore the ways in which the notion of 'culture' is being applied to and within the combined Trust in Somerset, and the implications of those applications for local practice and national policy around partnership.

  10. Social richness, socio-technical tension and the virtual commissioning of NHS research

    PubMed Central

    Morgan, Philip A; McCourt, Christine A; Youll, Penny

    2007-01-01

    Background This paper draws on a recent study that evaluated the process of commissioning NHS funded research using virtual committees. Building on an earlier paper that reported our evaluation, here we focus on the effects of asynchronous computer mediated communication (CMC) when used to support group work. Methods To do this the discussion focuses on how CMC affected three key group factors, building relationships, group cohesion and group commitment. The notion of socio-technical tension is elaborated and the paper explores how social richness can act to counter the socially impoverishing and time extending effects of asynchronous CMC. Results We argue that social richness in this context results from the presence of five principal influences. These are: a dynamic range of participant aspirations and personal agendas; participant commitment to and identification with the work and ideals of the group; a rich diversity of social, professional and work-related backgrounds; a website designed to enhance participation and interaction and the mediating effects of an effective chairperson. Conclusion If virtual work groups are to be used by the NHS in the future, then there is a need for more research into the role of social context and its relationship to the effectiveness of newly formed virtual groups. Equally as important are studies that examine the effects of socio-technical interaction on groups undertaking tasks in the real world of work. PMID:17553135

  11. NHS values, compassion and quality indicators for relationship based person-centred healthcare

    PubMed Central

    Cox, John

    2015-01-01

    The paper by Gilbert et al. should be on the table of every politician and National Health Service (NHS) manager in the run up to the general election, when the NHS is at the hustings. They have raised profound moral dilemmas of the internal and external market in their present form, such as the practicalities of distributive justice and the enhancement of autonomy – to which are added the preservation of personhood, the values of listening, the maintenance of altruism and the origins of compassion. It is asserted that the quality of healthcare is dependent on the quality of the caring relationship between healthcare staff members, and between staff and patients. The nature of Compassionate Resilience is outlined with respect to Health Visitor training – and the contribution of faith communities to public health is also considered. The four Quality Indicators of an enabling environment first proposed by Cox and Gray are summarised, and the need for increased conceptual clarity of these key values recognised. PMID:26029903

  12. Positron annihilation Doppler broadening spectroscopy study on Fe-ion irradiated NHS steel

    NASA Astrophysics Data System (ADS)

    Zhu, Huiping; Wang, Zhiguang; Gao, Xing; Cui, Minghuan; Li, Bingsheng; Sun, Jianrong; Yao, Cunfeng; Wei, Kongfang; Shen, Tielong; Pang, Lilong; Zhu, Yabin; Li, Yuanfei; Wang, Ji; Song, Peng; Zhang, Peng; Cao, Xingzhong

    2015-02-01

    In order to study the evolution of irradiation-induced vacancy-type defects at different irradiation fluences and temperatures, a new type of ferritic/martensitic (F/M) steel named NHS (Novel High Silicon) was irradiated by 3.25 MeV Fe-ion at room temperature and 723 K to fluences of 4.3 × 1015 and 1.7 × 1016 ions/cm2. After irradiation, vacancy-type defects were investigated with variable-energy positron beam Doppler broadening spectra. Energetic Fe-ions produced a large number of vacancy-type defects in the NHS steel, but one single main type of vacancy-type defect was observed in both unirradiated and irradiated samples. The concentration of vacancy-type defects decreased with increasing temperature. With the increase of irradiation fluence, the concentration of vacancy-type defects increased in the sample irradiated at RT, whereas for the sample irradiated at 723 K, it decreased. The enhanced recombination between vacancies and excess interstitial Fe atoms from deeper layers, and high diffusion rate of self-interstitial atoms further improved by diffusion via grain boundary and dislocations at high temperature, are thought to be the main reasons for the reversed trend of vacancy-type defects between the samples irradiated at RT and 723 K.

  13. Women's interest in a personal breast cancer risk assessment and lifestyle advice at NHS mammography screening

    PubMed Central

    Wilkinson, L.; Valencia, A.

    2017-01-01

    Abstract Background Although mortality from breast cancer is declining, incidence continues to increase and is often detected at routine NHS screening. Most middle aged and older women in England attend for screening every 3 years. Assessing their personal breast cancer risk and providing preventative lifestyle advice could help to further reduce breast cancer incidence. Methods A cross-sectional, self-complete postal survey measured attendees' interest in having a personal risk assessment, expected impact on screening attendance, knowledge of associations between lifestyle and breast cancer and preferred ways of accessing preventative lifestyle advice. Results A total of 1803/4948 (36.4%) completed questionnaires were returned. Most participants (93.7%) expressed interest in a personal risk assessment and 95% (1713/1803) believed it would make no difference or encourage re-attendance. Two-thirds (1208/1803) associated lifestyle with breast cancer, but many were unaware of specific risks such as weight gain, obesity, alcohol consumption and physical inactivity. NHS sourced advice was expected to be more credible than other sources, and booklets, brief counselling or an interactive website were most preferred for accessing this. Conclusions Attendees appear to welcome an intervention that would facilitate more proactive clinical and lifestyle prevention and address critical research gaps in breast cancer prevention and early detection. PMID:26834190

  14. Cost effectiveness of collagen crosslinking for progressive keratoconus in the UK NHS

    PubMed Central

    Salmon, H A; Chalk, D; Stein, K; Frost, N A

    2015-01-01

    Background Keratoconus is a progressive degenerative corneal disorder of children and young adults that is traditionally managed by refractive error correction, with corneal transplantation reserved for the most severe cases. UVA collagen crosslinking is a novel procedure that aims to prevent disease progression, currently being considered for use in the UK NHS. We assess whether it might be a cost-effective alternative to standard management for patients with progressive keratoconus. Methods We constructed a Markov model in which we estimated disease progression from prospective follow-up studies, derived costs derived from the NHS National Tariff, and calculated utilities from linear regression models of visual acuity in the better-seeing eye. We performed deterministic and probabilistic sensitivity analyses to assess the impact of possible variations in the model parameters. Results Collagen crosslinking is cost effective compared with standard management at an incremental cost of £3174 per QALY in the base case. Deterministic sensitivity analysis shows that this could rise above £33 263 per QALY if the duration of treatment efficacy is limited to 5 years. Other model parameters are not decision significant. Collagen crosslinking is cost effective in 85% of simulations at a willingness-to-pay threshold of £30 000 per QALY. Conclusion UVA collagen crosslinking is very likely to be cost effective, compared with standard management, for the treatment of progressive keratoconus. However, further research to explore its efficacy beyond 5 years is desirable. PMID:26315704

  15. On Propagating Interpersonal Trust in Social Networks

    NASA Astrophysics Data System (ADS)

    Ziegler, Cai-Nicolas

    The age of information glut has fostered the proliferation of data and documents on the Web, created by man and machine alike. Hence, there is an enormous wealth of minable knowledge that is yet to be extracted, in particular, on the Semantic Web. However, besides understanding information stated by subjects, knowing about their credibility becomes equally crucial. Hence, trust and trust metrics, conceived as computational means to evaluate trust relationships between individuals, come into play. Our major contribution to Semantic Web trust management through this work is twofold. First, we introduce a classification scheme for trust metrics along various axes and discuss advantages and drawbacks of existing approaches for Semantic Web scenarios. Hereby, we devise an advocacy for local group trust metrics, guiding us to the second part, which presents Appleseed, our novel proposal for local group trust computation. Compelling in its simplicity, Appleseed borrows many ideas from spreading activation models in psychology and relates their concepts to trust evaluation in an intuitive fashion. Moreover, we provide extensions for the Appleseed nucleus that make our trust metric handle distrust statements.

  16. Monkey's health service: an evaluation of the implementation of resources designed to support the learning of primary school-aged children in England about healthy lifestyles and NHS services.

    PubMed

    Medforth, Nicholas; Timpson, Hannah; Greenop, Daz; Lavin, Rachel

    2015-01-01

    The National Health Service Institute for Innovation and Improvement was established to help the NHS to improve healthcare by rapidly developing and disseminating knowledge and evidence about new ways of working. One example is the Emergency and Urgent Care Pathway for Children and Young People which focused on providing high quality and safe healthcare for children and young people requiring urgent or emergency treatment for the most common illnesses and injuries. Monkey's Guide to Healthy Living and NHS Services was developed to increase awareness of acute health services in primary school-aged children. This free resource was posted to every primary school in England. A process and impact evaluation was undertaken to explore how the resource was being utilized during 2013-2014. A small number of in-depth case studies were developed involving classroom-based observations and teacher interviews along with a much larger online survey which was emailed to all primary schools in England. On the whole, the resource was viewed as useful, engaging, and informative; with children, teachers, and other professionals particularly valuing the monkey puppet, video clips, and teacher resources. The National Evaluation highlighted that most respondents integrated the materials into the curriculum, used them as a one-off lesson, or developed their own innovative and strategic approaches to make the best use of the resources; almost two-thirds of schools who responded to the survey felt the resources led to pupils knowing about the available NHS services and healthy lifestyles; over half felt pupils were now more informed about the most appropriate services to use.

  17. 25 CFR 1000.352 - What are “trust resources” for the purposes of the trust evaluation process?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... assets, trust revenue, royalties, or rental, including natural resources, land, water, minerals, funds... INDIAN SELF-DETERMINATION AND EDUCATION ACT Trust Evaluation Review § 1000.352 What are “trust resources” for the purposes of the trust evaluation process? (a) Trust resources include property and...

  18. Drawing on a Knowledge-Based Trust Perspective to Examine and Conceptualize within-School Trust Development by Principals

    ERIC Educational Resources Information Center

    Cosner, Shelby

    2010-01-01

    Research has revealed the importance of trust to schools and pointed to the central role that principals play in cultivating within-school trust, yet less is known about the ways that principals cultivate such trust. Moreover, divergent perspectives and varied contexts for examining trust have limited the transfer of trust scholarship to practice…

  19. A Model of Trust for Developing Trustworthy Systems From Untrustworthy Actors

    DTIC Science & Technology

    2007-04-01

    Major components of the trust management system in- clude a database engine to store and manage trust data, a trust specification engine for defining and...managing trust relationships, a trust analysis engine to process results of a trust query, a trust eval- uation engine for evaluating trust...expressions and a trust monitor for updating trust relationship information in the database engine . We have also developed an SQL like language, called TrustQL

  20. Trust in Culturally Diverse Teams

    DTIC Science & Technology

    2008-09-01

    DRDC Toronto CR 2008-097 Trust in Culturally Diverse Teams by: Andrea L. Brown, Barbara D. Adams, Julie J. Famewo and Cheryl L. Karthaus...prendre des risques ont été évaluées uniquement après la mission. D’après les résultats, une culture commune a une incidence sur la confiance et les...attentes dès avant une mission; autrement dit , les participants ont manifesté une plus grande confiance envers leur coéquipier et une confiance

  1. Keys to Heart Disease Care: Communication and Trust

    MedlinePlus

    ... fullstory_164421.html Keys to Heart Disease Care: Communication and Trust These factors linked to patients' greater ... trusted the medical profession. It's no secret that communication and trust are important in any doctor-patient ...

  2. A Strategic Model of Trust Management in Web Services

    NASA Astrophysics Data System (ADS)

    Sun, Junqing; Sun, Zhaohao; Li, Yuanzhe; Zhao, Shuliang

    This article examines trust and trust management in web services and proposes a multiagent model of trust relationship in web services. It looks at the hierarchical structure of trust management in web services and proposes a strategic model of trust management in web services. The proposed approach in this article will facilitate research and development of trust management in e-commerce, web services and social networking.

  3. Services for young people with attention deficit/hyperactivity disorder transitioning from child to adult mental health services: a national survey of mental health trusts in England.

    PubMed

    Hall, Charlotte L; Newell, Karen; Taylor, John; Sayal, Kapil; Hollis, Chris

    2015-01-01

    Transition from child to adult mental health services is considered to be a difficult process, particularly for individuals with neurodevelopmental disorders such as attention deficit/hyperactivity disorder (ADHD). This article presents results from a national survey of 36 mental health National Health Service (NHS) trusts across England, the findings indicate a lack of accurate data on the number of young people with ADHD transitioning to, and being seen by, adult services. Less than half of the trusts had a specialist adult ADHD service and in only a third of the trusts were there specific commissioning arrangements for adult ADHD. Half of the trusts reported that young people with ADHD were prematurely discharged from child and adolescent mental health services (CAMHS) because there were no suitable adult services. There was also a lack of written transition protocols, care pathways, commissioned services for adults with ADHD and inadequate information sharing between services. The findings advocate the need to provide a better transition service underpinned by clear, structured guidelines and protocols, routine data collection and information sharing across child and adult services. An increase in the commission of specialist adult ADHD clinics is needed to ensure individuals have access to appropriate support and care.

  4. Price transparency: building community trust.

    PubMed

    Clarke, Richard L

    2007-01-01

    With the push from policymakers, payers, and consumers for hospitals to make their prices public, healthcare executives need to recognize two central issues related to price transparency: 1) meaningful price transparency involves helping patients and consumers understand their financial obligation for an episode of care, and 2) price transparency is key to the most critical success strategy for healthcare providers: building trust. This article reviews the history of pricing and billing practices and explores why price transparency is not easily achieved in today's environment. Pricing is a mystery even to those of us who work in the field, yet despite its complexity, the call for price transparency is not going to go away. For transparency, the goal should be to establish a rational pricing system that is easily explainable and justified to all stakeholders. Healthcare executives must make pricing a priority, understand cost, develop a pricing philosophy, understand the overall revenue requirements, examine market conditions and prices, and set up systems for review. A rational process of price setting should enhance community trust. In this matter there is nothing less at stake than the hearts of our community members.

  5. Young Children and Trust in Turkey

    ERIC Educational Resources Information Center

    Alat, Zeynep

    2014-01-01

    The aim of the study was to examine differences in children's generalised trust and the maternal behaviour, child temperament, and demographic factors on the levels of trust in children. A total of 314 mothers and their children participated in the study. Results showed no evidence of sex differences in children's beliefs. Children living in urban…

  6. Further Exploration of Organizational Trust Factors

    ERIC Educational Resources Information Center

    Adams, Samuel H.; Wiswell, Albert K.

    2008-01-01

    Trust facilitates individual and organizational learning, and is often misunderstood by organizations although they must continuously learn in order to attain strategic goals and survive. Furthermore, leaders of organizations often view trust defensively and their reactions may impede organizational learning. This paper builds on prior research…

  7. 12 CFR 7.2022 - Voting trusts.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 1 2011-01-01 2011-01-01 false Voting trusts. 7.2022 Section 7.2022 Banks and Banking COMPTROLLER OF THE CURRENCY, DEPARTMENT OF THE TREASURY BANK ACTIVITIES AND OPERATIONS Corporate... applicable law of a state selected by the participants and designated in the trust agreement, provided...

  8. The Winston Churchill Memorial Trust of Australia

    ERIC Educational Resources Information Center

    Hilton, Nicolette

    2013-01-01

    The Churchill Trust was established in 1965 to honour the memory of Sir Winston Churchill by awarding overseas research Fellowships known as "Churchill Fellowships". Since its inception, The Churchill Trust has awarded Churchill Fellowships to more than 3,700 Australians who, like Churchill, are innovative, filled with a spirit of…

  9. New Superintendents: Trust, Networking, and Social Capital

    ERIC Educational Resources Information Center

    Ripley, Joan; Mitchell, Roxanne M.; Richman, John A.

    2013-01-01

    This instrumental case study explored how five newly appointed superintendents identified key stakeholders and built trust and social capital with stakeholders in their districts. Stakeholder, trust, and social capital theory were the lenses that guided this study. We utilized a pragmatic research design and thematic data analysis to interpret our…

  10. The Importance of Trust in Electronic Commerce.

    ERIC Educational Resources Information Center

    Ratnasingham, Pauline

    1998-01-01

    Introduces the new concept of trust and how it influences the process of managing the security of an organization operating in an electronic commerce environment. Theoretically, the study aims to develop a framework of trust and security to provide a set of guidelines for secure electronic commerce. (Author/LRW)

  11. Development of Trust and Reciprocity in Adolescence

    ERIC Educational Resources Information Center

    van den Bos, Wouter; Westenberg, Michiel; van Dijk, Eric; Crone, Eveline A.

    2010-01-01

    We investigate the development of two types of prosocial behavior, trust and reciprocity, as defined using a game-theoretical task that allows investigation of real-time social interaction, among 4 age groups from 9 to 25 years. By manipulating the possible outcome alternatives, we could distinguish among important determinants of trust and…

  12. 26 CFR 301.7701-4 - Trusts.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... federal, state, or local environmental laws; all contributors to the trust have (at the time of... federal, state, or local environmental laws for environmental remediation of the waste site; and the trust... environmental laws for remediation of the existing waste site if there is authority under a federal, state,...

  13. 26 CFR 301.7701-4 - Trusts.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... federal, state, or local environmental laws; all contributors to the trust have (at the time of... federal, state, or local environmental laws for environmental remediation of the waste site; and the trust... environmental laws for remediation of the existing waste site if there is authority under a federal, state,...

  14. 26 CFR 301.7701-4 - Trusts.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... federal, state, or local environmental laws; all contributors to the trust have (at the time of... federal, state, or local environmental laws for environmental remediation of the waste site; and the trust... environmental laws for remediation of the existing waste site if there is authority under a federal, state,...

  15. 26 CFR 301.7701-4 - Trusts.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... federal, state, or local environmental laws; all contributors to the trust have (at the time of... federal, state, or local environmental laws for environmental remediation of the waste site; and the trust... environmental laws for remediation of the existing waste site if there is authority under a federal, state,...

  16. 76 FR 60757 - Executive Branch Qualified Trusts

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-30

    ... make a few minor substantive changes, but would primarily put the regulation in a more logical order... most universally adaptable qualified trust. An interested party may put most types of assets (such as... may put only readily marketable securities into a qualified diversified trust. In addition,...

  17. 77 FR 39143 - Executive Branch Qualified Trusts

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-02

    ... put the regulation in a more logical order, make it more readable, and eliminate redundant provisions... qualified trust. An interested party may put most types of assets (such as cash, stocks, bonds, mutual funds... duties by those interests. (b) Qualified diversified trust. (1) An interested party may put only...

  18. Explaining Math Achievement: Personality, Motivation, and Trust

    ERIC Educational Resources Information Center

    Kilic-Bebek, Ebru

    2009-01-01

    This study investigated the statistical significance of student trust next to the well-tested constructs of personality and motivation to determine whether trust is a significant predictor of course achievement in college math courses. Participants were 175 students who were taking undergraduate math courses in an urban public university. The…

  19. Social capital and trust in providers.

    PubMed

    Ahern, Melissa M; Hendryx, Michael S

    2003-10-01

    Trust in providers has been in decline in recent decades. This study attempts to identify sources of trust in characteristics of health care systems and the wider community. The design is cross-sectional. Data are from (1) the 1996 Household Survey of the Community Tracking Study, drawn from 24 Metropolitan Statistical Areas; (2) a 1996 multi-city broadcast media marketing database including key social capital indicators; (3) Interstudy; (4) the American Hospital Association; and (5) the American Medical Association. Independent variables include individual socio-demographic variables, HMO enrollment, community-level health sector variables, and social capital. The dependent variable is self-reported trust in physicians. Data are merged from the various sources and analyzed using SUDAAN. Subjects include adults in the Household Survey who responded to the items on trust in physicians (N=17,653). Trust in physicians is independently predicted by community social capital (p<0.001). Trust is also negatively related to HMO enrollment and to many individual characteristics. The effect of HMOs is not uniform across all communities. Social capital plays a role in how health care is perceived by citizens, and how health care is delivered by providers. Efforts to build trust and collaboration in a community may improve trust in physicians, health care quality, access, and preserve local health care control.

  20. Effects of Cognitive Load on Trust

    DTIC Science & Technology

    2013-10-01

    27 5. Operational Processes ...the person’s benevolence. 3.1. Cognitive Load and Trust Cognitive load is a key component of the four-stage model of human information processing ...capacity of working memory and processing of novel information (Baddeley, 2003; Paas et al., 2003). It is clear that, like trust, cognitive load plays

  1. Perceptions of Trust in Public Examinations

    ERIC Educational Resources Information Center

    Simpson, Lucy; Baird, Jo-Anne

    2013-01-01

    Over recent years, the credibility of public examinations in England has increasingly come to the fore. Government agencies have invested time and money into researching public perceptions of the reliability and validity of examinations. Whilst such research overlaps into the conceptual domain of trust, trust in examinations remains an elusive…

  2. Trusting Facebook in Crisis Situations: The Role of General Use and General Trust Toward Facebook.

    PubMed

    Szymczak, Hermann; Kücükbalaban, Pinar; Lemanski, Sandra; Knuth, Daniela; Schmidt, Silke

    2016-01-01

    An important concept that has been rather neglected in research on social media is the concept of trust. Although there is a considerable amount of research on online trust in general, little has been done in the area of social media. As a situation of risk is necessary for trust, the perceived trustworthiness of Facebook in crisis situations was examined in this study. A sample of 340 European Facebook users were questioned as part of a large European study about social media in the context of emergency situations. We found that participants' general trust toward Facebook as a medium predicted to a significant degree how much they would trust Facebook in a crisis situation. General use of Facebook and dispositional trust were also significantly associated with trust toward Facebook in a crisis situation.

  3. Trust in the workplace: factors affecting trust formation between team members.

    PubMed

    Spector, Michele D; Jones, Gwen E

    2004-06-01

    The authors used survey data from 127 professional-level employees working in 8 industries to assess the effects of respondent's trusting stance and (a) the trustee's organization membership (internal or external), (b) the hierarchical relationship (supervisor or peer), and (c) the gender of the trustee, on initial trust level for a new project team member. The authors found that trusting stance was positively related to initial trust level. The authors also found an interaction effect between respondent gender and trustee gender on initial trust. Specifically, male initial trust level was higher for a new male team member and lower for a new female team member. The present study provided additional understanding of the formation of initial trust levels and its importance for team functioning.

  4. DualTrust: A Distributed Trust Model for Swarm-Based Autonomic Computing Systems

    SciTech Connect

    Maiden, Wendy M.; Dionysiou, Ioanna; Frincke, Deborah A.; Fink, Glenn A.; Bakken, David E.

    2011-02-01

    For autonomic computing systems that utilize mobile agents and ant colony algorithms for their sensor layer, trust management is important for the acceptance of the mobile agent sensors and to protect the system from malicious behavior by insiders and entities that have penetrated network defenses. This paper examines the trust relationships, evidence, and decisions in a representative system and finds that by monitoring the trustworthiness of the autonomic managers rather than the swarming sensors, the trust management problem becomes much more scalable and still serves to protect the swarm. We then propose the DualTrust conceptual trust model. By addressing the autonomic manager’s bi-directional primary relationships in the ACS architecture, DualTrust is able to monitor the trustworthiness of the autonomic managers, protect the sensor swarm in a scalable manner, and provide global trust awareness for the orchestrating autonomic manager.

  5. Is skill mix profitable in the current NHS dental contract in England?

    PubMed

    Brocklehurst, P R; Tickle, M

    2011-04-09

    The use of skill mix in medicine is now widespread, yet it appears that its use in dentistry is not as prominent. Unlike doctors, dentists are required to mitigate the financial risk produced by their capital investment and ensure an adequate cash flow to cover their annual running costs. Examining the financial incentives for employing dental care professionals is therefore an important step to understand why dentistry appears to lag behind medicine in skill mix. It is also apposite, given the announcement of the coalition government to develop a new contract, which could introduce incentives for the use of dental care professionals in this way. The purpose of this short paper is to examine whether skill mix is profitable for general dental practices under the existing NHS contract in England.

  6. Estimating conception statistics using gestational age information from NHS Numbers for Babies data.

    PubMed

    Chow, Yuan Huang; Dattani, Nirupa

    2009-01-01

    Conception statistics routinely published for England and Wales include pregnancies that result in one or more live- or stillbirths (a maternity) or an abortion. All live births are assumed to be 38 weeks gestation as information on gestation is not collected at birth registration. For the first time, gestational age information from the National Health Service (NHS) Numbers for Babies (NN4B) data has been used to re-estimate conception statistics for 2005. This shows that 72 per cent of conceptions leading to a maternity in fact have a gestati on period that differs from 38 weeks and most of these fall at either 37 or 39 weeks. The age-specific conception rates using this revised method are not significantly different to those produced using the current method.

  7. Policy through procurement - the introduction of digital signal process (DSP) hearing aids into the English NHS.

    PubMed

    Phillips, Wendy; Knight, Louise; Caldwell, Nigel; Warrington, John

    2007-01-01

    Despite being a major user of many technologies and innovations, the healthcare sector's role and influence as a procurer of technologies has been poorly represented by the literature and consequently is not fully understood. Providing a practical example of the introduction of digital signal process (DSP) hearing aids in to the English NHS, this paper discusses the role of public sector procurement agencies in the uptake of technologies from the private sector and their adoption by the public sector. Employing a system of innovation (SI) approach, the paper highlights the need for policy-makers to adopt a dynamic as well as systemic perspective that recognises the shifting roles, responsibilities and interactions of key stakeholders throughout the innovation process.

  8. The online Managed Knowledge Network that shares knowledge for eHealth in NHS Scotland.

    PubMed

    Dallest, Kathy; Strachan, Heather; Flett, Gillian

    2009-01-01

    The Managed Knowledge Network (MKN) for Nurses, Midwives and the Allied Health Professions (NMAHPs) in NHS Scotland was launched in November 2007. The online portal supports the NMAHP network to manage its knowledge and information sources that facilitate engagement with the national eHealth programme and realisation of benefits that eHealth offers to improve healthcare and service delivery. It is an integrated change management and knowledge management initiative. Web2 technologies support the social networking side of knowledge management and learning, allowing people to contact each other and collaborate. MKN resources are managed within the e-Library also giving access to over 5,000 online journals and over 500 bibliographic databases.

  9. Running an NHS community homeopathy clinic - 10-year anniversary 2001-2011.

    PubMed

    Bawden, Stella

    2012-01-01

    An outcome series was conducted over a five-year period of patients attending a community NHS homeopathy clinic in Dorchester, Dorset. 273 new patients were seen. 183 (67%) questionnaires were completed at six months after initial consultation. 44% of patients had been unwell for more than five years; 19% of all patients for more than 15 years. A wide variety of conditions were seen, the largest group with depression, anxiety or grief. For follow-up patients 75-81% indicated an improvement in their symptoms and activity while 58% recorded an improvement in their overall wellbeing. Six months after the initiation of treatment 155 (84.7%) felt an improvement in their condition with 148 (81%) attributing this to homeopathy. Nobody reported deterioration due to homeopathic treatment; conventional drug use was reduced in 46 patients (25%).

  10. Helium-Implantation-Induced Damage in NHS Steel Investigated by Slow-Positron Annihilation Spectroscopy

    NASA Astrophysics Data System (ADS)

    Li, Yuan-Fei; Shen, Tie-Long; Gao, Xing; Gao, Ning; Yao, Cun-Feng; Sun, Jian-Rong; Wei, Kong-Fang; Li, Bing-Sheng; Zhang, Peng; Cao, Xing-Zhong; Zhu, Ya-Bin; Pang, Li-Long; Cui, Ming-Huan; Chang, Hai-Long; Wang, Ji; Zhu, Hui-Ping; Wang, Dong; Song, Peng; Sheng, Yan-Bin; Zhang, Hong-Peng; Hu, Bi-Tao; Wang, Zhi-Guang

    2014-03-01

    Evolutions of defects and helium contained defects produced by atomic displacement and helium deposition with helium implantation at different temperatures in novel high silicon (NHS) steel are investigated by a slow positron beam. Differences of the defect information among samples implanted by helium to a fluence of 1 × 1017 ions/cm2 at room temperature, 300°C, 450°C and 750°C are discussed. It is found that the mobility of vacancies and vacancy clusters, a recombination of vacancy-type defects and the formation of the He-V complex lead to the occurrence of these differences. At high temperature irradiations, a change of the diffusion mechanism of He atoms/He bubbles might be one of the reasons for the change of the S-parameter.

  11. Causes for concern: is NICE failing to uphold its responsibilities to all NHS patients?

    PubMed

    Claxton, Karl; Sculpher, Mark; Palmer, Stephen; Culyer, Anthony J

    2015-01-01

    Organisations across diverse health care systems making decisions about the funding of new medical technologies face extensive stakeholder and political pressures. As a consequence, there is quite understandable pressure to take account of other attributes of benefit and to fund technologies, even when the opportunity costs are likely exceed the benefits they offer. Recent evidence suggests that NICE technology appraisal is already approving drugs where more health is likely to be lost than gained. Also, NICE recently proposed increasing the upper bound of the cost-effectiveness threshold to reflect other attributes of benefit but without a proper assessment of the type of benefits that are expected to be displaced. It appears that NICE has taken a direction of travel, which means that more harm than good is being, and will continue to be, done, but it is unidentified NHS patients who bear the real opportunity costs.

  12. Principles and indicators of successful consumer involvement in NHS research: results of a Delphi study and subgroup analysis.

    PubMed

    Boote, Jonathan; Barber, Rosemary; Cooper, Cindy

    2006-02-01

    Consumer involvement in NHS research is Department of Health policy within the UK. Despite the existence of policy directives and guidance, until recently there has been no consensus among consumers and researchers about what it means to involve consumers successfully in NHS research. This paper discusses the value of consensus research in this policy area, and presents the detailed findings of a Delphi study carried out to reach consensus on principles and indicators of successful consumer involvement in NHS research. Study participants, comprising consumers, researchers and consumer-researchers, were identified using a purposive sampling strategy. Consensus was reached on eight clear and valid principles of successful consumer involvement in NHS research, with each principle having at least one clear and valid indicator. Subgroup analysis revealed few significant differences in how consumers, researchers and consumer-researchers rated the principles and indicators. The implications and limitations of the study are discussed. Further research is needed to assess: (1) the usefulness of the principles and indicators for differing models of consumer involvement, health research methodologies, and subject areas within health research; and (2) the impact of 'successful' consumer involvement on health research processes and outcomes.

  13. A Safe Place to Stay Sharp: Action Learning Meets Cooperative Inquiry in the Service of NHS OD Capacity Building

    ERIC Educational Resources Information Center

    Traeger, James; Norgate, Carolyn

    2015-01-01

    This is an account of practice. It explores the meeting point between action learning and action research, as a way of doing capacity building in organisational development (OD) in the NHS in the UK. The authors were part of a short cooperative inquiry (Heron, J. 1996. "Co-operative Inquiry: Research into the Human Condition." London:…

  14. Illness Induction Syndrome: Paper I--A Series of 41 Children from 37 Families Identified at the Great Ormond Street Hospital for Children NHS Trust.

    ERIC Educational Resources Information Center

    Gray, Jenny; Bentovim, Arnon

    1996-01-01

    This study reviewed the case records of 41 British children with illnesses induced by a parent, almost always the mother. Four patterns emerged: (1) failure-to-thrive through withholding of food; (2) allegation of allergy and withholding of food; (3) allegation and fabrication of medical symptoms; and (4) active interference by poisoning or…

  15. A SHOCKING REQUIREMENT IN THE LAW ON NEGLIGENCE LIABILITY FOR PSYCHIATRIC ILLNESS: LIVERPOOL WOMEN'S HOSPITAL NHS FOUNDATION TRUST V RONAYNE [2015] EWCA CIV 588.

    PubMed

    Burrows, Andrew S; Burrows, John H

    2016-01-01

    The Ronayne case concerned a husband who suffered a psychiatric illness, described as an adjustment disorder, in seeing the condition of his wife who was the primary victim of admitted medical negligence. His claim for compensation, as a 'secondary victim', failed because he could not satisfy the legal requirement that there must be a sudden shocking event. This commentary criticises that requirement which appears to make no medical sense.

  16. Complexity in the new NHS: longitudinal case studies of CCGs in England

    PubMed Central

    Checkland, Katherine; Coleman, Anna; Perkins, Neil

    2016-01-01

    Objective The reform in the English National Health Services (NHS) under the Health and Social Care Act 2012 is unlike previous NHS reorganisations. The establishment of clinical commissioning groups (CCGs) was intended to be ‘bottom up’ with no central blueprint. This paper sets out to offer evidence about how this process has played out in practice and examines the implications of the complexity and variation which emerged. Design Detailed case studies in CCGs across England, using interviews, observation and documentary analysis. Using realist framework, we unpacked the complexity of CCG structures. Setting/participants In phase 1 of the study (January 2011 to September 2012), we conducted 96 interviews, 439 h of observation in a wide variety of meetings, 2 online surveys and 38 follow-up telephone interviews. In phase 2 (April 2013 to March 2015), we conducted 42 interviews with general practitioners (GPs) and managers and observation of 48 different types of meetings. Results Our study has highlighted the complexity inherent in CCGs, arising out of the relatively permissive environment in which they developed. Not only are they very different from one another in size, but also in structure, functions between different bodies and the roles played by GPs. Conclusions The complexity and lack of uniformity of CCGs is important as it makes it difficult for those who must engage with CCGs to know who to approach at what level. This is of increasing importance as CCGs are moving towards greater integration across health and social care. Our study also suggests that there is little consensus as to what being a ‘membership’ organisation means and how it should operate. The lack of uniformity in CCG structure and lack of clarity over the meaning of ‘membership’ raises questions over accountability, which becomes of greater importance as CCG is taking over responsibility for primary care co-commissioning. PMID:26743708

  17. Hype and Public Trust in Science

    PubMed Central

    Resnik, David B.

    2014-01-01

    Social scientists have begun elucidating the variables that influence public trust in science, yet little is known about hype in biotechnology and its effects on public trust. Many scholars claim that hyping biotechnology results in a loss of public trust, and possibly public enthusiasm or support for science, because public expectations of the biotechnological promises will be unmet. We argue for the need for empirical research that examines the relationships between hype, public trust, and public enthusiasm/support. We discuss the complexities in designing empirical studies that provide evidence for a causal link between hype, public trust, and public enthusiasm/support, but also illustrate how this may be remedied. Further empirical research on hype and public trust is needed in order to improve public communication of science and to design evidence-based education on the responsible conduct of research for scientists. We conclude that conceptual arguments made on hype and public trust must be nuanced to reflect our current understanding of this relationship. PMID:22045550

  18. Genetic Influences Are Virtually Absent for Trust

    PubMed Central

    Van Lange, Paul A. M.; Vinkhuyzen, Anna A. E.; Posthuma, Danielle

    2014-01-01

    Over the past decades, numerous twin studies have revealed moderate to high heritability estimates for individual differences in a wide range of human traits, including cognitive ability, psychiatric disorders, and personality traits. Even factors that are generally believed to be environmental in nature have been shown to be under genetic control, albeit modest. Is such heritability also present in social traits that are conceptualized as causes and consequences of social interactions or in other ways strongly shaped by behavior of other people? Here we examine a population-based sample of 1,012 twins and relatives. We show that the genetic influence on generalized trust in other people (trust-in-others: h2 = 5%, ns), and beliefs regarding other people’s trust in the self (trust-in-self: h2 = 13%, ns), is virtually absent. As test-retest reliability for both scales were found to be moderate or high (r = .76 and r = .53, respectively) in an independent sample, we conclude that all variance in trust is likely to be accounted for by non-shared environmental influences. We show that, relative to cognitive abilities, psychiatric disorders, and classic personality variables, genetic influences are smaller for trust, and propose that experiences with or observations of the behavior of other people shape trust more strongly than other traits. PMID:24709897

  19. A Novel Trust Service Provider for Internet Based Commerce Applications.

    ERIC Educational Resources Information Center

    Siyal, M. Y.; Barkat, B.

    2002-01-01

    Presents a framework for enhancing trust in Internet commerce. Shows how trust can be provided through a network of Trust Service Providers (TSp). Identifies a set of services that should be offered by a TSp. Presents a distributed object-oriented implementation of trust services using CORBA, JAVA and XML. (Author/AEF)

  20. Trust Matters: Leadership for Successful Schools, 2nd Edition

    ERIC Educational Resources Information Center

    Tschannen-Moran, Megan

    2014-01-01

    Make your school soar by escalating trust between teachers, students, and families. Trust is an essential element in all healthy relationships, and the relationships that exist in your school are no different. How can your school leaders or teachers cultivate trust? How can your institution maintain trust once it is established? These are the…

  1. 49 CFR 1013.2 - The irrevocability of the trust.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 8 2010-10-01 2010-10-01 false The irrevocability of the trust. 1013.2 Section... BOARD, DEPARTMENT OF TRANSPORTATION GENERAL RULES AND REGULATIONS GUIDELINES FOR THE PROPER USE OF VOTING TRUSTS § 1013.2 The irrevocability of the trust. (a) The trust and the nomination of the...

  2. The Nature and Function of Trust in Schools

    ERIC Educational Resources Information Center

    Adams, Curt M.; Forsyth, Patrick B.

    2009-01-01

    Our purpose was to advance and test a theoretical model of the nature and function of trust in schools. Unlike other studies, ours specified school trust as a latent construct manifested through parent and teacher trust perceptions. We hypothesized that trust would have a larger direct effect on collective teacher efficacy and achievement…

  3. 26 CFR 1.851-7 - Certain unit investment trusts.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... of $100 and a short- term capital gain of $50, computed as follows: (1) B is treated as owning 110... trust will be treated as directly owning the assets of such trust for taxable years of such holder which... proportionate share of the trust assets in exchange for his interest in the trust. Also, no gain or loss will...

  4. Guide to the Administration of Charitable Remainder Trusts. Third Edition.

    ERIC Educational Resources Information Center

    Clark, David W.; And Others

    This is the third edition of a workbook prepared as a kind of primer for those responsible for the administration of charitable remainder trusts in accordance with the Tax Reform Act of 1969. The topics covered include: trust administration in general; pooled income fund; unitrust; annuity trust; gift annuity; short term income (lead) trust; gift…

  5. 25 CFR 1000.354 - What is a trust evaluation?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... evaluation is an annual review and evaluation of trust functions performed by a Tribe/Consortium to ensure that the functions are performed in accordance with trust standards as defined by Federal law. Trust evaluations address trust functions performed by the Tribe/Consortium on its own behalf as well as...

  6. 25 CFR 1000.354 - What is a trust evaluation?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... evaluation is an annual review and evaluation of trust functions performed by a Tribe/Consortium to ensure that the functions are performed in accordance with trust standards as defined by Federal law. Trust evaluations address trust functions performed by the Tribe/Consortium on its own behalf as well as...

  7. 25 CFR 1000.354 - What is a trust evaluation?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... evaluation is an annual review and evaluation of trust functions performed by a Tribe/Consortium to ensure that the functions are performed in accordance with trust standards as defined by Federal law. Trust evaluations address trust functions performed by the Tribe/Consortium on its own behalf as well as...

  8. 25 CFR 1000.354 - What is a trust evaluation?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... evaluation is an annual review and evaluation of trust functions performed by a Tribe/Consortium to ensure that the functions are performed in accordance with trust standards as defined by Federal law. Trust evaluations address trust functions performed by the Tribe/Consortium on its own behalf as well as...

  9. Teacher Trust in District Administration: A Promising Line of Inquiry

    ERIC Educational Resources Information Center

    Adams, Curt M.; Miskell, Ryan C.

    2016-01-01

    Purpose: We set out in this study to establish a foundation for a line of inquiry around teacher trust in district administration by (1) describing the role of trust in capacity building, (2) conceptualizing trust in district administration, (3) developing a scale to measure teacher trust in district administration, and (4) testing the…

  10. 49 CFR 1013.2 - The irrevocability of the trust.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 8 2013-10-01 2013-10-01 false The irrevocability of the trust. 1013.2 Section... BOARD, DEPARTMENT OF TRANSPORTATION GENERAL RULES AND REGULATIONS GUIDELINES FOR THE PROPER USE OF VOTING TRUSTS § 1013.2 The irrevocability of the trust. (a) The trust and the nomination of the...

  11. 49 CFR 1013.2 - The irrevocability of the trust.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 8 2012-10-01 2012-10-01 false The irrevocability of the trust. 1013.2 Section... BOARD, DEPARTMENT OF TRANSPORTATION GENERAL RULES AND REGULATIONS GUIDELINES FOR THE PROPER USE OF VOTING TRUSTS § 1013.2 The irrevocability of the trust. (a) The trust and the nomination of the...

  12. Dynamic Trust Management for Mobile Networks and Its Applications

    ERIC Educational Resources Information Center

    Bao, Fenye

    2013-01-01

    Trust management in mobile networks is challenging due to dynamically changing network environments and the lack of a centralized trusted authority. In this dissertation research, we "design" and "validate" a class of dynamic trust management protocols for mobile networks, and demonstrate the utility of dynamic trust management…

  13. 12 CFR 745.9-1 - Trust accounts.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Trust accounts. 745.9-1 Section 745.9-1 Banks... AND APPENDIX Clarification and Definition of Account Insurance Coverage § 745.9-1 Trust accounts. (a) For purposes of this section, “trust” refers to an irrevocable trust. (b) All trust interests...

  14. 26 CFR 1.47-5 - Estates and trusts.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 1 2010-04-01 2010-04-01 true Estates and trusts. 1.47-5 Section 1.47-5... Computing Credit for Investment in Certain Depreciable Property § 1.47-5 Estates and trusts. (a) In general—(1) Disposition or cessation in hands of estate or trust. If an estate or trust disposes of...

  15. 26 CFR 8.1 - Charitable remainder trusts.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 14 2010-04-01 2010-04-01 false Charitable remainder trusts. 8.1 Section 8.1... Charitable remainder trusts. (a) Certain wills and trusts in existence on September 21, 1974. In the case of a will executed before September 21, 1974, or a trust created (within the meaning of...

  16. 24 CFR 92.500 - The HOME Investment Trust Fund.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false The HOME Investment Trust Fund. 92... Investment Trust Fund. (a) General. A HOME Investment Trust Fund consists of the accounts described in this... Investment Trust Fund United States Treasury account for each participating jurisdiction. Each...

  17. Do Reputation Systems Undermine Trust? Divergent Effects of Enforcement Type on Generalized Trust and Trustworthiness.

    PubMed

    Kuwabara, Ko

    2015-03-01

    Research shows that enforcing cooperation using contracts or tangible sanctions can backfire, undermining people's intrinsic motivation to cooperate: when the enforcement is removed, people are less trusting or trustworthy than when there is no enforcement to begin with. The author examines whether reputation systems have similar consequences for generalized trust and trustworthiness. Using a web-based experiment simulating online market transactions (studies 1 and 2), he shows that reputation systems can reinforce generalized trust and trustworthiness, unlike contractual enforcement or relational enforcement based on repeated interactions. In a survey experiment (study 3), he finds that recalling their eBay feedback scores made participants more trusting and trustworthy. These results are predicated on the diffuse nature of reputational enforcement to reinforce perceptions of trust and trustworthiness. These results have implications for understanding how different forms of governance affect generalized trust and trustworthiness.

  18. DualTrust: A Trust Management Model for Swarm-Based Autonomic Computing Systems

    SciTech Connect

    Maiden, Wendy M.

    2010-05-01

    Trust management techniques must be adapted to the unique needs of the application architectures and problem domains to which they are applied. For autonomic computing systems that utilize mobile agents and ant colony algorithms for their sensor layer, certain characteristics of the mobile agent ant swarm -- their lightweight, ephemeral nature and indirect communication -- make this adaptation especially challenging. This thesis looks at the trust issues and opportunities in swarm-based autonomic computing systems and finds that by monitoring the trustworthiness of the autonomic managers rather than the swarming sensors, the trust management problem becomes much more scalable and still serves to protect the swarm. After analyzing the applicability of trust management research as it has been applied to architectures with similar characteristics, this thesis specifies the required characteristics for trust management mechanisms used to monitor the trustworthiness of entities in a swarm-based autonomic computing system and describes a trust model that meets these requirements.

  19. Trust in health care providers: factors predicting trust among homeless veterans over time.

    PubMed

    van den Berk-Clark, Carissa; McGuire, James

    2014-08-01

    We examined whether a combination of predisposing, enabling, need, and primary care experience variables would predict trust in medical health care providers for homeless veterans over 18 months. Linear mixed model analysis indicated that, among these variables, race, social support, service-connected disability status, and satisfaction and continuity with providers predicted trust in provider over time. Trust in providers improved during the initial stages of the relationship between patient and provider and then declined to slightly below baseline levels over time. Further research is needed to determine generalizability and effects of provider trust on patient health care status over longer periods of time.

  20. Online trust building through third party trust transfer and third party protection

    NASA Astrophysics Data System (ADS)

    Wandoko, Wanda; Saleh Abbas, Bahtiar; Budiastuti, Dyah; Kosala, Raymond

    2017-03-01

    The primary objective of this research is to develop an online trust building mechanism for SME (Small Medium Enterprise). Trust is very important in e-commerce. The nature of online shopping has a greater uncertainty than offline shopping. Seeing as there is an uncertainty that can produce risks, a prospective buyer’s trust is needed. A lot of people’s unwillingness to shop online is caused by their lack of trust toward e-commerce. E-commerce is said to be one of the ways for SME to compete with bigger companies. However, building trust requires immense time and cost. SME with limited resources may experience difficulties in building trust just with their own resources. Base on literature research that needs to be validated in next research, we found that trust can be built through trust transfer from the reputable and well-known trust-mark issuer, and third party protection such as escrow account service and credit card issuer.

  1. Mortality of doctors in different specialties: findings from a cohort of 20000 NHS hospital consultants.

    PubMed Central

    Carpenter, L M; Swerdlow, A J; Fear, N T

    1997-01-01

    OBJECTIVES: To examine patterns of cause specific mortality in NHS hospital consultants according to their specialty and to assess these in the context of potential occupational exposures. METHODS: A historical cohort assembled from Department of Health records with follow up through the NHS Central Register involving 18,358 male and 2168 female NHS hospital consultants employed in England and Wales between 1962 and 1979. Main outcome measures examined were cause specific mortality during 1962-92 in all consultants combined, and separately for 17 specialty groups, with age, sex, and calendar year adjusted standardised mortality ratios (SMRs) for comparison with national rates, and rate ratios (RRs) for comparison with rates in all consultants combined. RESULTS: The 2798 deaths at ages 25 to 74 reported during the 30 year study period were less than half the number expected on the basis of national rates (SMR 48, 95% confidence interval (95% CI) 46 to 49). Low mortality was evident for cardiovascular disease, lung cancer, other diseases related to smoking, and particularly for diabetes (SMR 14, 95% CI 6 to 29). Death rates from accidental poisoning were significantly raised among male consultants (SMR 227, 95% CI 135 to 359), the excess being most apparent in obstetricians and gynaecologists (SMR 934); almost all deaths from accidental poisoning involved prescription drugs. A significantly raised death rate from injury and poisoning among female consultants was due largely to a twofold excess of suicide (SMR 215, 95% CI 93 to 423), the rate for this cause being significantly raised in anaesthetists (SMR 405). Compared with all consultants, significantly raised mortality was found in psychiatrists for all causes combined (RR 1.12), ischaemic heart disease (RR 1.18), and injury and poisoning (RR 1.46); in anaesthetists for cirrhosis (RR 2.22); and in radiologists and radiotherapists for respiratory disease (RR 1.68). There were significant excesses of colon cancer in

  2. Leaking Underground Storage Tank (LUST) Trust Fund

    EPA Pesticide Factsheets

    In 1986, Congress created the Leaking Underground Storage Tank (LUST) Trust Fund to address releases from federally regulated underground storage tanks (USTs) by amending Subtitle I of the Solid Waste Disposal Act.

  3. Usability and trust in e-banking.

    PubMed

    Pravettoni, Gabriella; Leotta, Salvatore Nuccio; Lucchiari, Claudio; Misuraca, Raffaella

    2007-12-01

    This study assessed the role of usability in trust of e-banking services. A questionnaire was administered to 185 Italian undergraduate working students who volunteered for the experiment (M age = 30.5 yr., SD = 3.1). Participants were differentiated on computer ability (Expert, n = 104; Nonexpert, n = 81) and e-banking use (User, n = 93; Nonusers, n = 92). Analysis showed that the website usability of e-banking services did not play a very important role for the User group. Instead, institution-based trust, e.g., the trust in the security policy of the Web merchant, customers, and the overall trust of the bank were the crucial factors in the adoption of e-banking.

  4. Environmental Education at The Wildfowl Trust

    ERIC Educational Resources Information Center

    Gadsby, Brian

    1975-01-01

    Describes the work of Wildfowl Trust in the areas of research, education, recreation and conservation. Presents the advantages of the wetland habitat for biological study and describes the facilities available to educational bodies at Martin Mere. (Author/GS)

  5. A General Framework of Human Trust in Networks

    DTIC Science & Technology

    2009-06-01

    information dominance and complete mission objectives. Soldiers must possess a sufficient amount of trust in networks for adequate mission performance. We are investigating human trust in tactical networks by establishing a theoretical framework for analysis and an approach for validation of the framework. We identify reliability and availability as network parameters that define the relationship between quality of service performance and human trust in networks. A general framework is being developed for human trust in networks, which combines singular elements of trust

  6. 24 Hours to Save the NHS - The Chief Executive's Account of Reform 2000 to 2006 Crisp Nigel 24 Hours to Save the NHS - The Chief Executive's Account of Reform 2000 to 2006 248pp Oxford University Press 9780199639953 0199639957 [Formula: see text].

    PubMed

    2012-02-22

    The title of this book comes from Tony Blair's political slogan on the eve of the 1997 election when he told voters they had '24 hours to save the NHS' by voting for a Labour government. The new millennium, however, still found the NHS in decline.

  7. Temperament Constructs Related to Betrayal of Trust

    DTIC Science & Technology

    1991-12-01

    empirical evidence for the use of such tests in identifying potential betrayers within organizations. It is argued that white-collar crimes such as...psychometric instruments provided some empirical evidence for the use of such tests in identifying potential trust betrayers within organizations. This research...workplace attitudes should be included in any empirical design to predict trust betrayal; (e) integrity tests have demonstrated an ability to distinguish

  8. Patient care: Is interpersonal trust missing?

    PubMed Central

    Bourne, Paul A.; Francis, Cynthia G.; Kerr-Campbell, Maureen D.

    2010-01-01

    Background: Health statistics and studies in the Caribbean have omitted interpersonal trust in their investigations. Aims: This study will examine the effect of interpersonal trust and other conditions on psychosocial subjective wellbeing and self-reported health, in order to assess the significance of interpersonal trust, as well as other socio-demographic factors on health. Materials and Method: The current study utilized primary data commissioned by the Centre of Leadership and Governance, Department of Government, the University of West Indies, Mona, Jamaica, between July and August 2006. It was a nationally representative probability sampling survey. A sample of 1,338 respondents was interviewed with a detailed 166-item questionnaire. Results: Generally, the psychosocial subjective wellbeing of Jamaicans was high (mean = 6.8 ± 1.8), and self-reported health was moderately high (mean = 6.3 ± 2.6). The current study has revealed that income, political system, subjective social class, employment status, and interpersonal trust determine psychosocial subjective wellbeing as well as self-reported health. Interpersonal trust accounted for between 9.4 to 10.4% of the explanatory power of the wellbeing and self-reported health of Jamaicans. Conclusion: The current study highlights that the determinants of health include interpersonal trust. It is critical to point out here that trust must be taken into consideration in any evaluation of health statistics, as it is a factor of subjective wellbeing and health. It is within this context that clinicians need to incorporate interpersonal trust along with other conditions, as it is a part of the psychosocial determinants of health, subjective wellbeing, and health treatment. PMID:22624126

  9. More Anonymous Onion Routing Through Trust

    DTIC Science & Technology

    2009-07-01

    attempt to compromise his anonymity . How should he take this trust into account when he selects his paths? 2.1. The model To make this question concrete...It also does not take into account the total effect of an adversary’s actions on a user’s anonymity , such as the analysis performed in [24]. The...More Anonymous Onion Routing Through Trust Aaron Johnson Computer Science Department Yale University New Haven, CT 06520 USA aaron.johnson@yale.edu

  10. Improving the labeling of S-acetyl NHS-MAG(3)-conjugated morpholino oligomers.

    PubMed

    Liu, Guozheng; Zhang, Surong; He, Jiang; Zhu, Zhihong; Rusckowski, Mary; Hnatowich, Donald J

    2002-01-01

    S-Acetyl MAG(3) (S-acetylmercaptoacetyltriglycine) has been used as a chelator for the (99m)Tc labeling of a variety of biomolecules. The objective of this study was to improve upon the labeling of morpholino (MORF), a DNA analogue, as a model biomolecule. A 15mer MORF with a primary amine was conjugated with NHS-MAG(3) in the usual manner, and the MORF-MAG(3) was purified over a P4 column as before. The conjugate was radiolabeled using stannous ion as usual, and the impurities were identified using size exclusion high-performance liquid chromatography (SE HPLC). Various methods were then investigated to remove the impurities. With tartrate as the transchelator, two impurities were identified as labeled MAG(3) and labeled tartrate. The labeled MAG(3) could not be removed by simply repurifying the conjugate using the usual pH 5.2 NH(4)OAc buffer before labeling. However, this impurity could be completely removed if the conjugate was adjusted to pH 7.6 and heated before repurification. The labeled tartrate impurity was removed by heating during labeling. On the basis of these observations, the following procedure for purification of the conjugation mixture and subsequent labeling was adopted. After MORF was conjugated with NHS-MAG(3) and purified over P4 with pH 5.2 NH(4)OAc eluant, the oligomer fractions were combined, adjusted to pH 7.6, and heated in a boiling water bath for 20 min. The conjugated oligomer was then repurified over P4 for storage at refrigerator temperatures. Labeling is achieved simply by adding fresh stannous ion to a solution of the MORF-MAG(3) in pH 7.6 containing tartrate followed by (99m)Tc-pertechnetate. After the mixture is heated for 20 min in boiling water, the labeling efficiency is always over 90% as determined by size exclusion HPLC and paper chromatography and the specific activities can exceed 7 mCi/microg. By making several relatively simple changes to the routine procedure used to conjugate and radiolabel biomolecules with (99m

  11. Interpersonal Trust across Six Asia-Pacific Countries: Testing and Extending the ‘High Trust Society’ and ‘Low Trust Society’ Theory

    PubMed Central

    Ward, Paul R.; Mamerow, Loreen; Meyer, Samantha B.

    2014-01-01

    Background Trust is regarded as a necessary component for the smooth running of society, although societal and political modernising processes have been linked to an increase in mistrust, potentially signalling social and economic problems. Fukuyama developed the notion of ‘high trust’ and ‘low trust’ societies, as a way of understanding trust within different societies. The purpose of this paper is to empirically test and extend Fukuyama’s theory utilising data on interpersonal trust in Taiwan, Hong Kong, South Korea, Japan, Australia and Thailand. This paper focuses on trust in family, neighbours, strangers, foreigners and people with a different religion. Methods Cross-sectional surveys were undertaken in 2009–10, with an overall sample of 6331. Analyses of differences in overall levels of trust between countries were undertaken using Chi square analyses. Multivariate binomial logistic regression analysis was undertaken to identify socio-demographic predictors of trust in each country. Results Our data indicate a tripartite trust model: ‘high trust’ in Australia and Hong Kong; ‘medium trust’ in Japan and Taiwan; and ‘low trust’ in South Korea and Thailand. Trust in family and neighbours were very high across all countries, although trust in people with a different religion, trust in strangers and trust in foreigners varied considerably between countries. The regression models found a consistent group of subpopulations with low trust across the countries: people on low incomes, younger people and people with poor self-rated health. The results were conflicting for gender: females had lower trust in Thailand and Hong Kong, although in Australia, males had lower trust in strangers, whereas females had lower trust in foreigners. Conclusion This paper identifies high, medium and low trust societies, in addition to high and low trusting population subgroups. Our analyses extend the seminal work of Fukuyama, providing both corroboration and

  12. Trust makers, breakers and brokers: building trust in the Australian food system

    PubMed Central

    2013-01-01

    Background The importance of consumer trust in the food supply has previously been identified, and dimensions of consumer trust in food—who they trust and the type of trust that they exhibit—has been explored. However, there is a lack of research about the mechanisms through which consumer trust in the food supply is developed, maintained, broken and repaired. This study seeks to address this gap by exploring if, and how, consumer trust in the food supply is considered by the media, food industry and governments when responding to food scares. The aim of the research is to develop models of trust building that can be implemented following food scares. Methods Semi-structured interviews will be undertaken with media, public relations officials and policy makers in Australia, New Zealand and the United Kingdom. Participants will be recruited through purposive sampling and will be asked to discuss a hypothetical case study outlining a food incident, and any experiences of specific food scares. Models of trust development, maintenance and repair will be developed from interview data. Comment on these models will be sought from experts in food-related organizations through a Delphi study, where participants will be asked to consider the usefulness of the models. Participants’ comments will be used to revise the models until consensus is reached on the suitability and usability of the models. Discussion This study will contribute to the literature about systems-based trust, and explore trust as a social and regulatory process. The protocol and results will be of interest and use to the food industry, food regulators, consumer advocate groups, media seeking to report food-related issues and policy makers concerned with public health and consumer health and well-being. This research represents an important contribution to the translation of the theoretical conceptualizations of trust into practical use in the context of food. PMID:23496819

  13. Cross section limits for the Cm248(Mg25,4n-5n)Hs268,269 reactions

    NASA Astrophysics Data System (ADS)

    Dvorak, J.; Brüchle, W.; Düllmann, Ch. E.; Dvorakova, Z.; Eberhardt, K.; Eichler, R.; Jäger, E.; Nagame, Y.; Qin, Z.; Schädel, M.; Schausten, B.; Schimpf, E.; Schuber, R.; Semchenkov, A.; Thörle, P.; Türler, A.; Wegrzecki, M.; Yakushev, A.

    2009-03-01

    We report on an attempt to produce and detect Hs268 and Hs269 in the nuclear fusion reaction Mg25+Cm248 using the gas phase chemistry apparatus COMPACT. No decay chains attributable to the decay of hassium isotopes were observed during the course of this experiment. From the nonobservation of Hs269 we derive a cross section limit of 0.4 pb (63% confidence limit) for the reaction Cm248(Mg25,4n)Hs269 at a center-of-target beam energy of 140 MeV. The evaluated cross section limit for the Cm248(Mg25,5n)Hs268 reaction depends on the assumed half-life of unknown Hs268. Current systematics of the half-lives for even-even Hs isotopes suggests a value of 0.5 s, resulting in a cross section limit of 1.3 pb.

  14. Artificial intelligence techniques to optimize the EDC/NHS-mediated immobilization of cellulase on Eudragit L-100.

    PubMed

    Zhang, Yu; Xu, Jing-Liang; Yuan, Zhen-Hong; Qi, Wei; Liu, Yun-Yun; He, Min-Chao

    2012-01-01

    Two artificial intelligence techniques, namely artificial neural network (ANN) and genetic algorithm (GA) were combined to be used as a tool for optimizing the covalent immobilization of cellulase on a smart polymer, Eudragit L-100. 1-Ethyl-3-(3-dimethyllaminopropyl) carbodiimide (EDC) concentration, N-hydroxysuccinimide (NHS) concentration and coupling time were taken as independent variables, and immobilization efficiency was taken as the response. The data of the central composite design were used to train ANN by back-propagation algorithm, and the result showed that the trained ANN fitted the data accurately (correlation coefficient R(2) = 0.99). Then a maximum immobilization efficiency of 88.76% was searched by genetic algorithm at a EDC concentration of 0.44%, NHS concentration of 0.37% and a coupling time of 2.22 h, where the experimental value was 87.97 ± 6.45%. The application of ANN based optimization by GA is quite successful.

  15. The Influence of Trust in Physicians and Trust in the Healthcare System on Linkage, Retention, and Adherence to HIV Care.

    PubMed

    Graham, James L; Shahani, Lokesh; Grimes, Richard M; Hartman, Christine; Giordano, Thomas P

    2015-12-01

    Lack of trust by the patient in the physicians or the healthcare system has been associated with poorer health outcomes. The present study was designed to determine if trust in physicians and the healthcare system among persons newly diagnosed with HIV infection was predictive of patients' subsequent linkage, retention, and adherence to HIV care. 178 newly diagnosed HIV infected patients were administered the trust-in-physicians and trust-in-healthcare system scales. Median trust-in-physicians and trust-in-healthcare system scores were compared for all the mentioned subsequent linkage, retention, and adherence to HIV care. Univariate logistic regression using the trust-in-physician scale confirmed significant association with retention in care (p = 0.04), which persisted in multivariate analyses (p = 0.04). No significant association was found between trust-in-physicians and linkage to care or adherence to antiretroviral therapy. Trust in the healthcare system was not associated with any of the outcomes. Patients with higher trust in physicians were more likely to be retained in HIV care. Trust at diagnosis may not be a barrier to better clinical outcomes, either because trust changes based on subsequent interactions, or because trust is not a determining feature. Interventions to improve retention in care could include improving trust in physicians or target persons with low trust in physicians.

  16. Postcode Lotteries in Public Health - The NHS Health Checks Programme in North West London

    PubMed Central

    2011-01-01

    Background Postcode lotteries in health refer to differences in health care between different geographic areas. These have been previously associated with clinical services. However there has been little documentation of postcode lotteries relating to preventative health care services. This paper describes a postcode lottery effect in relation to the NHS Health Checks Programme (a national cardiovascular screening programme in England) in eight PCTs in the North West sector of London. Methods A descriptive cross-sectional analysis of the Health Checks Programme was carried out in eight PCTs in North West London using a structured data-collecting instrument. Results The analysis found variation in the implementation of the national Health Checks Programme in terms of: the screening approach taken; the allocated budget (which varied from £69,000 to £1.4 million per 100,000 eligible population); payment rates made to providers of Health Checks; tools used to identify and measure risk of cardiovascular disease and diabetes; monitoring and evaluation; and preventative services available following the health check. Conclusions This study identifies a postcode lottery effect related to a national public health programme. Although it is important to allow enough flexibility in the design of the Health Checks Programme so that it fits in with local factors, aspects of the programme may benefit from greater standardisation or stronger national guidance. PMID:21955810

  17. Continuities in caring? Emotion work in a NHS Direct call centre.

    PubMed

    Weir, Hannele; Waddington, Kathryn

    2008-03-01

    Changes in technological and economic aspects of society have impacted on how we understand professional and client relationships. These relationships are constructed in terms of patients/users requiring care, and customers whose complaints have become a yardstick of satisfaction. A consequence of these changes is an interest in the related concepts of emotional labour and emotion work. For nurses, caring for people in illness and in health is central to their work, and it is this aspect of emotion at work that distinguishes nursing from other occupational groups. This paper is concerned with emotion work in a National Health Service Direct (NHS Direct) call centre in the United Kingdom. Drawing upon theoretical perspectives from organizational psychology and sociology it focuses upon the social processes that narrate emotion events in a specific context. It is based on a qualitative study exploring the experience and emotion work of nurses working in a call centre. Issues in caring without the face-to-face contact using communication technology were crucial to the way nurses perceived their work. These factors contributed to nurses' orientation to work and to the way that conflict and dissonance with expectations of callers and managers impacted on nurses' emotion work.

  18. Influencing organisational change in the NHS: lessons learned from workplace wellness initiatives in practice.

    PubMed

    Blake, Holly; Lloyd, Scott

    2008-01-01

    This article presents a discussion of the key issues in influencing organisational change in NHS settings, in the development of workplace wellness interventions to improve employee health and wellbeing. To tackle poor public health and associated rising healthcare costs, there must be a focus on the root cause of many preventable diseases - unhealthy lifestyle choices. Workplace wellness initiatives are now an important prevention strategy adopted by socially responsible organisations to target the health and wellbeing of working age adults. Lessons learned from initiatives in secondary care suggest that effective implementation requires change in organisational 'health culture', through a combination of education, behaviour change intervention, needs-based facilities, and services and strategies for developing supportive and health-promoting work environments. Most of all, employers must demonstrate a commitment to health and wellness that is fully integrated with their mission, values and long-term vision, paving the way for sustainable lifestyle changes. Evaluation systems must be in place to measure the impact and outcomes of wellness schemes.

  19. International nurse recruitment and NHS vacancies: a cross-sectional analysis.

    PubMed

    Batata, Amber S

    2005-04-22

    BACKGROUND: Foreign-trained nurse recruits exceeded the number of new British-trained recruits on the UK nurse register for the first time in 2001. As the nursing shortage continues, health care service providers rely increasingly on overseas nurses to fill the void. Which areas benefit the most? And where would the NHS be without them? METHODS: Using cross-sectional data from the 2004 Nursing and Midwifery Council register, nurse resident postcodes are mapped to Strategic Health Authorities to see where foreign recruits locate and how they affect nurse shortages throughout the UK. RESULTS: Areas with the highest vacancy rates also have the highest representation of foreign recruits, with 24% of foreign-trained nurses in the UK residing in the London area and another 16% in the SouthEast (comparable numbers for British-trained nurses are 11% and 13%, respectively). Without foreign recruitment, vacancy rates could be up to five times higher (three times higher if only Filipino recruits remained). CONCLUSION: The UK heavily relies on foreign recruitment to fill vacancies, without which the staffing crisis would be far worse, particularly in high vacancy areas.

  20. Nursing work in NHS Direct: constructing a nursing identity in the call-centre environment.

    PubMed

    Snelgrove, Sherrill Ray

    2009-12-01

    The introduction of nurse-led telephone helplines for patients to have access to information and advice has led to the development of a new kind of practise for nurses. This study focuses on the ways NHS Direct (NHSD) nurses construct a nursing identity and shape their work in a call-centre environment. The empirical findings are drawn from a study investigating the impact of NHSD on professional nursing issues that was part of a wider evaluation of the service in South Wales, UK. Data were gathered from responses to free text questions included in a questionnaire sent to nurses in three NHSD sites. Further data were collected from focus groups held with NHSD nurses. The nurses defend their identity as nurses rather than call-centre workers. The discourses of the nurses show a strong alignment with the traditional values of nursing, encompassing holistic and empathetic practise that has moved with the nurses across locales. We argue that the nurses frame a nursing identity in NHSD around the importance of previous experience and claim to practise holistic nursing. However, the development of new skills and adaptation of old skills in response to the demand of NHSD work challenges normative notions of traditional 'hands-on' models of practise and indicates a possible movement towards a cognitive model of nursing based upon knowledge, analytical and communication skills that reflects the transformative and dynamic nature of professional identity and boundaries.

  1. Facing the future: the effects of the impending financial drought on NHS finances and how UK radiology services can contribute to expected efficiency savings

    PubMed Central

    Grant, L; Appleby, J; Griffin, N; Adam, A; Gishen, P

    2012-01-01

    The recent turmoil within the banking sector has led to the development of the most significant recession since the “great depression” of the 1930s. Although the coalition government has promised to “guarantee that health spending increases in real terms in each year of Parliament”, this may still not be enough to meet future needs over the coming years due to increasing demand and cost pressures. The expected mismatch between actual National Health Service (NHS) funding post-2011 and that required to satisfy increasing demand has been estimated by the Department of Health to require efficiency savings representing up to one-fifth of the overall NHS budget. This paper explains the reasons behind the anticipated slowdown in the growth of real NHS funding, and how, as a discipline, radiology can increase the efficiency of the services it provides in anticipation of future financial austerity within the NHS. PMID:22167516

  2. Facing the future: the effects of the impending financial drought on NHS finances and how UK radiology services can contribute to expected efficiency savings.

    PubMed

    Grant, L; Appleby, J; Griffin, N; Adam, A; Gishen, P

    2012-06-01

    The recent turmoil within the banking sector has led to the development of the most significant recession since the "great depression" of the 1930s. Although the coalition government has promised to "guarantee that health spending increases in real terms in each year of Parliament", this may still not be enough to meet future needs over the coming years due to increasing demand and cost pressures. The expected mismatch between actual National Health Service (NHS) funding post-2011 and that required to satisfy increasing demand has been estimated by the Department of Health to require efficiency savings representing up to one-fifth of the overall NHS budget. This paper explains the reasons behind the anticipated slowdown in the growth of real NHS funding, and how, as a discipline, radiology can increase the efficiency of the services it provides in anticipation of future financial austerity within the NHS.

  3. In Public Education Expenditures We Trust: Does Trust Increase Support for Public Education Expenditures?

    ERIC Educational Resources Information Center

    Gur, Nurullah; Boyaci, Israfil; Ozcan, Yunus

    2015-01-01

    Trust is one crucial prerequisite for the welfare state. However, very few empirical studies exist that help us understand the mechanisms through which trust affects the welfare state. Influencing public support for developing friendly public policies might be one of these mechanisms. In this study, we use unique micro data from 34 countries to…

  4. Trust and Its Role in Principal Succession: A Preliminary Examination of a Continuum of Trust

    ERIC Educational Resources Information Center

    Macmillan, Robert B.; Meyer, Matthew J.; Northfield, Shawn

    2004-01-01

    Trust is a critical factor in determining whether principal-teacher working relationships are positive or negative. This article begins to explore the concept of trust and its development in twelve Canadian secondary schools that experienced frequent principal turnover in a period of eight years. The authors found that the development of trust…

  5. 26 CFR 26.2654-1 - Certain trusts treated as separate trusts.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... death of the grantor if the trust is includible in its entirety in the grantor's gross estate for... of a pecuniary amount at the death of the transferor from an inter vivos trust that is includible in... death $500,000 is payable to T's spouse, S, with the balance of the principal to be held for the...

  6. Building a Culture of Trust: Trust in the Use of Educational Technology

    ERIC Educational Resources Information Center

    Kirkman, Jacqueline

    2014-01-01

    This paper investigates the place of trust in a school context and its importance in achieving the aims of schooling, "namely high academic performance and positive affects among members of the school community" (Forsyth, 2008). The role of trust in the use of technology and technological change is examined. Literature is surveyed in the…

  7. 'A potential fifth column': conflicts and struggles for control in the context of local NHS privatization.

    PubMed

    Aldred, Rachel

    2009-09-01

    This article uses case study data to discuss how a new procurement policy (Local Improvement Finance Trust, or LIFT) in English primary care may affect general practitioners' control over their work. LIFT, a series of 51 public-private partnerships, will enable over the medium term a shift towards the corporate ownership of surgeries and the creation of polyclinics or 'onestop-shops'. In this article, I explore the struggles over work autonomy and control within these new LIFT structures, as expressed by clinicians and managers in meetings and in research interviews. More generally, I consider how the findings inform debates over the changing position of professionals within increasingly financialized 'local health economies'.

  8. Trust in health information websites: A systematic literature review on the antecedents of trust.

    PubMed

    Kim, Yeolib

    2016-06-01

    Health websites are important sources of information for consumers. In choosing websites, trust in websites largely determines which website to access and how to best utilize the information. Thus, it is critical to understand why consumers trust certain websites and distrust others. A systematic literature review was conducted with the goal of identifying the antecedents of trust in health information websites. After four rounds of screening process, 20 articles between 2000 and 2013 were harvested. Factors that determine trust are classified into individual difference antecedents, website-related antecedents, and consumer-to-website interaction-related antecedents. The most frequently studied antecedents were socio-demographics, information quality, appearance, and perceived reputation of the website. Each antecedent of trust are discussed in detail and future research directions are proposed.

  9. Can one trust quantum simulators?

    NASA Astrophysics Data System (ADS)

    Hauke, Philipp; Cucchietti, Fernando M.; Tagliacozzo, Luca; Deutsch, Ivan; Lewenstein, Maciej

    2012-08-01

    Various fundamental phenomena of strongly correlated quantum systems such as high-Tc superconductivity, the fractional quantum-Hall effect and quark confinement are still awaiting a universally accepted explanation. The main obstacle is the computational complexity of solving even the most simplified theoretical models which are designed to capture the relevant quantum correlations of the many-body system of interest. In his seminal 1982 paper (Feynman 1982 Int. J. Theor. Phys. 21 467), Richard Feynman suggested that such models might be solved by ‘simulation’ with a new type of computer whose constituent parts are effectively governed by a desired quantum many-body dynamics. Measurements on this engineered machine, now known as a ‘quantum simulator,’ would reveal some unknown or difficult to compute properties of a model of interest. We argue that a useful quantum simulator must satisfy four conditions: relevance, controllability, reliability and efficiency. We review the current state of the art of digital and analog quantum simulators. Whereas so far the majority of the focus, both theoretically and experimentally, has been on controllability of relevant models, we emphasize here the need for a careful analysis of reliability and efficiency in the presence of imperfections. We discuss how disorder and noise can impact these conditions, and illustrate our concerns with novel numerical simulations of a paradigmatic example: a disordered quantum spin chain governed by the Ising model in a transverse magnetic field. We find that disorder can decrease the reliability of an analog quantum simulator of this model, although large errors in local observables are introduced only for strong levels of disorder. We conclude that the answer to the question ‘Can we trust quantum simulators?’ is … to some extent.

  10. Duncan Tanner Essay Prize Winner 2014. Against the 'Sacred Cow': NHS Opposition and the Fellowship for Freedom in Medicine, 1948-72.

    PubMed

    Seaton, Andrew

    2015-01-01

    This essay recovers organized opposition to the National Health Service (NHS) by considering the Fellowship for Freedom in Medicine (FFM), a conservative organization of doctors who challenged the 'Sacred Cow' of nationalized healthcare in the 1950s and 1960s. While there has been little interest in anti-NHS politics because of shortcomings in the institution's historiography, this study suggests ways a new history of the service can be written. Central to that project is taking the broader ideological and emotive quality of the NHS seriously, and appreciating the way, for all sides of the political spectrum, as well as the general public, the service has always been a contested symbol of post-war British identity. This essay argues that two NHS 'crises'--panics over costs, and disillusionment within general practice--were not merely disagreements over budgets and pay-packets but politically charged moments infused with conservative anxieties over Britain's post-war trajectory. The FFM imagined the NHS as an economically dangerous bureaucratic machine that crushed medical independence and risked pushing the country towards dictatorship. Allies within the Conservative Party, private health insurance industry, and free-market 'think-tanks' worked with the FFM to challenge defences of both the service's operation and meaning. To appreciate why the NHS remains 'the closest thing the English have to a religion', one must consider the apostates as well as the faithful.

  11. Early findings from an evaluation of a post-registration staff development programme: The Flying Start NHS initiative in Scotland, UK.

    PubMed

    Roxburgh, Michelle; Lauder, William; Topping, Keith; Holland, Karen; Johnson, Martin; Watson, Roger

    2010-03-01

    The first year post-qualifying as a nurse or midwife is often seen as a key transitional period. Flying Start NHS is the national development programme for all newly qualified nurses, midwives and allied health professionals in NHS Scotland. It is designed to support the transition from student to newly qualified health professional through supporting learning in everyday practice. It is a web-based or CD-ROM programme which seeks to increase the confidence and competence of newly qualified nurses and midwives during their first year of employment following registration. The aims of this study were to establish levels of self-report competency, self-efficacy, job demands and career intentions in newly qualified nurses undertaking Flying Start NHS programme in Scotland. The aims were met by conducting a cross-sectional survey of Flying Start NHS students. Newly qualified nurse participants (n=97) comprised a convenience sample of newly qualified nurses who were registered as undertaking the Flying Start NHS on-line programme during Autumn-Winter 2007. Most newly qualified nurses intend to remain in the NHS although a small but important number may leave.

  12. Power decreases trust in social exchange.

    PubMed

    Schilke, Oliver; Reimann, Martin; Cook, Karen S

    2015-10-20

    How does lacking vs. possessing power in a social exchange affect people's trust in their exchange partner? An answer to this question has broad implications for a number of exchange settings in which dependence plays an important role. Here, we report on a series of experiments in which we manipulated participants' power position in terms of structural dependence and observed their trust perceptions and behaviors. Over a variety of different experimental paradigms and measures, we find that more powerful actors place less trust in others than less powerful actors do. Our results contradict predictions by rational actor models, which assume that low-power individuals are able to anticipate that a more powerful exchange partner will place little value on the relationship with them, thus tends to behave opportunistically, and consequently cannot be trusted. Conversely, our results support predictions by motivated cognition theory, which posits that low-power individuals want their exchange partner to be trustworthy and then act according to that desire. Mediation analyses show that, consistent with the motivated cognition account, having low power increases individuals' hope and, in turn, their perceptions of their exchange partners' benevolence, which ultimately leads them to trust.

  13. The motivation and behaviour of hospital Trusts.

    PubMed

    Crilly, Tessa; Le Grand, J Julian

    2004-05-01

    This paper explores the motivation and behaviour of hospitals, using data from UK hospital Trusts. Managers and consultants (hospital specialists) are identified as the main alternative sources of power within Trusts. It is hypothesised that consultants are interested in production or service (volume and quality) while managers are interested primarily in financial break-even, and that in the long run consultants will dominate. A survey of 1500 consultants and managers and a statistical analysis of the behaviour of 100 Trusts over 3 years yielded the empirical results that were largely but not entirely consistent with these hypotheses. Consultants did indeed consider production goals to be more important than financial breakeven, but within those goals, considered quality to be more important than service volume. While the break-even target was found to be the primary goal of managers on average, they proved to be a heterogeneous group with quality ranking as the main priority among those managers who are closest to service delivery. This is at odds with the apparent objective of Trusts, which both groups perceive as being the single-minded pursuit of financial targets, consistent with the formal, government-set requirements. We find that this strong and unequivocal financial driver is not owned or acted upon by either consultants or managers and it is inferred that, in accordance with the dominant motivation of consultants, the Trust's primary objective is to maintain service quality.

  14. Power decreases trust in social exchange

    PubMed Central

    Schilke, Oliver; Reimann, Martin; Cook, Karen S.

    2015-01-01

    How does lacking vs. possessing power in a social exchange affect people’s trust in their exchange partner? An answer to this question has broad implications for a number of exchange settings in which dependence plays an important role. Here, we report on a series of experiments in which we manipulated participants’ power position in terms of structural dependence and observed their trust perceptions and behaviors. Over a variety of different experimental paradigms and measures, we find that more powerful actors place less trust in others than less powerful actors do. Our results contradict predictions by rational actor models, which assume that low-power individuals are able to anticipate that a more powerful exchange partner will place little value on the relationship with them, thus tends to behave opportunistically, and consequently cannot be trusted. Conversely, our results support predictions by motivated cognition theory, which posits that low-power individuals want their exchange partner to be trustworthy and then act according to that desire. Mediation analyses show that, consistent with the motivated cognition account, having low power increases individuals’ hope and, in turn, their perceptions of their exchange partners’ benevolence, which ultimately leads them to trust. PMID:26438869

  15. Identifying and managing patients with delirium in acute care settings.

    PubMed

    Bond, Penny; Goudie, Karen

    2015-11-01

    Delirium is an acute medical emergency affecting about one in eight acute hospital inpatients. It is associated with poor outcomes, is more prevalent in older people and it is estimated that half of all patients receiving intensive care or surgery for a hip fracture will be affected. Despite its prevalence and impact, delirium is not reliably identified or well managed. Improving the identification and management of patients with delirium has been a focus for the national improving older people's acute care work programme in NHS Scotland. A delirium toolkit has been developed, which includes the 4AT rapid assessment test, information for patients and carers and a care bundle for managing delirium based on existing guidance. This toolkit has been tested and implemented by teams from a range of acute care settings to support improvements in the identification and immediate management of delirium.

  16. Trust and health: testing the reverse causality hypothesis

    PubMed Central

    Giordano, Giuseppe Nicola; Lindström, Martin

    2016-01-01

    Background Social capital research has consistently shown positive associations between generalised trust and health outcomes over 2 decades. Longitudinal studies attempting to test causal relationships further support the theory that trust is an independent predictor of health. However, as the reverse causality hypothesis has yet to be empirically tested, a knowledge gap remains. The aim of this study, therefore, was to investigate if health status predicts trust. Methods Data employed in this study came from 4 waves of the British Household Panel Survey between years 2000 and 2007 (N=8114). The sample was stratified by baseline trust to investigate temporal relationships between prior self-rated health (SRH) and changes in trust. We used logistic regression models with random effects, as trust was expected to be more similar within the same individuals over time. Results From the ‘Can trust at baseline’ cohort, poor SRH at time (t−1) predicted low trust at time (t) (OR=1.38). Likewise, good health predicted high trust within the ‘Cannot’ trust cohort (OR=1.30). These patterns of positive association remained after robustness checks, which adjusted for misclassification of outcome (trust) status and the existence of other temporal pathways. Conclusions This study offers empirical evidence to support the circular nature of trust/health relationship. The stability of association between prior health status and changes in trust over time differed between cohorts, hinting at the existence of complex pathways rather than a simple positive feedback loop. PMID:26546287

  17. National community pharmacy NHS influenza vaccination service in Wales: a primary care mixed methods study

    PubMed Central

    Evans, Andrew M; Wood, Fiona C; Carter, Ben

    2016-01-01

    Background Influenza is a significant cause of morbidity and excess mortality, yet vaccine coverage in the UK remains below target. Community pharmacies are increasingly being promoted as an alternative to vaccination by GPs. Aim To explore and verify the factors that influence the relative performance of pharmacies providing NHS influenza vaccinations. Design and setting A mixed methods study utilising qualitative, semi-structured interviews and quantitative analysis of predictors of vaccination numbers in community pharmacies in Wales. Method Interviews were conducted with 16 pharmacists who participated in the Welsh national pharmacy influenza service in 2013–2014. A purposive sampling strategy was used. Qualitative findings were analysed using framework analysis. Potential predictors of vaccination numbers were identified from interviews and a literature review, and included in a multivariable regression model. Results The contribution of community pharmacies towards vaccination in Wales is small. Findings suggest that community pharmacies reach younger at-risk individuals, in whom vaccine uptake is low, in greater proportion than influenza vaccination programmes as a whole. Extended opening hours and urban locations were positively associated with the number of vaccinations given, although pharmacists reported that workload, vaccine costs, unforeseen delays, lack of public awareness, and GPs’ views of the service limited their contribution. Pharmacists, aware of the potential for conflict with GPs, moderated their behaviour to mitigate such risk. Conclusion Before community pharmacies take greater responsibility for delivering healthcare services, obstacles including increasing pharmacist capacity, vaccine procurement, health service delays, managing GP–pharmacy relationships, and improving public awareness must be overcome. PMID:26965025

  18. Unfashionable tales: narratives about what is (still) great in NHS general practice

    PubMed Central

    Spooner, Sharon

    2016-01-01

    Background There is clear evidence that general practice has become a less popular career choice and among GPs there are high levels of dissatisfaction and demotivation. Little empirical evidence has emerged to indicate which factors contribute intrinsic value to the working lives of GPs and sustain their ongoing commitment. Aim To understand which aspects of work continue to motivate and engage senior GPs by exploring their narrative accounts. Design and setting This was part of a qualitative study in which senior GPs and hospital specialists contributed narratives in which they reflected on their working lives. Method Individual, open interviews were conducted with eight GPs who had graduated in the early 1980s. Thematic analysis and situational analysis mapping were used to identify and connect related themes. Results During interviews in which doctors drew on a wide range of encounters and experiences, they revealed which aspects of work were associated with greater intrinsic rewards and contributed to their continuing motivation. Having chosen careers that suited their preferred settings and working practices, they recounted adjustments made in response to new challenges and confirmed experiencing greater enjoyment when performing roles affirming their sense of providing valued health care. Conclusion This study’s findings offer an alternative angle from which to consider the current unpopularity of general practice careers. The article proposes that long-term engagement of practitioners may be achieved through provision of adequate supportive resources to allow them to enact a sense of medical identity that matches with their acquired expectations of their role in the NHS. PMID:26740605

  19. Novel collagen scaffolds prepared by using unnatural D-amino acids assisted EDC/NHS crosslinking.

    PubMed

    Krishnamoorthy, Ganesan; Sehgal, Praveen Kumar; Mandal, Asit Baran; Sadulla, Sayeed

    2013-01-01

    This work discusses the preparation and characterization of novel collagen scaffolds by using unnatural D-amino acids (Coll-D-AAs)-assisted 1-ethyl-3-(3-dimethylaminopropyl)-carbodiimide (EDC)/N-hydroxyl succinimide(NHS)-initiated crosslinking. The mechanical strength, hydrothermal and structural stability, resistance to biodegradation and the biocompatibility of Coll-D-AAs matrices were investigated. The results from Thermo mechanical analysis, Differential scanning calorimetric analysis and Thermo gravimetric analysis of the Coll-D-AAs matrices indicate a significant increase in the tensile strength (TS, 180±3), % elongation (% E, 80±9), elastic modulus (E, 170±4) denaturation temperature (T d, 108±4) and a significant decrease in decomposition rate (Tg, 64±6). Scanning electron microscopic and Atomic force microscopic analyses revealed a well-ordered with properly oriented and well-aligned structure of the Coll-D-AAs matrices. FT-IR results suggest that the incorporation of D-AAs favours the molecular stability of collagen matrix. The D-AAs stabilizing the collagen matrices against degradation by collagenase would have been brought about by protecting the active sites in collagen. The Coll-D-AAs matrices have good biocompatibility when compared with native collagen matrix. Molecular docking studies also indicate better understanding of bonding pattern of collagen with D-AAs. These Coll-D-AAs matrices have been produced in high mechanical strength, thermally and biologically stable, and highly biocompatible forms that can be further manipulated into the functional matrix suitable in designing scaffolds for tissue engineering and regenerative medical applications.

  20. Health care reform in Portugal: an evaluation of the NHS experience.

    PubMed

    Oliveira, Mónica Duarte; Pinto, Carlos Gouveia

    2005-09-01

    Since 1979, the Portuguese health care system has been based on a National Health Service structure that is expected to promote equity, efficiency, quality, accountability and the devolution of power. In this article, we analyse the content and impact of policies designed to reform the system between 1979 and 2002. This article differs from previous studies in that it uses a stage-based framework to evaluate the policy-making process and the impact of health care reform throughout different political cycles. We show that the NHS model has never been fully implemented and that many policies have diverted the system from its original objectives. Different governments have endorsed a progressive split between financing and provision and the institution of 'new public management' rules in public providers. We conclude that most policies put forward by Social Democratic governments have aimed at influencing demand, while Socialist governments have targeted the supply side. These policies have led to increases in health expenditure that have been comparatively more cost-shared by the State under Socialist governments. We show some overriding trends, namely as follows: despite huge improvements in health outcomes, the system is nonetheless lasting to meet its goals, particularly in terms of the equity of access and utilisation; accountability problems, inadequacies in the use of operational reforming tools (such as resource allocation mechanisms) and a lack of mechanisms to promote efficient behaviour, are all associated with cost containment problems. Structural reforms have been undertaken since 2002 and these have offered some potential for improving accountability and efficiency. Nonetheless, the success of these reforms calls for certain conditions that do not seem to have been fulfilled.

  1. Lost to the NHS: a mixed methods study of why GPs leave practice early in England

    PubMed Central

    Doran, Natasha; Fox, Fiona; Rodham, Karen; Taylor, Gordon; Harris, Michael

    2016-01-01

    Background The loss of GPs in the early stages of their careers is contributing to the GP workforce crisis. Recruitment in the UK remains below the numbers needed to support the demand for GP care. Aim To explore the reasons why GPs leave general practice early. Design and setting A mixed methods study using online survey data triangulated with qualitative interviews. Method Participants were GPs aged <50 years who had left the English Medical Performers List in the last 5 years (2009–2014). A total of 143 early GP leavers participated in an online survey, of which 21 took part in recorded telephone interviews. Survey data were analysed using descriptive statistics, and qualitative data using thematic analysis techniques. Results Reasons for leaving were cumulative and multifactorial. Organisational changes to the NHS have led to an increase in administrative tasks and overall workload that is perceived by GP participants to have fundamentally changed the doctor–patient relationship. Lack of time with patients has compromised the ability to practise more patient-centred care, and, with it, GPs’ sense of professional autonomy and values, resulting in diminished job satisfaction. In this context, the additional pressures of increased patient demand and the negative media portrayal left many feeling unsupported and vulnerable to burnout and ill health, and, ultimately, to the decision to leave general practice. Conclusion To improve retention of young GPs, the pace of administrative change needs to be minimised and the time spent by GPs on work that is not face-to-face patient care reduced. PMID:26740606

  2. Distributed Trust Management for Validating SLA Choreographies

    NASA Astrophysics Data System (ADS)

    Haq, Irfan Ul; Alnemr, Rehab; Paschke, Adrian; Schikuta, Erich; Boley, Harold; Meinel, Christoph

    For business workflow automation in a service-enriched environment such as a grid or a cloud, services scattered across heterogeneous Virtual Organizations (VOs) can be aggregated in a producer-consumer manner, building hierarchical structures of added value. In order to preserve the supply chain, the Service Level Agreements (SLAs) corresponding to the underlying choreography of services should also be incrementally aggregated. This cross-VO hierarchical SLA aggregation requires validation, for which a distributed trust system becomes a prerequisite. Elaborating our previous work on rule-based SLA validation, we propose a hybrid distributed trust model. This new model is based on Public Key Infrastructure (PKI) and reputation-based trust systems. It helps preventing SLA violations by identifying violation-prone services at service selection stage and actively contributes in breach management at the time of penalty enforcement.

  3. Scientific research and the public trust.

    PubMed

    Resnik, David B

    2011-09-01

    This essay analyzes the concept of public trust in science and offers some guidance for ethicists, scientists, and policymakers who use this idea defend ethical rules or policies pertaining to the conduct of research. While the notion that public trusts science makes sense in the abstract, it may not be sufficiently focused to support the various rules and policies that authors have tried to derive from it, because the public is not a uniform body with a common set of interests. Well-focused arguments that use public trust to support rules or policies for the conduct of research should specify (a) which public is being referred to (e.g. the general public or a specific public, such as a particular community or group); (b) what this public expects from scientists; (c) how the rule or policy will ensure that these expectations are met; and (d) why is it important to meet these expectations.

  4. Scientific Research and the Public Trust

    PubMed Central

    Resnik, David B.

    2011-01-01

    This essay analyzes the concept of public trust in science and offers some guidance for ethicists, scientists, and policymakers who use this idea defend ethical rules or policies pertaining to the conduct of research. While the notion the public trusts science makes sense in the abstract, it may not be sufficiently focused to support the various rules and policies that authors have tried to derive from it, because the public is not a uniform body with a common set of interests. Well-focused arguments that use public trust to support rules or policies for the conduct of research should specify a) which public is being referred to (e.g. the general public or a specific public, such as a particular community or group); b) what this public expects from scientists; c) how the rule or policy will ensure that these expectations are met; and d) why is it important to meet these expectations. PMID:20803259

  5. Redefining Genomic Privacy: Trust and Empowerment

    PubMed Central

    Erlich, Yaniv; Williams, James B.; Glazer, David; Yocum, Kenneth; Farahany, Nita; Olson, Maynard; Narayanan, Arvind; Stein, Lincoln D.; Witkowski, Jan A.; Kain, Robert C.

    2014-01-01

    Fulfilling the promise of the genetic revolution requires the analysis of large datasets containing information from thousands to millions of participants. However, sharing human genomic data requires protecting subjects from potential harm. Current models rely on de-identification techniques in which privacy versus data utility becomes a zero-sum game. Instead, we propose the use of trust-enabling techniques to create a solution in which researchers and participants both win. To do so we introduce three principles that facilitate trust in genetic research and outline one possible framework built upon those principles. Our hope is that such trust-centric frameworks provide a sustainable solution that reconciles genetic privacy with data sharing and facilitates genetic research. PMID:25369215

  6. Trust--can it be controlled?

    PubMed

    Box, Debra; Pottas, Dalenca

    2010-01-01

    Trust is an important component in the security of an information system. The advent of the electronic health record (EHR) and the health information system (HIS) have raised it to greater prominence. These systems and their intended benefits are rendered less effective through a low level of trust between the stakeholders. The potential reciprocal relationship between accountability and trust is investigated. A literature study examines both concepts and their interrelationship. The accountability and audit controls provided by the NIST SP 800-53 security guide and the ISO 27799 security standard are extracted, collated and expanded to strengthen the accountability mechanisms within an HIS security program. A dedicated set of accountability controls (NIM) which is specific to the healthcare environment is produced. It is proposed that through the strengthening of the accountability function of the HIS, its level of trustworthiness may be improved.

  7. Trust but verify: the interactive effects of trust and autonomy preferences on health outcomes.

    PubMed

    Lee, Yin-Yang; Lin, Julia L

    2009-09-01

    Patients' trust in their physicians improves their health outcomes because of better compliance, more disclosure, stronger placebo effect, and more physicians' trustworthy behaviors. Patients' autonomy may also impact on health outcomes and is increasingly being emphasized in health care. However, despite the critical role of trust and autonomy, patients that naïvely trust their physicians may become overly dependent and lack the motivation to participate in medical care. In this article, we argue that increased trust does not necessarily imply decreased autonomy. Furthermore, patients with high levels of trust and autonomy preferences are most likely to have the best health outcomes. We propose a framework for understanding simultaneous trust and autonomy preferences and for recognizing their interactive effects on health outcomes in the dynamic medical encounter. This framework argues that policy makers and health care providers should make efforts to foster not only patients' trust but also their preferences for autonomy and thus gain the best position for achieving health-related goals.

  8. A Marketing Perspective: Try Looking at Charitable Trusts from the Donor's Point of View.

    ERIC Educational Resources Information Center

    Thoren, Linda J.

    1979-01-01

    Charitable remainder trusts and charitable income trusts are discussed as essentials in any "marketing mix" of gift-giving options. Unitrusts and annuity trusts are described and tax benefits of the charitable income trust are explained. (MLW)

  9. Swift Trust in Distributed Ad Hoc Teams

    DTIC Science & Technology

    2007-10-04

    team at risk. Questionnaires assessed the impact of regimental identity and potential trust violations on levels of team trust before the mission...personnellement. Cette notion est de plus en plus utilisée dans les ouvrages spécialisés pour expliquer comment les membres des équipes spéciales... questionnaires distribués aux participants ont permis d’évaluer l’impact de l’identité régimentaire et des abus de confiance sur le niveau de confiance

  10. Capturing Trust in Social Web Applications

    NASA Astrophysics Data System (ADS)

    O'Donovan, John

    The Social Web constitutes a shift in information flow from the traditional Web. Previously, content was provided by the owners of a website, for consumption by the end-user. Nowadays, these websites are being replaced by Social Web applications which are frameworks for the publication of user-provided content. Traditionally, Web content could be `trusted' to some extent based on the site it originated from. Algorithms such as Google's PageRank were (and still are) used to compute the importance of a website, based on analysis of underlying link topology. In the Social Web, analysis of link topology merely tells us about the importance of the information framework which hosts the content. Consumers of information still need to know about the importance/reliability of the content they are reading, and therefore about the reliability of the producers of that content. Research into trust and reputation of the producers of information in the Social Web is still very much in its infancy. Every day, people are forced to make trusting decisions about strangers on the Web based on a very limited amount of information. For example, purchasing a product from an eBay seller with a `reputation' of 99%, downloading a file from a peer-to-peer application such as Bit-Torrent, or allowing Amazon.com tell you what products you will like. Even something as simple as reading comments on a Web-blog requires the consumer to make a trusting decision about the quality of that information. In all of these example cases, and indeed throughout the Social Web, there is a pressing demand for increased information upon which we can make trusting decisions. This chapter examines the diversity of sources from which trust information can be harnessed within Social Web applications and discusses a high level classification of those sources. Three different techniques for harnessing and using trust from a range of sources are presented. These techniques are deployed in two sample Social Web

  11. Trust and Partnering with the Joint Team

    DTIC Science & Technology

    2009-04-01

    ways shown in Figure 1 can improve trust within the Joint team. Notes 1 Barbara D. Adams, Ph.D. and Robert D.G. Webb, Ph.D., Trust in Small Military...decade after Vietnam, (Washington D.C.: Air Force History and Museums Program), 2001, xi. 5 Major Bruce H. McClintock , The Transformation Trinity: A...2002, 15. http://www.au.af.mil/au/aul/aupress/saas_Theses/ McClintock /McClintock.pdf 6 David Knott, Stephen Muers and Stephen Aldridge, Achieving

  12. Macroeconomic Dynamics of Assets, Leverage and Trust

    NASA Astrophysics Data System (ADS)

    Rozendaal, Jeroen C.; Malevergne, Yannick; Sornette, Didier

    A macroeconomic model based on the economic variables (i) assets, (ii) leverage (defined as debt over asset) and (iii) trust (defined as the maximum sustainable leverage) is proposed to investigate the role of credit in the dynamics of economic growth, and how credit may be associated with both economic performance and confidence. Our first notable finding is the mechanism of reward/penalty associated with patience, as quantified by the return on assets. In regular economies where the EBITA/Assets ratio is larger than the cost of debt, starting with a trust higher than leverage results in the highest long-term return on assets (which can be seen as a proxy for economic growth). Therefore, patient economies that first build trust and then increase leverage are positively rewarded. Our second main finding concerns a recommendation for the reaction of a central bank to an external shock that affects negatively the economic growth. We find that late policy intervention in the model economy results in the highest long-term return on assets. However, this comes at the cost of suffering longer from the crisis until the intervention occurs. The phenomenon that late intervention is most effective to attain a high long-term return on assets can be ascribed to the fact that postponing intervention allows trust to increase first, and it is most effective to intervene when trust is high. These results are derived from two fundamental assumptions underlying our model: (a) trust tends to increase when it is above leverage; (b) economic agents learn optimally to adjust debt for a given level of trust and amount of assets. Using a Markov Switching Model for the EBITA/Assets ratio, we have successfully calibrated our model to the empirical data of the return on equity of the EURO STOXX 50 for the time period 2000-2013. We find that dynamics of leverage and trust can be highly nonmonotonous with curved trajectories, as a result of the nonlinear coupling between the variables. This

  13. Trust Networks on the Semantic Web

    DTIC Science & Technology

    2006-01-01

    to show trust levels for the mail sender either on a general level or with respect to a certain topic. To generate ratings, TrustMail makes a call to...attention to? Since the name is unfamiliar, the message is not distinguishable from other, not-so-important mail in the inbox . This scenario is exactly...the web service, passing in the email address of the sender and the address of the mailbox to where the message was delivered. It is necessary to use

  14. FAQs for Beneficiaries to the VW Mitigation Trust Agreement

    EPA Pesticide Factsheets

    The November 2016 partial Volkswagen settlement requires the defendant, Volkswagen, to establish and fund a $2.7 billion environmental mitigation trust. The trust will be administered by an independent trustee.

  15. [Trust and palliative care, the risk of vulnerability].

    PubMed

    Miniac, Véronique

    2013-10-01

    Patients receiving palliative care experience extreme vulnerability reminding them of the fragility of their human condition. How are they to trust nurses bearing bad news in these crucial moments? Trust is built on team coherence and rigorous support.

  16. Expectations of patients and parents of children with asthma regarding access to complementary therapy information and services via the NHS: a qualitative study

    PubMed Central

    Shaw, Alison; Thompson, Elizabeth A.; Sharp, Deborah J.

    2006-01-01

    Abstract Objective  To explore the expectations of patients and parents of children with asthma regarding access to complementary therapies via the NHS. Methods  Fifty semi‐structured interviews with adults and parents of children with asthma, from a range of health‐care settings, including users and non‐users of complementary therapies. Interviews were recorded, transcribed verbatim and the data were analysed thematically. Results  Thirty‐one patients were using complementary therapies for asthma, six were using complementary therapies for other health problems and 13 were non‐users. Various therapies were used for asthma, most commonly homeopathy and breathing techniques, predominantly outside the NHS. Two broad themes emerging from the data were expectations about access to information and knowledge about complementary therapies via NHS health professionals, and expectations regarding access to complementary therapy services via the NHS. As a minimum, the majority of participants wanted NHS health professionals to be more ‘open’ towards and know more about complementary therapies than their patients – perceived as not currently usual. Most were positive about greater NHS access to complementary therapy services, for enhancing patient choice, improving equality in access for less affluent patients and facilitating patients’ self‐help. Participants who were highly sceptical about complementary therapies argued that lack of scientific evidence of effectiveness prohibited the need for greater complementary therapy knowledge or service provision within the NHS. Alongside their expectations, patients and parents expressed realistic views about facilitators and barriers to greater access. Conclusions  While health service planners and providers often express reservations about the value of complementary therapies, it is important to take patients’ preferences into account if policy discourses regarding patient‐centred care and choice are

  17. Use of a service evaluation and lean thinking transformation to redesign an NHS 111 refer to community Pharmacy for Emergency Repeat Medication Supply Service (PERMSS)

    PubMed Central

    Nazar, Hamde; Nazar, Zachariah; Simpson, Jill; Yeung, Andre; Whittlesea, Cate

    2016-01-01

    Objectives To demonstrate the contribution of community pharmacy from NHS 111 referrals out of hours (OOH) for emergency supply repeat medication requests via presentation of service activity, community pharmacist feedback and lean thinking transformation. Design Descriptive service evaluation using routine service activity data over the pilot period; survey of community pharmacists, and service redesign through lean thinking transformation. Setting North East of England NHS 111 provider and accredited community pharmacies across the North East of England. Participants Patients calling the North East of England NHS 111 provider during OOH with emergency repeat medication supply requests. Interventions NHS 111 referral to community pharmacies for assessment and if appropriate, supply of emergency repeat medication. Main outcome measures Number of emergency repeat medication supply referrals, completion rates, reasons for rejections, time of request, reason for access, medication(s), pharmaceutical advice and services provided. Secondary outcomes were community pharmacist feedback and lean thinking transformation of the patient pathway. Results NHS 111 referred 1468 patients to 114 community pharmacies (15/12/2014–7/4/2015). Most patients presented on Saturdays, with increased activity over national holidays. Community pharmacists completed 951 (64.8%) referrals providing 2297 medications; 412 were high risk. The most common reason for rejecting referrals was no medication in stock. Community pharmacists were positive about the provision of this service. The lean thinking transformation reduced the number of non-added value steps, waits and bottlenecks in the patient pathway. Conclusions NHS 111 can redirect callers OOH from urgent and emergency care services to community pharmacy for management of emergency repeat medication supply. Existing IT and community pharmacy regulations allowed patients to receive a medication supply and pharmaceutical advice. Community

  18. 26 CFR 1.50A-6 - Estates and trusts.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 1 2010-04-01 2010-04-01 true Estates and trusts. 1.50A-6 Section 1.50A-6... Computing Credit for Expenses of Work Incentive Programs § 1.50A-6 Estates and trusts. (a) In general—(1) Termination of employment by an estate or trust. If an estate or trust terminates (in a termination subject...

  19. Cancelled Procedures in the English NHS: Evidence from the 2010 Tariff Reform.

    PubMed

    Cookson, Graham; Jones, Simon; Laliotis, Ioannis

    2017-02-16

    This paper explores the role of incentives in the English National Health Service. Until financial year 2009/2010, elective procedures that were cancelled after admission received a fixed reimbursement associated with a specific healthcare resource group code. We investigate whether this induced trusts to admit and then cancel, rather than cancel before admission and/or to cancel low fee over high fee work. As the tariff was ended in April 2010, we conduct an interrupted time series analysis to examine if their behaviour was affected after the tariff removal. The results indicate a small, yet statistically significant, decline in the probability of a last minute cancellation in the post-tariff period, especially for certain types of patients and diagnoses. Copyright © 2017 John Wiley & Sons, Ltd.

  20. 26 CFR 1.679-2 - Trusts treated as having a U.S. beneficiary.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 26 Internal Revenue 8 2014-04-01 2014-04-01 false Trusts treated as having a U.S. beneficiary. 1... the trust income. The trust instrument further provides that in 2011, the trust will terminate and the... trust terminates unexpectedly prior to 2011, all trust assets must be distributed to C. Because it...

  1. 12 CFR 303.242 - Exercise of trust powers.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 5 2013-01-01 2013-01-01 false Exercise of trust powers. 303.242 Section 303... PROCEDURES Other Filings § 303.242 Exercise of trust powers. (a) Scope. This section contains the procedures to be followed by a state nonmember bank to seek the FDIC's prior consent to exercise trust...

  2. 12 CFR 303.242 - Exercise of trust powers.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 5 2014-01-01 2014-01-01 false Exercise of trust powers. 303.242 Section 303... PROCEDURES Other Filings § 303.242 Exercise of trust powers. (a) Scope. This section contains the procedures to be followed by a state nonmember bank to seek the FDIC's prior consent to exercise trust...

  3. 12 CFR 303.242 - Exercise of trust powers.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 5 2012-01-01 2012-01-01 false Exercise of trust powers. 303.242 Section 303... PROCEDURES Other Filings § 303.242 Exercise of trust powers. (a) Scope. This section contains the procedures to be followed by a state nonmember bank to seek the FDIC's prior consent to exercise trust...

  4. 36 CFR 401.10 - Monument Trust Fund Program.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Monument Trust Fund Program... MONUMENTS AND MEMORIALS § 401.10 Monument Trust Fund Program. Pursuant to the provisions of 36 U.S.C. 2106(d), the Commission operates a Monument Trust Fund Program (MTFP) in countries where there is a...

  5. 77 FR 67689 - Fidelity Aberdeen Street Trust, et al.;

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-13

    ... COMMISSION Fidelity Aberdeen Street Trust, et al.; Notice of Application November 6, 2012. AGENCY: Securities... certain joint arrangements (``Prior Order'').\\1\\ \\1\\ Colchester Street Trust, et al., Investment Company..., Colchester Street Trust, et al., Investment Company Act Release Nos. 23787 (Apr. 15, 1999) (notice) and...

  6. 26 CFR 1.851-7 - Certain unit investment trusts.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 26 Internal Revenue 9 2011-04-01 2011-04-01 false Certain unit investment trusts. 1.851-7 Section... (CONTINUED) INCOME TAXES (CONTINUED) Regulated Investment Companies and Real Estate Investment Trusts § 1.851-7 Certain unit investment trusts. (a) In general. For purposes of the Internal Revenue Code, a...

  7. Trust in School: A Pathway to Inhibit Teacher Burnout?

    ERIC Educational Resources Information Center

    Van Maele, Dimitri; Van Houtte, Mieke

    2015-01-01

    Purpose: The purpose of this paper is to consider trust as an important relational source in schools by exploring whether trust lowers teacher burnout. The authors examine how trust relationships with different school parties such as the principal relate to distinct dimensions of teacher burnout. The authors further analyze whether school-level…

  8. Paying a Price: Culture, Trust, and Negotiation Consequences

    ERIC Educational Resources Information Center

    Gunia, Brian C.; Brett, Jeanne M.; Nandkeolyar, Amit K.; Kamdar, Dishan

    2011-01-01

    Three studies contrasting Indian and American negotiators tested hypotheses derived from theory proposing why there are cultural differences in trust and how cultural differences in trust influence negotiation strategy. Study 1 (a survey) documented that Indian negotiators trust their counterparts less than American negotiators. Study 2 (a…

  9. 76 FR 44625 - Northern Lights Variable Trust, et al.;

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-26

    ... COMMISSION Northern Lights Variable Trust, et al.; Notice of Application July 19, 2011. AGENCY: Securities.... APPLICANTS: Northern Lights Variable Trust (the ``Fund'') and Gemini Fund Services, LLC (``Gemini.... Northern Lights Variable Trust, c/o Emile Molineaux, Esquire, Gemini Fund Services, LLC, 450...

  10. Trusting Relationships and Emotional Epistemologies: A Foundational Leadership Issue

    ERIC Educational Resources Information Center

    Beatty, Brenda R.; Brew, Christine R.

    2004-01-01

    The connections among relational trust, learning and development are implicit in transformational leadership theory. They have also been established empirically in recent studies. Leadership preparation programs often endorse the need for leaders to build effective collaborative relationships that rely on trust. Trust is an emotional phenomenon.…

  11. 12 CFR 303.242 - Exercise of trust powers.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 4 2011-01-01 2011-01-01 false Exercise of trust powers. 303.242 Section 303... PROCEDURES Other Filings § 303.242 Exercise of trust powers. (a) Scope. This section contains the procedures to be followed by a state nonmember bank to seek the FDIC's prior consent to exercise trust...

  12. Exploring the Antecedents of Trust in Virtual Communities

    ERIC Educational Resources Information Center

    Hsu, Meng-Hsiang; Chang, Chun-Ming; Yen, Chia-Hui

    2011-01-01

    Although previous research has established that interpersonal trust and system trust are critical in shaping individual behaviour in virtual settings, the two perspectives have not been examined by IS researchers in virtual communities (VCs) simultaneously. Drawing from prior literature on trust and VCs, a research model for understanding the…

  13. 7 CFR 3550.72 - Community land trusts.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 15 2014-01-01 2014-01-01 false Community land trusts. 3550.72 Section 3550.72... AGRICULTURE DIRECT SINGLE FAMILY HOUSING LOANS AND GRANTS Section 502 Origination § 3550.72 Community land trusts. Eligible dwellings located on land owned by a community land trust may be financed if: (a)...

  14. 26 CFR 25.2702-5 - Personal residence trusts.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... governing instrument must provide that the right of the term holder to receive the annuity amount begins on... right to use the condominium during L's lifetime. The trust is a qualified personal residence trust... enclosures for confinement of farm animals. W transfers the farm to an irrevocable trust, retaining the...

  15. 12 CFR 303.242 - Exercise of trust powers.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Exercise of trust powers. 303.242 Section 303... PROCEDURES Other Filings § 303.242 Exercise of trust powers. (a) Scope. This section contains the procedures to be followed by a state nonmember bank to seek the FDIC's prior consent to exercise trust...

  16. A Trust That Can't Be Breached.

    ERIC Educational Resources Information Center

    Penning, Nick

    1990-01-01

    Children's Investment Trust is a proposed trust fund for children's services (nutrition, health, education, and social services) similar in design to Social Security fund. The trust would be funded by a small, progressive payroll tax levied on both employer and employee on wages greater than $5 per hour. The tax would raise $25 billion more every…

  17. Conceptions of Trust: How Designers Approach Usable Privacy and Security

    ERIC Educational Resources Information Center

    Birge, Colin

    2013-01-01

    Designers who create user interfaces are frequently required to ask users for personal information. For the user, this is a "trust question": Do I, the user, trust the system or entity that is asking me for this information? The creation and management of these trust questions is an important aspect of the research field called usable…

  18. Teachers' Beliefs about the Development of Teacher-Adolescent Trust

    ERIC Educational Resources Information Center

    Russell, Shannon L.; Wentzel, Kathryn R.; Donlan, Alice E.

    2016-01-01

    In this study, we examined teachers' beliefs concerning the meaning and nature of teacher--student trust in a diverse sample of secondary-school teachers (n = 34). Using a grounded-theory approach, a process model of teacher-adolescent trust emerged based on semi-structured interviews and focus groups. Antecedents of trust could be categorised as…

  19. The Relationship between Loneliness and Interpersonal Trust during Middle Childhood

    ERIC Educational Resources Information Center

    Rotenberg, Ken J.; MacDonald, Keltie J.; King, Emily V.

    2004-01-01

    The authors administered measures of loneliness, generalized trust beliefs in peers, and trust beliefs in specific familiar peers (i.e., opposite-gender peers, same-gender peers, close same-gender peers) to a sample of 63 children (33 girls, 30 boys) from 4th and 5th grades (M age = 10 years, 6 months). They assessed children's trusting behavior…

  20. Investigation of the Relationship between Organizational Trust and Organizational Commitment

    ERIC Educational Resources Information Center

    Bastug, Gülsüm; Pala, Adem; Kumartasli, Mehmet; Günel, Ilker; Duyan, Mehdi

    2016-01-01

    Organizational trust and organizational commitment are considered as the most important entraining factors for organizational success. The most important factor in the formation of organizational commitment is trust that employees have in their organizations. In this study, the relationship between organizational trust and organizational…

  1. 7 CFR 3550.72 - Community land trusts.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Community land trusts. 3550.72 Section 3550.72... AGRICULTURE DIRECT SINGLE FAMILY HOUSING LOANS AND GRANTS Section 502 Origination § 3550.72 Community land trusts. Eligible dwellings located on land owned by a community land trust may be financed if: (a)...

  2. 7 CFR 3550.72 - Community land trusts.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 15 2013-01-01 2013-01-01 false Community land trusts. 3550.72 Section 3550.72... AGRICULTURE DIRECT SINGLE FAMILY HOUSING LOANS AND GRANTS Section 502 Origination § 3550.72 Community land trusts. Eligible dwellings located on land owned by a community land trust may be financed if: (a)...

  3. 77 FR 17091 - Trust Land Consolidation Draft Plan

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-23

    ... Office of the Secretary Trust Land Consolidation Draft Plan AGENCY: Office of the Secretary, Interior... Agreement established a trust land consolidation fund to be used for consolidating Indian trust and restricted lands and acquiring fractional interests in these lands. We are reopening the period...

  4. 7 CFR 3550.72 - Community land trusts.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 15 2012-01-01 2012-01-01 false Community land trusts. 3550.72 Section 3550.72... AGRICULTURE DIRECT SINGLE FAMILY HOUSING LOANS AND GRANTS Section 502 Origination § 3550.72 Community land trusts. Eligible dwellings located on land owned by a community land trust may be financed if: (a)...

  5. Collective Trust: A Social Indicator of Instructional Capacity

    ERIC Educational Resources Information Center

    Adams, Curt M.

    2013-01-01

    Purpose: The purpose of this study is to test the validity of using collective trust as a social indicator of instructional capacity. Design/methodology/approach: A hypothesized model was advanced for the empirical investigation. Collective trust was specified as a latent construct with observable indicators being principal trust in faculty (PTF),…

  6. Revisiting the Trust Effect in Urban Elementary Schools

    ERIC Educational Resources Information Center

    Adams, Curt M.; Forsyth, Patrick B.

    2013-01-01

    More than a decade after Goddard, Tschannen-Moran, and Hoy (2001) found that collective faculty trust in clients predicts student achievement in urban elementary schools, we sought to identify a plausible link for this relationship. Our purpose in revisiting the trust effect was twofold: (1) to test the main effect of collective faculty trust on…

  7. 9 CFR 201.42 - Custodial accounts for trust funds.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Custodial accounts for trust funds... STOCKYARDS ACT Proceeds of Sale § 201.42 Custodial accounts for trust funds. (a) Payments for livestock are trust funds. Each payment that a livestock buyer makes to a market agency selling on commission is...

  8. 26 CFR 1.678(c)-1 - Trusts for support.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 8 2010-04-01 2010-04-01 false Trusts for support. 1.678(c)-1 Section 1.678(c... (CONTINUED) INCOME TAXES Grantors and Others Treated As Substantial Owners § 1.678(c)-1 Trusts for support... cotrustee, to apply the income of the trust to the support or maintenance of a person whom the holder...

  9. 26 CFR 1.318-3 - Estates, trusts, and options.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 4 2010-04-01 2010-04-01 false Estates, trusts, and options. 1.318-3 Section 1... (CONTINUED) INCOME TAXES Definitions; Constructive Ownership of Stock § 1.318-3 Estates, trusts, and options... of section 318(a)(2)(B) stock owned by a trust will be considered as being owned by its...

  10. 24 CFR 203.434 - Declaration of trust.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Declaration of trust. 203.434... Mortgage § 203.434 Declaration of trust. A sale of a beneficial interest in a group of insured mortgages... interest in a specific mortgage shall be made only pursuant to a declaration of trust, which has...

  11. 43 CFR 12.937 - Property trust relationship.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Property trust relationship. 12.937... Requirements § 12.937 Property trust relationship. Real property, equipment, intangible property and debt instruments that are acquired or improved with Federal funds shall be held in trust by the recipient...

  12. The Lifecycle of Trust in Educational Leadership: An Ecological Perspective

    ERIC Educational Resources Information Center

    Kutsyuruba, Benjamin; Walker, Keith

    2015-01-01

    As establishing and fostering trust are imperative activities for school leaders, cognizance of the fundamental importance of trust is essential for the leader's moral agency and ethical decision-making. In this article, we use an ecological perspective to uncover the dynamics of the lifecycle of trust as evident from extant literature on…

  13. 78 FR 70959 - Commission on Indian Trust Administration and Reform

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-27

    ... Office of the Secretary Commission on Indian Trust Administration and Reform AGENCY: Office of the Secretary, Interior. ACTION: Notice of Renewal of the Commission on Indian Trust Administration and Reform... Secretary of the Interior is renewing the Commission on Indian Trust Administration and Reform. FOR...

  14. 26 CFR 1.1493-1 - Definition of foreign trust.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 12 2010-04-01 2010-04-01 false Definition of foreign trust. 1.1493-1 Section 1... (CONTINUED) INCOME TAXES Tax on Transfers to Avoid Income Tax § 1.1493-1 Definition of foreign trust. For taxable years beginning before January 1, 1967, a trust is to be considered a “foreign trust” within...

  15. 7 CFR 795.9 - Estate or trust.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 7 2010-01-01 2010-01-01 false Estate or trust. 795.9 Section 795.9 Agriculture... PROVISIONS COMMON TO MORE THAN ONE PROGRAM PAYMENT LIMITATION General § 795.9 Estate or trust. (a) An estate or irrevocable trust shall be considered as one person except that, where two or more estates...

  16. 17 CFR 240.16b-8 - Voting trusts.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 17 Commodity and Securities Exchanges 3 2010-04-01 2010-04-01 false Voting trusts. 240.16b-8... Exchange Act of 1934 Exemption of Certain Transactions from Section 16(b) § 240.16b-8 Voting trusts. Any... deposit or withdrawal from a voting trust or deposit agreement shall be exempt from section 16(b) of...

  17. 26 CFR 1.677(b)-1 - Trusts for support.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 8 2010-04-01 2010-04-01 false Trusts for support. 1.677(b)-1 Section 1.677(b... (CONTINUED) INCOME TAXES Grantors and Others Treated As Substantial Owners § 1.677(b)-1 Trusts for support. (a) Section 677(b) provides that a grantor is not treated as the owner of a trust merely because...

  18. 12 CFR 330.13 - Irrevocable trust accounts.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Irrevocable trust accounts. 330.13 Section 330... POLICY DEPOSIT INSURANCE COVERAGE § 330.13 Irrevocable trust accounts. (a) General rule. Funds representing the “non-contingent trust interest(s)” (as defined in § 330.1(l)) of a beneficiary deposited...

  19. 24 CFR 203.493 - Declaration of trust.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Declaration of trust. 203.493... Declaration of trust. A sale of a beneficial interest in a group of insured loans, where the interest to be... be made only pursuant to a declaration of trust, which has been approved by the Commissioner prior...

  20. 5 CFR 2634.405 - Certification of trusts.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... FINANCIAL DISCLOSURE, QUALIFIED TRUSTS, AND CERTIFICATES OF DIVESTITURE Qualified Trusts § 2634.405... must be certified by the Director of the Office of Government Ethics. (1) A trust will be certified for purposes of this subpart only if: (i) It is established to the Director's satisfaction that...

  1. 25 CFR 1000.354 - What is a trust evaluation?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Indians OFFICE OF THE ASSISTANT SECRETARY, INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR ANNUAL FUNDING AGREEMENTS UNDER THE TRIBAL SELF-GOVERNMENT ACT AMENDMENTS TO THE INDIAN SELF-DETERMINATION AND EDUCATION ACT Trust Evaluation Review Annual Trust Evaluations § 1000.354 What is a trust evaluation? A...

  2. How I broke through.

    PubMed

    Moore, Alison

    2016-10-05

    Wellington Makala joined North East London NHS Foundation Trust (NELFT) in 2001 as a nursing student, remained with the trust when he qualified as a mental health nurse, and is now deputy director for operations for the mental health inpatients and acute directorate.

  3. Feedback on heart attack.

    PubMed

    Pearce, Lynne

    2016-04-13

    The Royal Brompton & Harefield NHS Foundation Trust in London is the largest heart and lung centre in the UK. This article explores a project carried out by nurses at the trust looking at the experiences of having an acute myocardial infarction, and how patients felt about taking part in a research study.

  4. Dimensions of trust: the tensions and challenges in provider--interpreter trust.

    PubMed

    Hsieh, Elaine; Ju, Hyejung; Kong, Haiying

    2010-02-01

    In this study we examined the challenges to providers' and interpreters' collaboration in bilingual health care. We conducted in-depth interviews and focus groups with 26 medical interpreters (speaking 17 languages) and 32 providers (from four specialties) in the United States to provide an empirically based framework of provider-interpreter trust. Constant comparative analysis was used for data analysis. We identified four dimensions of trust, theoretical constructs that can strengthen or compromise provider-interpreter trust: interpreter competence, shared goals, professional boundaries, and established patterns of collaboration. In this article we describe how these dimensions highlight tensions and challenges that are unique in provider-interpreter relationships. We conclude with practical guidelines that can enhance provider-interpreter trust, and propose future research directions in bilingual health care.

  5. Security and Trust Management for Virtual Organisations: GridTrust Approach

    NASA Astrophysics Data System (ADS)

    Naqvi, Syed; Mori, Paolo

    The GridTrust Security Framework (GSF) offers security and trust management for the next generation Grids (NGG). It follows a vertical approach for Grid security from requirements level right down to application and middleware levels. New access control models for collaborative computing, such as the usage control model (UCON), are implemented for securing the Grid systems. The GSF is composed of security and trust services and tools provided at the middleware and Grid foundation middleware layers. GSF addresses three layers of the NGG architecture: the Grid application layer, the Grid service middleware layer, and the Grid foundation layer. The framework is composed of security and trust services and tools provided at the middleware and Grid foundation middleware layers. GSF provides policy-driven autonomic access control solutions that provide a continuous monitoring of the usage of resources by users.

  6. Study of Trust as an Organizational Contingency, Part II: Examining Four Dimensions of Trust in ELICIT Experimentation

    DTIC Science & Technology

    2010-06-01

    several interrelated cognitive processes and orientations” (p. 571). Zand (1972) is more emphatic, stating that trust “is not a global feeling of warmth ...economic activity overwhelm interpersonal trust relations” (p. 411). Schoorman et al. (2007) take a different view, asserting that the bureaucracy... Interpersonal Trust. Journal of Personality, 35 (4), 651-665. Rotter J. B. (1980). Interpersonal trust, trustworthiness, and gullibility. American Psychology

  7. Summative service and stakeholder evaluation of an NHS-funded community Pharmacy Emergency Repeat Medication Supply Service (PERMSS)

    PubMed Central

    Nazar, Hamde; Nazar, Zachariah; Simpson, Jill; Yeung, Andre; Whittlesea, Cate

    2016-01-01

    Objectives Service and stakeholder evaluation of an NHS-funded service providing out-ofhours (OOH) emergency repeat medications to patients self-presenting at community pharmacies. Setting Community pharmacies across the North East of England accredited to provide this service. Participants Patients self-presenting to community pharmacies during OOH periods with emergency repeat medication supply requests. Intervention Community pharmacists assessed each request for clinical appropriateness and when suitable provide an emergency repeat medication supply, with additional pharmaceutical advice and services if required. Primary outcomes Number of emergency repeat medication supplies, time of request, reason for access, medication(s), pharmaceutical advice and services provided. Secondary outcomes were community pharmacist and patient satisfaction. Results A total of 2485 patients were managed across 227 community pharmacies (15 December 2014 to 7 April 2015). Most patients presented on Saturdays, with increased activity over national holidays. Older age was associated with increased service use. Of the 3226 medications provided, 439 were classified as high risk. Patients found this service easy to access and were willing to access the community pharmacy in the future for medication-related issues. In the absence of this service, 50% of patients would have missed their medication(s) until they saw their doctor and a further 46% would have accessed an alternative service. The cost of National Health Service (NHS) service(s) for patients who would have accessed an alternative OOH service was estimated as 37 times that of the community pharmacy service provided. Community pharmacists were happy to provide this service despite increased consultation times and workload. Conclusions Community pharmacists were able to manage patients’ OOH requests for emergency repeat medication and patients were happy with the service provided. Since the service cost was favourable when

  8. Exploring the role of communications in quality improvement: A case study of the 1000 Lives Campaign in NHS Wales

    PubMed Central

    Cooper, Andrew; Gray, Jonathon; Willson, Alan; Lines, Chris; McCannon, Joe; McHardy, Karina

    2015-01-01

    Introduction Effective communication is critical to successful large-scale change. Yet, in our experience, communications strategies are not formally incorporated into quality improvement (QI) frameworks. The 1000 Lives Campaign (‘Campaign’) was a large-scale national QI collaborative that aimed to save an additional 1000 lives and prevent 50 000 episodes of harm in Welsh health care over a 2-year period. We use the Campaign as a case study to describe the development, application, and impact of a communications strategy embedded in a large-scale QI initiative. Methods A comprehensive communications strategy guided communications work during the Campaign. The main aims of the communications strategy were to engage the hearts and minds of frontline National Health Service (NHS) staff in the Campaign and promote their awareness and understanding of specific QI interventions and the wider patient safety agenda. We used qualitative and quantitative measures to monitor communications outputs and assess how the communications strategy influenced awareness and knowledge of frontline NHS staff. Results The communications strategy facilitated clear and consistent framing of Campaign messages and allowed dissemination of information related to the range of QI interventions. It reaffirmed the aim and value of the Campaign to frontline staff, thereby promoting sustained engagement with Campaign activities. The communications strategy also built the profile of the Campaign both internally with NHS organizations across Wales and externally with the media, and played a pivotal role in improving awareness and understanding of the patient safety agenda. Ultimately, outcomes from the communications strategy could not be separated from overall Campaign outcomes. Conclusion and recommendations Systematic and structured communications can support and enhance QI initiatives. From our experience, we developed a ‘communications bundle’ consisting of six core components. We

  9. Inequity in cardiovascular care in the English National Health Service (NHS): a scoping review of the literature.

    PubMed

    Asthana, Sheena; Moon, Graham; Gibson, Alex; Bailey, Trevor; Hewson, Paul; Dibben, Chris

    2016-10-16

    There is a general understanding that socioeconomically disadvantaged people are also disadvantaged with respect to their access to NHS care. Insofar as considerable NHS funding has been targeted at deprived areas, it is important to better understand whether and why socioeconomic variations in access and utilisation exist. Exploring this question with reference to cardiovascular care, our aims were to synthesise and evaluate evidence relating to access to and/or use of English NHS services around (i) different points on the care pathway (i.e. presentation, primary management and specialist management) and (ii) different dimensions of inequality (socioeconomic, age- and gender-related, ethnic or geographical). Restricting our search period from 2004 to 2016, we were concerned to examine whether, compared to earlier research, there has been a change in the focus of research examining inequalities in cardiac care and whether the pro-rich bias reported in the late 1990s and early 2000s still applies today. We conducted a scoping study drawing on Arksey & O'Malley's framework. A total of 174 studies were included in the review and appraised for methodological quality. Although, in the past decade, there has been a shift in research focus away from gender and age inequalities in access/use and towards socioeconomic status and ethnicity, evidence that deprived people are less likely to access and use cardiovascular care is very contradictory. Patterns of use appear to vary by ethnicity; South Asian populations enjoying higher access, black populations lower. By contrast, female gender and older age are consistently associated with inequity in cardiovascular care. The degree of geographical variation in access/use is also striking. Finally, evidence of inequality increases with stage on the care pathway, which may indicate that barriers to access arise from the way in which health professionals are adjudicating health needs rather than a failure to seek help in the first

  10. Principles of Trust for Embedded Systems

    DTIC Science & Technology

    2012-03-01

    EITHER EXPRESSED OR IMPLIED, AS TO ANY MATTER INCLUDING, BUT NOT LIMITED TO, WARRANTY OF FITNESS FOR PURPOSE OR MERCHANTABILITY, EXCLUSIVITY, OR RESULTS... punctual on Wednesdays may say little about their tardiness on Fridays. CMU/SEI-2012-TN-007 | 6 Evidence of trust is only needed for those functions

  11. Trust and Transitions in Modes of Exchange

    ERIC Educational Resources Information Center

    Cheshire, Coye; Gerbasi, Alexandra; Cook, Karen S.

    2010-01-01

    In this study, we investigate the relationship between uncertainty and trust in exogenous shifts in modes of social exchange (i.e., those that are not initiated by the individuals in a given exchange system). We explore how transitions from a high uncertainty environment (reciprocal exchange) to lower-uncertainty environments (nonbinding or…

  12. The Devon NUT Campaign against Trust Schools

    ERIC Educational Resources Information Center

    Clinch, Dave

    2008-01-01

    When the Devon County Council announced that six secondary schools in the South Devon area were to become "Pathfinder Schools" for trust status, the Devon National Union of Teachers set about organising a campaign to defend the county's comprehensive schools. This campaign has proved successful in the case of Tavistock College, causing…

  13. Keeping "Community" in a Community Land Trust

    ERIC Educational Resources Information Center

    Gray, Karen A.; Galande, Mugdha

    2011-01-01

    This instrumental case study examined the role of grassroots community organizing in a community land trust (CLT) in a southern U.S. city. Twenty-nine homeowners, renters, board members, community members, and current and former CLT employees were interviewed. In addition, two focus groups of 11 and six participants composed of CLT residents and…

  14. Predicting Social Trust with Binary Logistic Regression

    ERIC Educational Resources Information Center

    Adwere-Boamah, Joseph; Hufstedler, Shirley

    2015-01-01

    This study used binary logistic regression to predict social trust with five demographic variables from a national sample of adult individuals who participated in The General Social Survey (GSS) in 2012. The five predictor variables were respondents' highest degree earned, race, sex, general happiness and the importance of personally assisting…

  15. Do Higher Education Institutes Communicate Trust Well?

    ERIC Educational Resources Information Center

    Gibbs, Paul; Dean, Aftab

    2015-01-01

    The relationship between trust and information sources for new purchasers of higher education is discussed. A range of sources is evaluated by potential entrants into UK higher education, and indicates that universities tend to be regarded as the most trustworthy when information is directly associated with them and social networks, and friends…

  16. The Importance of Trust in Leadership

    ERIC Educational Resources Information Center

    Mineo, David L.

    2014-01-01

    If one looks at the different philosophies on leadership, each espouses various attributes that are essential to create a bond between the leader and the followers who are being led. This article is intended to focus on how the bond is created that provides the leader with the vehicle for success. Trust is the glue which binds the leader to…

  17. Information Hiding based Trusted Computing System Design

    DTIC Science & Technology

    2014-07-18

    This has also been identified in the Defense Science Board study on High Performance Microchip Supply, “Trust cannot be added to integrated circuits...Science Board Task Force on High Performance Microchip Supply, February 2005. [27] B.S. Cohen. “On Integrated Circuits Supply Chain Issues in a Global

  18. Trust and the Client-Consultant Relationship

    ERIC Educational Resources Information Center

    Solomonson, William L.

    2012-01-01

    This study seeks to improve the contributions of performance consultants, instructional design consultants, and training consultants by explaining the effect that several variables have on trust as a mediator to relationship commitment within the context of the client-consultant relationship. The participants were 228 college students from two…

  19. The Role of Trust in Innovation

    ERIC Educational Resources Information Center

    Dovey, Ken

    2009-01-01

    Purpose: The purpose of this paper is to explore the role of trust in the collaborative learning processes that underpin innovation as a competitive strategy in organizations. Design/methodology/approach: As a conceptual paper, the argument is framed by academic perspectives, drawn from the academic literature on the topic and by professional and…

  20. 17 CFR 300.104 - Trust accounts.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 17 Commodity and Securities Exchanges 3 2010-04-01 2010-04-01 false Trust accounts. 300.104 Section 300.104 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION (CONTINUED) Schedule A to Part 285 RULES OF THE SECURITIES INVESTOR PROTECTION CORPORATION Accounts of...

  1. 17 CFR 300.104 - Trust accounts.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 17 Commodity and Securities Exchanges 3 2013-04-01 2013-04-01 false Trust accounts. 300.104 Section 300.104 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION (CONTINUED) Schedule A to Part 285 RULES OF THE SECURITIES INVESTOR PROTECTION CORPORATION Accounts of...

  2. 17 CFR 300.104 - Trust accounts.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 17 Commodity and Securities Exchanges 3 2011-04-01 2011-04-01 false Trust accounts. 300.104 Section 300.104 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION (CONTINUED) Schedule A to Part 285 RULES OF THE SECURITIES INVESTOR PROTECTION CORPORATION Accounts of...

  3. 17 CFR 300.104 - Trust accounts.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 17 Commodity and Securities Exchanges 4 2014-04-01 2014-04-01 false Trust accounts. 300.104 Section 300.104 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION (CONTINUED) Schedule A to Part 285 RULES OF THE SECURITIES INVESTOR PROTECTION CORPORATION Accounts of...

  4. 17 CFR 300.104 - Trust accounts.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 17 Commodity and Securities Exchanges 3 2012-04-01 2012-04-01 false Trust accounts. 300.104 Section 300.104 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION (CONTINUED) Schedule A to Part 285 RULES OF THE SECURITIES INVESTOR PROTECTION CORPORATION Accounts of...

  5. 7 CFR 1400.205 - Trusts.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... to be actively engaged in farming with respect to a farming operation if: (a) The trust independently and separately makes a significant contribution to the farming operation of capital, equipment, or... personal labor and active personal management to the farming operation. The combined interest of all...

  6. Cooperation under Indirect Reciprocity and Imitative Trust

    PubMed Central

    Saavedra, Serguei; Smith, David; Reed-Tsochas, Felix

    2010-01-01

    Indirect reciprocity, a key concept in behavioral experiments and evolutionary game theory, provides a mechanism that allows reciprocal altruism to emerge in a population of self-regarding individuals even when repeated interactions between pairs of actors are unlikely. Recent empirical evidence show that humans typically follow complex assessment strategies involving both reciprocity and social imitation when making cooperative decisions. However, currently, we have no systematic understanding of how imitation, a mechanism that may also generate negative effects via a process of cumulative advantage, affects cooperation when repeated interactions are unlikely or information about a recipient's reputation is unavailable. Here we extend existing evolutionary models, which use an image score for reputation to track how individuals cooperate by contributing resources, by introducing a new imitative-trust score, which tracks whether actors have been the recipients of cooperation in the past. We show that imitative trust can co-exist with indirect reciprocity mechanisms up to a threshold and then cooperation reverses -revealing the elusive nature of cooperation. Moreover, we find that when information about a recipient's reputation is limited, trusting the action of third parties towards her (i.e. imitating) does favor a higher collective cooperation compared to random-trusting and share-alike mechanisms. We believe these results shed new light on the factors favoring social imitation as an adaptive mechanism in populations of cooperating social actors. PMID:21048950

  7. 7 CFR 46.46 - Statutory trust.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... inventories of food or other products derived from such perishable agricultural commodities, and all... trust benefits. (1) The times for prompt accounting and prompt payment are set out in § 46.2(z) and (aa... payment must be disclosed on invoices, accountings, and other documents relating to the transaction....

  8. 7 CFR 1400.205 - Trusts.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... to be actively engaged in farming with respect to a farming operation if: (a) The trust independently and separately makes a significant contribution to the farming operation of capital, equipment, or... personal labor and active personal management to the farming operation. The combined interest of all...

  9. 7 CFR 1400.205 - Trusts.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... to be actively engaged in farming with respect to a farming operation if: (a) The trust independently and separately makes a significant contribution to the farming operation of capital, equipment, or... personal labor and active personal management to the farming operation. The combined interest of all...

  10. 7 CFR 1400.205 - Trusts.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... to be actively engaged in farming with respect to a farming operation if: (a) The trust independently and separately makes a significant contribution to the farming operation of capital, equipment, or... personal labor and active personal management to the farming operation. The combined interest of all...

  11. 7 CFR 1400.205 - Trusts.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... to be actively engaged in farming with respect to a farming operation if: (a) The trust independently and separately makes a significant contribution to the farming operation of capital, equipment, or... personal labor and active personal management to the farming operation. The combined interest of all...

  12. Cystitis - acute

    MedlinePlus

    Uncomplicated urinary tract infection; UTI - acute cystitis; Acute bladder infection; Acute bacterial cystitis ... cause. Menopause also increases the risk for a urinary tract infection. The following also increase your chances of having ...

  13. Taking Trust to the Field: Pilot Study on Trust and Communication in Teams

    DTIC Science & Technology

    2005-02-23

    The first iteration of the team trust scale seemed to perform relatively well, and we received positive feedback about the scale from participants...tailoring of the experimental context to data collection (e.g. performance data) and the time intensity of content analysis. Recommendations for...Teams Scale seemed to perform relatively well, and we received positive feedback about the scale from participants. More importantly, the Trust in

  14. Regional variations in the provision of NHS gynecological and abortion services.

    PubMed

    Maresh, M

    1979-07-01

    In the effort to investigate possible causes of the existing widespread variations in the provision of abortion services, analysis of the provision and workload of gynecological services in England was undertaken at an Area Health Authority level. A questionnaire was circulated to all 90 Area Health Administrators in England in November 1977. The total response was 75% (68). Due to the facts that Area Health Administrators (AHAs) often did not distinguish between residents and non-residents and private and National Health Service cases and that some AHAs were unwilling to divulge any abortion statistics, the data published by the Office of Population, Censuses and Surveys in their abortion monitor were used. There is a wide variation in the provision and usage of gynecological services when analyzed on the basis of AHA residents. Although the abortion rate is fairly constant in England, with a tendency to lower rates in some rural areas and markedly increased rates in 8 London AHAs, the National Health Service abortion rate varies more. The variation in the percentage of residents who have abortions performed by the NHS is more marked. The correlation coefficients show that the 6 factors analyzed - consultant gynecologic sessions per week, available gynecological beds, total gynecological admissions, gynecological waitings lists, gynecological admissions per available bed, and gynecological admissions per consultant session - are poorly, and in some cases not at all, related to the percentage of abortions performed under the National Health Service, and the scatter of points was large. The little correlation between available gynecological services and the proportion of National Health Service abortions suggests that other factors such as the personal policies of the consultants predominate. A way of improving the current situation is to have day-care National Health Service abortion facilities which can deal efficiently with the majority of abortion cases. In

  15. Making change last: applying the NHS institute for innovation and improvement sustainability model to healthcare improvement.

    PubMed

    Doyle, Cathal; Howe, Cathy; Woodcock, Thomas; Myron, Rowan; Phekoo, Karen; McNicholas, Chris; Saffer, Jessica; Bell, Derek

    2013-10-26

    The implementation of evidence-based treatments to deliver high-quality care is essential to meet the healthcare demands of aging populations. However, the sustainable application of recommended practice is difficult to achieve and variable outcomes well recognised. The NHS Institute for Innovation and Improvement Sustainability Model (SM) was designed to help healthcare teams recognise determinants of sustainability and take action to embed new practice in routine care. This article describes a formative evaluation of the application of the SM by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Northwest London (CLAHRC NWL). Data from project teams' responses to the SM and formal reviews was used to assess acceptability of the SM and the extent to which it prompted teams to take action. Projects were classified as 'engaged,' 'partially engaged' and 'non-engaged.' Quarterly survey feedback data was used to explore reasons for variation in engagement. Score patterns were compared against formal review data and a 'diversity of opinion' measure was derived to assess response variance over time. Of the 19 teams, six were categorized as 'engaged,' six 'partially engaged,' and seven as 'non-engaged.' Twelve teams found the model acceptable to some extent. Diversity of opinion reduced over time. A minority of teams used the SM consistently to take action to promote sustainability but for the majority SM use was sporadic. Feedback from some team members indicates difficulty in understanding and applying the model and negative views regarding its usefulness. The SM is an important attempt to enable teams to systematically consider determinants of sustainability, provide timely data to assess progress, and prompt action to create conditions for sustained practice. Tools such as these need to be tested in healthcare settings to assess strengths and weaknesses and findings disseminated to aid development. This

  16. Making change last: applying the NHS institute for innovation and improvement sustainability model to healthcare improvement

    PubMed Central

    2013-01-01

    The implementation of evidence-based treatments to deliver high-quality care is essential to meet the healthcare demands of aging populations. However, the sustainable application of recommended practice is difficult to achieve and variable outcomes well recognised. The NHS Institute for Innovation and Improvement Sustainability Model (SM) was designed to help healthcare teams recognise determinants of sustainability and take action to embed new practice in routine care. This article describes a formative evaluation of the application of the SM by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Northwest London (CLAHRC NWL). Data from project teams’ responses to the SM and formal reviews was used to assess acceptability of the SM and the extent to which it prompted teams to take action. Projects were classified as ‘engaged,’ ‘partially engaged’ and ‘non-engaged.’ Quarterly survey feedback data was used to explore reasons for variation in engagement. Score patterns were compared against formal review data and a ‘diversity of opinion’ measure was derived to assess response variance over time. Of the 19 teams, six were categorized as ‘engaged,’ six ‘partially engaged,’ and seven as ‘non-engaged.’ Twelve teams found the model acceptable to some extent. Diversity of opinion reduced over time. A minority of teams used the SM consistently to take action to promote sustainability but for the majority SM use was sporadic. Feedback from some team members indicates difficulty in understanding and applying the model and negative views regarding its usefulness. The SM is an important attempt to enable teams to systematically consider determinants of sustainability, provide timely data to assess progress, and prompt action to create conditions for sustained practice. Tools such as these need to be tested in healthcare settings to assess strengths and weaknesses and findings disseminated

  17. Human trafficking and health: a cross-sectional survey of NHS professionals’ contact with victims of human trafficking

    PubMed Central

    Ross, Claire; Dimitrova, Stoyanka; Howard, Louise M; Dewey, Michael; Zimmerman, Cathy; Oram, Siân

    2015-01-01

    Objectives (1) To estimate the proportion of National Health Service (NHS) professionals who have come into contact with trafficked people and (2) to measure NHS professionals’ knowledge and confidence to respond to human trafficking. Design A cross-sectional survey. Setting Face-to-face mandatory child protection and/or vulnerable adults training sessions at 10 secondary healthcare provider organisations in England, and meetings of the UK College of Emergency Medicine. Participants 782/892 (84.4%) NHS professionals participated, including from emergency medicine, maternity, mental health, paediatrics and other clinical disciplines. Measures Self-completed questionnaire developed by an expert panel. Questionnaire asks about prior training and contact with potential victims of trafficking, perceived and actual human trafficking knowledge, confidence in responding to human trafficking, and interest in future human trafficking training. Results 13% participants reported previous contact with a patient they knew or suspected of having been trafficked; among maternity services professionals this was 20.4%. However, 86.8% (n=679) reported lacking knowledge of what questions to ask to identify potential victims and 78.3% (n=613) reported that they had insufficient training to assist trafficked people. 71% (n=556), 67.5% (n=528) and 53.4% (n=418) lacked confidence in making appropriate referrals for men, women and children, respectively, who had been trafficked. 95.3% (n=746) of respondents were unaware of the scale of human trafficking in the UK, and 76.5% (n=598) were unaware that calling the police could put patients in more danger. Psychometric analysis showed that subscales measuring perceived knowledge, actual knowledge and confidence to respond to human trafficking demonstrated good internal consistency (Cronbach's αs 0.93, 0.63 and 0.64, respectively) and internal correlations. Conclusions NHS professionals working in secondary care are in contact with potential

  18. 25 CFR 1000.353 - What are “trust functions” for the purposes of the trust evaluation process?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... management of assets held in trust by the United States for an Indian Tribe or individual Indian. Annual..., DEPARTMENT OF THE INTERIOR ANNUAL FUNDING AGREEMENTS UNDER THE TRIBAL SELF-GOVERNMENT ACT AMENDMENTS TO THE INDIAN SELF-DETERMINATION AND EDUCATION ACT Trust Evaluation Review § 1000.353 What are “trust...

  19. 25 CFR 1000.353 - What are “trust functions” for the purposes of the trust evaluation process?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... management of assets held in trust by the United States for an Indian Tribe or individual Indian. Annual..., DEPARTMENT OF THE INTERIOR ANNUAL FUNDING AGREEMENTS UNDER THE TRIBAL SELF-GOVERNMENT ACT AMENDMENTS TO THE INDIAN SELF-DETERMINATION AND EDUCATION ACT Trust Evaluation Review § 1000.353 What are “trust...

  20. 25 CFR 1000.353 - What are “trust functions” for the purposes of the trust evaluation process?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... management of assets held in trust by the United States for an Indian Tribe or individual Indian. Annual..., DEPARTMENT OF THE INTERIOR ANNUAL FUNDING AGREEMENTS UNDER THE TRIBAL SELF-GOVERNMENT ACT AMENDMENTS TO THE INDIAN SELF-DETERMINATION AND EDUCATION ACT Trust Evaluation Review § 1000.353 What are “trust...