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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. PMID:10162938

  2. An analysis of catering options within NHS acute hospitals.

    PubMed

    Hwang, J L; Desombre, T; Eves, A; Kipps, M

    1999-01-01

    Reforms of the NHS's healthcare structure have placed additional pressure on all aspects of hospital management. Evaluation of the effects of these reforms is difficult without more information on current conditions. Hospital catering in acute care trusts has little contemporary background research available. With this in mind, a survey of all the acute care NHS trusts within the eight regions in England was undertaken to investigate the hospital meal service process. A mailed questionnaire asked for the meal production system, food service method and food delivery personnel used by each trust, and a copy of a weekly menu. Results, from an 80.7 per cent response rate, indicate that most trusts use batch cooking to prepare their meals, and plated meal service to deliver the food to the wards. Almost 75 per cent of the trusts use nurses, at least in part, to serve food. English foodstuffs dominate the menus. Most of the trusts have moved towards meeting the goals set by the Patients' Charter and other NHS recommendations. PMID:10724573

  3. 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. PMID:10162758

  4. Can we achieve high uptakes of influenza vaccination of healthcare workers in hospitals? A cross-sectional survey of acute NHS trusts in England.

    PubMed

    Edelstein, M; Pebody, R

    2014-02-01

    It is unknown which intervention strategies are used or effective to increase influenza vaccine uptake by healthcare workers (HCWs) in acute hospitals in England. We undertook a survey in acute hospitals, described strategies employed from 2008 to 2012 and used multivariable binomial regression to identify those effective. Eighty out of 166 trusts responded and reported 25 strategies. Every intervention showed increased use: peer vaccination from 3·8% to 38·8% (+921%); educational DVDs from 3·8% to 22·5% (+492%); Twitter from 2·5% to 12·5% (+400%) and Facebook from 1·3% to 6·3% (+384%). Peer vaccination increased uptake by 7·3% [95% confidence interval (CI) 1·1-13·6, P = 0·02] overall; educational DVDs by 9·7% overall (95% CI 1·8-17·6, P = 0·02), 11·9% in non-doctor, non-nurse HCWs (95% CI 0·9-22·8, P = 0·03). For doctors, using a champion doctor increased uptake by 17·8% (95% CI 7·6-28·0, P < 0·01). No intervention increased uptake by nurses. Increasing uptake requires multi-intervention strategies targeted at different HCW groups. PMID:23672975

  5. Workplace bullying in NHS community trust: staff questionnaire survey

    PubMed Central

    Quine, Lyn

    1999-01-01

    Objectives To determine the prevalence of workplace bullying in an NHS community trust; to examine the association between bullying and occupational health outcomes; and to investigate the relation between support at work and bullying. Design Questionnaire survey. Setting NHS community trust in the south east of England. Subjects Trust employees. Main outcome measures Measures included a 20 item inventory of bullying behaviours designed for the study, the job induced stress scale, the hospital anxiety and depression scale, the overall job satisfaction scale, the support at work scale, and the propensity to leave scale. Results 1100 employees returned questionnaires—a response rate of 70%. 421 (38%) employees reported experiencing one or more types of bullying in the previous year. 460 (42%) had witnessed the bullying of others. When bullying occurred it was most likely to be by a manager. Two thirds of the victims of bullying had tried to take action when the bullying occurred, but most were dissatisfied with the outcome. Staff who had been bullied had significantly lower levels of job satisfaction (mean 10.5 (SD 2.7) v 12.2 (2.3), P<0.001) and higher levels of job induced stress (mean 22.5 (SD 6.1) v 16.9 (5.8), P<0.001), depression (8% (33) v 1% (7), P<0.001), anxiety (30% (125) v 9% (60), P<0.001), and intention to leave the job (8.5 (2.9) v 7.0 (2.7), P<0.001). Support at work seemed to protect people from some of the damaging effects of bullying. Conclusions Bullying is a serious problem. Setting up systems for supporting staff and for dealing with interpersonal conflict may have benefits for both employers and staff. Key messages38% of staff in a community NHS trust reported being subjected to bullying behaviours in the workplace in the previous year and 42% had witnessed the bullying of othersStaff who had been bullied had lower levels of job satisfaction and higher levels of job induced stress, depression, anxiety, and intention to leaveSupport at work

  6. Organizational Failure in an NHS Hospital Trust: A Qualitative Study.

    PubMed

    Ravaghi, Hamid; Mannion, Russell; Sajadi, Haniye Sadat

    2015-01-01

    The objective was to explore the key factors associated with organizational failure in an NHS Hospital Trust. This case study adopted a qualitative design. Fifty-seven semistructured interviews and document analyses were conducted as well. Data were analyzed using a framework analysis method. A range of symptoms of organizational performance failure was identified. These relate to a financial deficit, lack of good external relationships, inability to meet core targets, a lack of clear management systems, and low staff morale. These markers had not been taken seriously by the previous senior management team. Symptoms of failure were the reflection of presence of secondary and primary causes of failure. Poor managerial leadership, poor financial control and performance management, lack of open culture, distraction by 2 large projects, and the lack of clinician engagement were perceived as internal causes of failure and the high level of policy changes within the NHS as the key external cause. The level of deprivation in the area was also thought to have had a negative impact on performance. The findings reinforce and expand on those of recent studies across the public sector. Tracking an organization's performance and early diagnosis of performance problems, focusing on performance management systems, and taking into account contextual factors are issues that should be considered. PMID:26506299

  7. Feedback from reporting patient safety incidents--are NHS trusts learning lessons?

    PubMed

    Wallace, Louise

    2010-01-01

    For the study, first published in 2006, the researchers examined how well NHS organisations had attempted to use the information they gathered from adverse clinical incidents and whether they were learning from it. By looking at existing relevant research worldwide, interviewing experts, surveying NHS organizations (acute, community and ambulance), consulting health care and other high-risk industry safety experts and NHS risk managers, and investigating case studies of good practice, they developed a model to assess how ready NHS systems were to learn from incidents. This is known as Safety Action and Information Feedback from Incident Reporting (SAIFIR). PMID:20075136

  8. Process and impact of mergers of NHS trusts: multicentre case study and management cost analysis

    PubMed Central

    Fulop, Naomi; Protopsaltis, Gerasimos; Hutchings, Andrew; King, Annette; Allen, Pauline; Normand, Charles; Walters, Rhiannon

    2002-01-01

    Objective To study the processes involved in and impact of mergers between NHS trusts, including the effect on management costs. Design Cross sectional study involving in depth interviews and documentary analysis; case study to compare savings in management costs between case trusts and control trusts. Setting Nine trusts (cross sectional study) and four trusts (case study) in London. Participants 96 interviews with trust board members, other senior managers, clinicians, service managers, and representatives of health authorities, regional office, community health councils, local authorities, other trusts in the area, and primary care groups and trusts. Main outcome measures Stated and unstated drivers, and impact of merger on delivery and development of services, management structures, and staff recruitment, retention, and morale. Effects of difference in trust size before and after the merger. Savings in management costs two years after merger. Results Some important drivers for merger are not publicly stated. Mergers had a negative effect on delivery of services because of a loss of managerial focus on services. Planned developments in services were delayed by at least 18 months. Trusts' larger sizes after mergers had unintended negative consequences, as well as predicted advantages. The tendency for one trust's management team to dominate over the other resulted in tension. No improvement in recruitment or retention of clinical and managerial staff was reported. Perceived differences in organisational culture were an important barrier to bringing together two or more organisations. Two years after merger, merged trusts had not achieved the objective of saving £500 000 a year in management costs. Conclusions Important unintended consequences need to be accounted for when mergers are planned. Mergers can cause considerable disruptions to services, and require greater management support than previously acknowledged. Other organisations undergoing restructuring

  9. 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

  10. Changing an ingrained culture: Improving the safety of oxygen therapy at University Hospitals Bristol NHS Foundation Trust.

    PubMed

    Gatter, Michelle; Dixon, Giles; Wall, Josh; Mew, Ed

    2015-01-01

    Oxygen is one of the most commonly administered drugs in UK hospitals. Our quality improvement project aimed to increase the safety of oxygen therapy at University Hospitals Bristol NHS Foundation Trust. We aimed to increase the rate of oxygen prescribing and increase the percentage of nurses signing appropriately for oxygen titration and administration. We hypothesised this would result in a higher percentage of patients achieving their appropriate oxygen saturations. Our project ran on several acute medical and surgical wards. We tested several interventions with a plan, do, study, act method of continuous data collection. We firstly focussed on the education of junior doctors and then the wider multi-disciplinary team with a trust-wide "safety focus". We utilised patient safety systems already in place in the hospital, such as the clinical risk register and incident reporting system. We also trialled an intervention that was successfully implemented by another group in a different trust in the UK. Oxygen prescription increased from 44.4% to 76.9% over the duration of the project. Appropriate nursing signatures increased from 26.6% to 60%. The number of patients achieving appropriate target saturations rose from 61.8% to 76.7%. The most successful interventions were the trust safety briefing and oxygen safety hangers. Our project has showed the importance of integrating new projects within safety schemes already available. Persistence and careful intervention are key to changing strongly engrained cultures in large organisations. Interventions that have proved to be successful in other trusts can be implemented to enact change. PMID:26732123

  11. The management of ultrasound equipment at Sheffield Teaching Hospitals NHS Foundation Trust

    PubMed Central

    Peacock, M

    2013-01-01

    Management of ultrasound equipment at Sheffield Teaching Hospitals NHS Foundation Trust is described. The organisation and input of various stakeholders and their involvement with ultrasound equipment management and scientific ultrasound is discussed. Two important stakeholders are the Medical Equipment Management Group and the Radiation Safety Steering Committee. The Medical Equipment Management Group has a specific sub-group, the Ultrasound sub-group, and its role is to coordinate the purchase, replacement and quality assurance of ultrasound equipment in the Trust. The Radiation Safety Steering Committee has a non-ionising radiation representative and the role of this committee is to provide corporate assurance that any health and safety issues arising from the use of radiation to either patients, members of the public or staff within the Trust are being effectively managed. The Ultrasound sub-group of the Medical Equipment Management Group has successfully brought together management of all ultrasound equipment within the Trust and is in the process of fulfilling the quality assurance and training milestones set out by the Medical Equipment Management Group. Advice from the Radiation Safety Steering Committee has helped to increase awareness of ultrasound safety and good scanning practice, especially in the case of neonatal ultrasound imaging, within the Trust. In addition, the RSSC has given advice on clinical pathways for patients undergoing ionising radiation imaging while being treated by extra-corporeal shockwave lithotripsy. PMID:27433195

  12. 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. PMID:27251912

  13. 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. PMID:10177367

  14. 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. PMID:25595009

  15. An investigation of the suitability of the EFQM Excellence Model for a pharmacy department within an NHS Trust.

    PubMed

    Stewart, Ann

    2003-01-01

    Explores whether the EFQM Excellence Model provides a suitable framework for quality management within the pharmacy department at Hope Hospital, Salford Royal Hospitals NHS Trust. Research involved a literature search of the work of authors in the field of quality, generically and in healthcare, the development of quality awards, and practical cases of implementation of the model in NHS Trusts. Common themes were identified from this search. Interviews with staff and customers showed high levels of customer awareness, customer satisfaction and generic training. This was compared with the data from the literature search and the researcher's observations. The Excellence Model was seen to be a suitable framework for quality management provision, although there was little knowledge of it in the pharmacy department. A quality service was still being provided in spite of this, but the model could build further on this good work and provide a more structured approach. PMID:12870245

  16. 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. PMID:26768906

  17. A Multi-Faceted Approach of One Teaching Hospital NHS Trust during the Clostridium difficile Epidemic—Antibiotic Management and Beyond

    PubMed Central

    White, Helena; Wiselka, Martin; Bell, David

    2016-01-01

    The incidence of Clostridium difficile infection (CDI) in the UK rose dramatically during the early years of this century, in part associated with the emergence of the hyper-virulent ribotype 027 strain. The University Hospitals of Leicester (UHL), a 2000-bed acute UK NHS Trust, implemented a number of interventions, which led to an 80% reduction in new cases over a twelve month period. Changes were introduced as a result of collaboration between the Infection Prevention team, the departments of Microbiology and Infectious Diseases, and with the support of the Trust Executive. These strategies are described in detail and included; implementation of antimicrobial stewardship, specific hygiene and cleaning measures, the introduction of a care pathway form for all infected patients, the opening of an isolation ward for patients with CDI, strengthened organisation and clinical management, and rigorous attention to education within the Trust. The implementations described are of continued relevance in the face of new infection challenges, such as the increasing incidence of multi-drug resistant organisms. PMID:27025528

  18. Giving greater financial independence to hospitals--does it make a difference? The case of English NHS Trusts.

    PubMed

    Marini, Giorgia; Miraldo, Marisa; Jacobs, Rowena; Goddard, Maria

    2008-06-01

    In 2003 a new type of provider organisation, the Foundation Trust (FT), was introduced in England, and the best performing NHS hospitals were able to apply for 'Foundation status'. FTs enjoy greater financial flexibility and are subject to less central monitoring and control. The phased introduction of FTs represents an opportunity to examine whether the new financial structures facing FTs have produced any differences in financial performance compared with non-FTs. We use difference in difference methods to examine whether Foundation status had a significant effect on financial management. We find that Foundation status has had a limited impact in terms of acting as an instrument to signal strong financial management of FTs. This result may reflect the relatively early stage of the FT process or may be due to the fact that all types of Trusts are experiencing a challenging financial environment, including the introduction of a prospective payment system. However, we explore the nature of the trends emerging over time and discuss the implications of our findings for policy. PMID:17910094

  19. 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

  20. Improving efficiency in robotic theatres in the Royal Wolverhampton NHS Trust: a gynaecology theatres perspective.

    PubMed

    Harding, V; Williams, J

    2016-03-01

    Improving efficiency within the operating theatre is always a key concern when running a successful operating list. However, with robotic surgery, this can become paramount. Robotic procedures require a more technical set up, additional planning, and good solid communication within the multidisciplinary team. Efficiency needs to be at the forefront of everyone's mind. Forward planning requires knowledge of the procedures being carried out and adequate training with the robot. Trouble shooting will also improve efficiency in robotic surgery, as being able to expect the unexpected can be a major advantage. This article looks at the hurdles encountered by the theatre team at Royal Wolverhampton Trust at the implementation of the robotic programme, and how the theatre team made adjustments to working practice in order to minimise disruption and maximise efficiency. PMID:27149833

  1. NHS politics. Winging it.

    PubMed

    Dewar, Steve; Chantler, Cyril

    2002-03-14

    At present, NHS managers are highly constrained, suffering excessive regulation and central control. More autonomy for trusts would mean fewer directives and less performance management. Giving trusts a new organisational form, such as a public interest company or foundation hospital, might be reinvigorating and would not involve further reorganisation. These new freedoms should be accompanied by new accountabilities, not solely to politicians but to independent NHS regulators, local communities and patients. Devolved power and greater patient choice could produce a more responsive NHS. Its potential needs to be explored through experimentation and evaluation. PMID:11915404

  2. An analysis of National Health Service Trust websites on the occupational backgrounds of ‘Non-Executive Directors’ on England’s Acute Trusts

    PubMed Central

    Harding, Andrew JE

    2014-01-01

    Summary Objectives To explore the occupational backgrounds of English Non-Executive Directors (NED) on Acute National Health Service (NHS) Trusts. Design Data extrapolated from Trust websites of NED’ occupational backgrounds by gender and occupations, and inter-rater reliability test undertaken. Setting Data were available on all but 24 of the 166 Acute Trusts’ from all regions. Participants Trust Chairs and NED were categorised by their dominant occupation. Main outcome measure Differentiating NED with and without health or social care leadership experience. Results The ratings of NED’ occupations positively correlated (p < 0.001). Occupational categories were Commerce and Finance from private and public sectors or with Medical or Community leadership experience. Only 4% of Chairs were Medical, 2% from Community – the majority (61%) from Commerce and Finance. Of the 1001 NED, 8% and 6% respectively had Medical or Community leadership experience; most (86%) were Commerce, Finance and non-clinical Managerial backgrounds. Females made up 27% of NED. Conclusions With a predominance of Chairs and NED without health or social care leadership experience, are current Boards equipped to avoid inadvertently ‘doing the system's business’ (Francis, 2013) rather than developing a more patient-centred, clinically led and integrated NHS? It is suggested that Boards need more NED with health and social care leadership experience and methods to identify the ‘patient’s agenda’ to create ‘a common culture’ that places ‘patients at the centre of everything we do’ (Hunt, 2012). A key context for Trust Boards operations is funding, which Francis’ terms of reference excluded, an issue that is briefly discussed. PMID:25057396

  3. 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. PMID:12396550

  4. 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. PMID:25443028

  5. To explore and understand the leadership experiences of modern matrons, within an acute NHS Trust.

    PubMed

    Lawrence, Nigel; Richardson, Janet

    2014-01-01

    Aim  The aim of this study was to explore and understand the leadership experiences of modern matrons. Background  Modern matrons were re-introduced to the National Health Service in 2002, and effective leadership has been identified as being essential for the role to be successful. However, there is minimal evidence of how modern matrons experience effective leadership. Methods  The study used a descriptive generic qualitative methodology; one-to-one semi-structured interviews were conducted with nine matrons. This was subjected to an inductive thematic analysis. Results  Three themes were found to influence modern matron's leadership experiences: leadership behaviours, negative influences and leadership investment. They did not follow one leadership style but adapted this to their situation. Various factors appeared to restrict their leadership effectiveness. Conclusions  The findings suggest that exposure to a range of leadership styles should be included in preparation and CPD for the modern matron role and a more consistent job description and job purpose should be developed. Implications for nursing management  Leadership styles such as transformational leadership alone do not meet the complex demands of nursing leaders, and therefore there is a requirement for greater flexibility in leadership development for all health care professionals. PMID:23410106

  6. A Pilot Action Learning Set for NHS R&D Managers

    ERIC Educational Resources Information Center

    Boaden, Margaret

    2004-01-01

    A pilot action learning set was established in late September 2002, with the objective to develop a model of action learning appropriate for R&D managers. This initiative was one of a number of responses to a request for training and support by a small group of R&D managers who were based in non-teaching acute and primary care NHS trusts. The…

  7. NHS at forefront of carbon modelling.

    PubMed

    Brockway, Paul

    2010-10-01

    Paul Brockway, senior sustainability consultant at Arup, reports on a carbon footprint study undertaken at the Barts and the London NHS Trust which set out to "understand carbon hotspots and identify actions that can save both money and carbon". The completion of the Barts study, believed to have been the first such initiative involving an NHS Trust, follows a national, Sustainability Development Unit-commissioned footprint study led by the author in 2008, and described in detail in the article, "Assessing the full carbon impacts of healthcare", in the IFHE Digest 2010. PMID:21058618

  8. Processes for reducing NHS carbon footprint.

    PubMed

    2007-08-01

    NHS Trust boards face challenging targets for cutting carbon emissions from new and existing facilities. Spirax Sarco's Murdo Macdonald looks at the help available and some of the latest examples of good practice in steam systems for hospital heating and hot water. PMID:17847881

  9. Cutting the cost of NHS procurement.

    PubMed

    2013-10-01

    With the NHS spending over 20 billion sterling pounds annually on goods and services--accounting, typically, for around 30 per cent of each hospital's operating costs--but, in the view of Health Minister, Dr Dan Poulter MP, still 'failing to harness its enormous purchasing power', the Minister recently unveiled a new Procurement Development Programme for the service, (HEJ - September 2013) the goal being to help NHS Trusts 'find' over 1.5 billion sterling pounds of 'procurement efficiencies' over the next three years. HEJ reports. PMID:24341107

  10. 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

  11. Trust management of information vital.

    PubMed

    Rayfield, Jason

    2005-02-01

    The Freedom of Information (FOI) Act, which came into force on 1 January this year, requires all NHS bodies to disclose, when requested, any information they hold. Jason Rayfield reports on the work done by legal firm Morgan Cole to prepare NHS Trusts to deal with their responsibilities under the new legislation. PMID:15729999

  12. Doctors with problems in an NHS workforce.

    PubMed Central

    Donaldson, L. J.

    1994-01-01

    OBJECTIVES--To describe the incidence, nature, and implications of serious disciplinary problems among the medical staff of a large NHS hospital workforce. DESIGN--Descriptive study with analysis of case records. SETTING--Northern Health Region, an administrative area within the NHS covering a population of three million. SUBJECTS--Forty nine hospital doctors: 46 consultants and three associate specialists. MAIN OUTCOME MEASURES--The nature of the problems encountered within the doctors' practice, and the types of action taken by the employing authority. RESULTS--Over a five year period concerns serious enough to warrant the consideration of disciplinary action were raised about 6% of all senior medical staff (49/850). Ninety six types of problem were encountered, and were categorised as poor attitude and disruptive or irresponsible behaviour (32), lack of commitment to duties (21), poor skills and inadequate knowledge (19), dishonesty (11), sexual matters (seven), disorganised practice and poor communication with colleagues (five), and other problems (one). Twenty five of the 49 doctors retired or left the employer's service, whereas 21 remained in employment after counselling or under supervision. CONCLUSIONS--Existing procedures for hospital doctors within the NHS are inadequate to deal with serious problems. Dealing with such problems requires experience, objectivity, and a willingness to tolerate unpleasantness and criticism. Because most consultants' contracts are now held by NHS trust hospitals, however, those who had developed skill over the years in handling these complex issues are now no longer involved. Images p1278-a p1282-a PMID:8205022

  13. 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

  14. NHS Health Checks

    PubMed Central

    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. PMID:25340472

  15. From plough to plate--an NHS first?

    PubMed

    Baillie, Jonathan

    2011-10-01

    A recent Soil Association survey saw nearly a third of the 1,000 patients questioned about the food they had received during a recent hospital stay report that it was so bad that, at times, they could not recognise what was on their plate (HEJ - September 2011). The resulting report, however, also commended a number of healthcare organisations which had put considerable time, effort, and commitment, into providing first-class patient meals, often at negligible extra cost, and using high quality, locally sourced produce. One NHS Trust pioneering such an approach, while simultaneously boosting the fortunes of local farmers and other food producers, is Sussex Partnership NHS Foundation Trust, which, HEJ editor Jonathan Baillie discovered, is now not only being held up as a national exemplar of good NHS catering practice, but has also recently had the go-ahead for a new pound 2.2 million catering facility. PMID:22053361

  16. NHS values. I want to tell you a story.

    PubMed

    Pattison, S; Manning, S; Malby, B

    1999-02-25

    Many NHS staff feel that they are unable to put their values into action because of the constraints on the service. They want a working environment where trust is possible and mistakes can be made without retribution. The reality is often bullying and attempts at innovation being met with reproach. PMID:10387429

  17. 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

  18. 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

    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

  19. 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. PMID:10118487

  20. 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. PMID:26268017

  1. Options for change in the NHS consultant contract.

    PubMed Central

    Clarke, R. W.; Gray, C.

    1994-01-01

    The lead negotiators for the management and consultant sides in an NHS trust in northern England responded to debate in their trust about consultant contracts by offering to research the attitudes of their peers towards a variety of contract options. The options tested included the current contract; models already examined in the trust and elsewhere, such as time sensitive and mild performance related contracts; and some more radical and speculative possibilities, including consultants franchising their services to the trust. Beyond the predictable conclusion that consultants would prefer no change while managers desired it, a time sensitive contract emerged as having potential for successful negotiation. On the other hand, neither consultants nor managers favoured a strict performance related contract or a fee for service contract. There was a strong similarity of opinion between the two groups on the relative salary values of the options, though the consultants consistently priced these higher than the managers. PMID:8086915

  2. Experience based co-design reduces formal complaints on an acute mental health ward

    PubMed Central

    Springham, Neil; Robert, Glenn

    2015-01-01

    An acute mental health triage ward at Oxleas NHS Foundation Trust was attracting high levels of formal service user and family complaints. The Trust used experience based co-design to examine the issues and redesign procedures. This resulted in an immediate eradication of formal complaints for a period of 23 months. This paper describes two outcomes: firstly, the successful adaptations made to the experience based co-design methodology from its origins in physical care, in order to ensure it was safe and effective in an acute mental health setting; and, secondly, the changes made to the ward as a result of this quality improvement intervention. PMID:26734433

  3. 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. PMID:17847874

  4. 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

  5. The problem with rational approaches to reforming the NHS.

    PubMed

    Smith, Tom

    2002-12-01

    Several papers with a common theme published between May and August 2002 are drawn together to present a research-informed critique of economic logic present within recent NHS reform. They attempt to persuade the reader that excessive faith in predictive systems of thought that are underpinned by theories of rational behaviour is misplaced within the NHS. They suggest rational economic theory makes some problematic assumptions about human and individual behaviour. The problem is that there are many modes of thought at work within the NHS, and not all of these cogs are turned by economic rationality. Increasingly, over the last 10 years or so, economic concepts have become more and more prominent in the NHS. Their influence has gone beyond finance becoming a dominant issue. In addition to budgets, contracts and cost itemisation, theoretical relationships of supply and demand are now called upon to change professional behaviour. A new framework for the NHS has been built which is developing market forces. The papers provide some insight into whether the systems set in place to produce a patient-centred service do so in a meaningful way. The first paper examines an emerging primary care group (PCG). Now part of primary care trusts, PCGs were a lynchpin of new economic relationships in the new NHS. Community based, in theory PCGs take decisions made about healthcare resources closer to the patient for whom they are a proxy demander and shaper of services. To what extent do PCGs fulfil this role? The first paper is based on data collected during an in-depth 2 year observation study to test the applicability of health economics to healthcare organisations. It examines the early experience of commissioning services for coronary heart disease (CHD). PMID:12468703

  6. 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. PMID

  7. Trusting patients, trusting nurses.

    PubMed

    Sellman, Derek

    2007-01-01

    The general expectation that patients should be willing to trust nurses is rarely explored or challenged despite claims of diminishing public trust in social and professional institutions. Everyday meanings of trust take account of circumstance and suggest that our understanding of what it means to trust is contextually bound. However, in the context of health care, to trust implies a particular understanding which becomes apparent when abuses of this trust are reported and acknowledged as scandals. The predominant assumption in the literature that trust is something that occurs between equally competent adults cannot explain trust in nursing precisely because of the unequal power relationships between patients on the one hand and healthcare professionals on the other. Moreover, the tendency to conflate terms such as trust, reliance, confidence and so on suggests that confusion permeates discussions of trust in nursing. In this paper, I argue in support of Annette Baier's requirement of good will (or lack of ill will) as the essential feature of trust, and outline how this account (i) enables us to make the necessary distinctions between trust on the one hand and 'trust pretenders' on the other; and (ii) lays the foundations for understanding trust in relationships, such as those between patients and nurses, where power differentials exist. PMID:17238998

  8. 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

  9. Hypnobirth within the NHS: time to ditch the parent craft?

    PubMed

    Gavin-Jones, Teri

    2016-05-01

    Antenatal education within the National Health Service (NHS) is a service in decline within some hospital trusts. Classes on offer are being moved into online formats or discontinued completely. Whilst research into antenatal education remains limited, what is known is that good birth preparation is of value. "Participative preparation for childbirth can enhance women's overall satisfaction with the childbirth experience" (Schrader McMillan et al 2009: 49). There are pockets of excellent antenatal education within the NHS, but no system for regulating the quality and content. Traditional 'parent craft' classes can be oversubscribed, turning what should be a participative group into an audience. Offering good quality antenatal education has the potential to increase normality, improve the birth outcome and the experience of both woman and her birth partner. Is it time to ditch the parent craft and implement dynamic woman-focused education? PMID:27295754

  10. Is follow-up capacity the current NHS bottleneck?

    PubMed

    Allder, Steven; Walley, Paul; Silvester, Kate

    2011-02-01

    Capacity and demand theory suggests that the presence of a queue is not necessarily an indication of a shortage of capacity in a system. It is much more likely that either there is a demand and capacity variation that creates queues or there is a delay designed into the system. A shortage of capacity is only really indicated where a backlog is not stable and continues to grow. In this article, data are taken from one NHS trust that provides evidence for a continually growing backlog for follow-up outpatient services. It is believed that these data are representative of most locations within the NHS in England and therefore suggest an immediate shortage in effective follow-up capacity. To avoid compromise to patient care, the problem will have to be addressed before the situation becomes unmanageable. The paper highlights options to reduce or deflect demand or to increase effective capacity. PMID:21404781

  11. Delayed transfer of care from NHS secondary care to primary care in England: its determinants, effect on hospital bed days, prevalence of acute medical conditions and deaths during delay, in older adults aged 65 years and over

    PubMed Central

    Jasinarachchi, Krishantha H; Ibrahim, Ibrahim R; Keegan, Breffni C; Mathialagan, Rajaratnam; McGourty, John C; Phillips, James RN; Myint, Phyo K

    2009-01-01

    Background The delay in discharge or transfer of care back to the community following an acute admission to the hospital in older adults has long been a recognized challenge in the UK. We examined the determinants and outcomes of delayed transfer of care in older adults. Methods A prospective observational study was conducted in a district general hospital with a catchment population of 250,000 in England, UK. Those >= 65 years admitted to two care of the elderly wards during February 2007 were identified and prospectively followed-up till their discharge. Data was presented descriptively. Results 36.7% (58/158) of patients had a delay in transfer of care. They tended to be older, had poorer pre-morbid mobility, and were more likely to be confused at the time of admission. Compared to the 2003 National Audit Report, a significantly higher percentage (29.3%vs.17%) awaited therapist assessments or (27.6%vs.9%) domiciliary care, with a lower percentage (< 1%vs.14%) awaiting further NHS care. Of 18 in-patient deaths, five occurred during the delay. Seven patients developed medical conditions during the delay making them unfit for discharge. The number of extra bed days attributable to delayed discharges in this study was 682 (mean = 4.8) days. Conclusion Awaiting therapy and domiciliary care input were significant contributing factors in delayed transfer of care. Similar local assessments could provide valuable information in identifying areas for improvement. Based on available current evidence, efficacy driven changes to the organisation and provision of support, for example rapid response delayed discharge services at the time of "fit to discharge" may help to improve the situation. PMID:19161614

  12. Public spending and NHS finance.

    PubMed

    Jones, T

    1992-10-01

    Reliability, the Chancellor's Autumn Statement on the country's economic prospects, and the Government's public spending plans seldom go hand in hand. Last year's statement, however, offers an insight into this year's discussions and negotiations and their effect on NHS resources. Tom Jones sets the scene. PMID:10122088

  13. Complications of facial fillers: resource implications for NHS hospitals

    PubMed Central

    Hachach-Haram, Nadine; Gregori, Marco; Kirkpatrick, Niall; Young, Richard; Collier, Jonathan

    2013-01-01

    Facial rejuvenation seeks to reverse the negative sequelae of multiple factors but most importantly of genetic predisposition, sun damage and smoking. With the advent of the so-called ‘non-surgical’ techniques, and perhaps fuelled by these austere times, volumetric facial augmentation using dermal fillers has soared in popularity among both patients and practitioners. However, legislation has yet to keep pace with the change in clinical practices leaving patients poorly informed and with no protection against unscrupulous suppliers and unregulated practitioners. When things go wrong, patients often turn to the National Health Service (NHS) to rectify both the acute and chronic sequelae resulting in potentially difficult ethical and resource implications. Here, we report one of an increasing number of cases presenting to our NHS craniofacial service with acute filler-related complications. PMID:23362071

  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. PMID:25585766

  15. Cultural changes within the NHS.

    PubMed

    Oakley, P

    The NHS is in the throes of profound change. How much of it is cultural? Indeed, what do we mean when we talk about the culture of an organisation? And if we succeed in defining culture, how does an understanding of this concept help us to manage the service better? This article sets out to answer these questions and argues that an understanding of organisational culture is a necessary part of good human resource management. PMID:7551487

  16. Incidence and consequence of acute kidney injury in unselected emergency admissions to a large acute UK hospital trust

    PubMed Central

    2014-01-01

    Background AKI is common among hospital in-patients and places a huge financial burden on the UK National Health Service, causing increased length of hospital stay and use of critical care services, with increased requirement for complex interventions including dialysis. This may account for up to 0.6% of the total Health Service budget. To investigate the incidence and consequences of AKI, all unselected emergency admissions to a large acute UK single centre University Teaching Hospital over two separate 7 day periods were reviewed. Methods A retrospective audit of 745 case records was undertaken (54.6% male) including laboratory data post-discharge or death, with classification of AKI by RIFLE, AKIN and AKIB criteria. Participants were included whether admitted via their general practitioners, the emergency department, or as tertiary specialty transfers. Outcome measures were presence or absence of AKI recorded using each of the three AKI criteria, length of hospital stay (LOS), admission to, and LOS in critical care, and mortality. The most severe grade of AKI only, at any time during the admission, was recorded to prevent double counting. Renal outcome was determined by requirement for renal replacement therapy (RRT), and whether those receiving RRT remained dialysis dependent or not. Results AKI incidence was 25.4% overall. With approximately one third present on admission and two thirds developing post admission. The AKI group had LOS almost three times higher than the non AKI group (10 vs 4 days). Requirement for critical care beds was 8.1% in the AKI group compared to 1.7% in non AKI group. Overall mortality was 5.5%, with the AKI group at 11.4% versus 3.3% in the non AKI group. Conclusions AKI in acute unselected hospital admissions is more common than existing literature suggests, affecting 25% of unselected admissions. In many this is relatively mild and may resolve spontaneously, but is associated with increased LOS, likelihood of admission to

  17. 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

  18. Welsh Trust sees energy costs reduce.

    PubMed

    Churches, Wayne

    2009-02-01

    Working closely with Honeywell Building Solutions, a division of Honeywell International, under two long-term Energy Performance Contracts, should bring Gwent Healthcare NHS Trust in South Wales guaranteed annual savings of over pounds 1.1 million in energy costs over at least the next 15 years, as the Trust's estates manager, Wayne Churches, explained to delegates at the Healthcare Facilities Consortium (HFC) 2008 Annual Conference. PMID:19297847

  19. Influenza vaccination for NHS staff: attitudes and uptake

    PubMed Central

    Shrikrishna, Dinesh; Williams, Siân; Restrick, Louise

    2015-01-01

    Objectives Annual vaccination against influenza (flu) is recommended for all UK National Health Service (NHS) staff to help reduce the risk of contracting the virus and transmitting it to patients. However, despite flu campaigns and vaccination promotion, uptake remains low. The aim of this study was to investigate staff attitudes to flu vaccination to see how this may influence their decision to be vaccinated. Methods An online survey was sent to staff members across 6 NHS trusts, asking if staff had been vaccinated in the preceding flu season (2013–2014); the survey included questions about beliefs and attitudes to the vaccination, scored on a 5-point Likert scale. Results 3059 NHS staff members responded to the survey (86% in the 26–59 age group, 77% female and 84% hospital based). 68% of respondents reported being vaccinated in the preceding year. Using a stepwise regression model, the survey response retained as a positive predictor of having been vaccinated was ‘people working in healthcare should have the flu vaccination every year’ (p<0.001), and the responses retained as negative predictors were ‘the flu vaccination will make me unwell’ (p<0.001) and ‘the flu vaccination was too much trouble for me’ (p<0.001). Analysis by staff group showed a significant difference in the response to ‘the flu vaccination will make me unwell’ between groups (p=0.01), with doctors having a greater tendency to disagree with this statement than other staff members. Conclusions These results suggest that addressing NHS staff beliefs around the need for vaccination, while ensuring that practical barriers to having the vaccination are removed, may help to increase uptake. An emphasis on alleviating the concerns of particular staff groups regarding adverse effects of the vaccine may also be of benefit in improving uptake, to protect patients as well as staff. PMID:26019875

  20. What is the NHS Safety Thermometer?

    PubMed

    Power, Maxine; Stewart, Kevin; Brotherton, Ailsa

    2012-09-01

    The English National Health Service (NHS) announced a new programme to incentivize use of the NHS Safety Thermometer (NHS ST) in the NHS Operating Framework for 2012/13. For the first time, the NHS is using the Commissioning for Quality and Innovation (CQUIN) scheme, a contract lever, to incentivize ALL providers of NHS care to measure four common complications (harms) using the NHS ST in a proactive way on one day per month. This national CQUIN scheme provides financial reward for the collection of baseline data with a view to incentivizing the achievement of improvement goals in later years. In this paper, we describe the rationale for this large-scale data collection, the purpose of the instrument and its potential contribution to our current understanding of patient safety. It is not a comprehensive description of the method or preliminary data. This will be published separately. The focus of the NHS ST on pressure ulcers, falls, catheters and urine infection and venous thromboembolism is broadly applicable to patients across all healthcare settings, but is specifically pertinent to older people who, experiencing more healthcare intervention, are at risk of not one but multiple harms. In this paper, we also describe an innovative patient-level composite measure of the absence of harm from the four identified, termed as "harmfreecare" which is unique to the NHS ST and is under development to raise standards for patient safety. PMID:23136533

  1. 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. PMID:27401200

  2. Assessment of facilities management process capability: a NHS facilities case study.

    PubMed

    Amaratunga, Dilanthi; Haigh, Richard; Sarshar, Marjan; Baldry, David

    2002-01-01

    Describes a process to assess facilities management (FM) process capabilities: the structured process improvement for construction environments--facilities management (SPICE FM) approach. The SPICE FM framework is a method that FM organizations can use to monitor continuously and subsequently improve their performance. The SPICE FM framework is being tested in a series of case studies to ensure that its outputs are appropriate to the FM sector and of value in the real world. Documents the outcomes of a study undertaken at a facilities directorate of a healthcare NHS trust, in searching its applicability within the NHS. Further describes the study methodology and the key activities undertaken and reviews the key communication and management processes that are in place to support the implementation of the strategic FM objectives within the specific NHS facilities directorate. PMID:12500653

  3. Use staff wisely to save NHS money.

    PubMed

    Moore, Alison

    2015-12-01

    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. PMID:26647680

  4. 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. PMID:24841528

  5. Registered nurse, healthcare support worker, medical staffing levels and mortality in English hospital trusts: a cross-sectional study

    PubMed Central

    Griffiths, Peter; Ball, Jane; Murrells, Trevor; Jones, Simon; Rafferty, Anne Marie

    2016-01-01

    Objectives To examine associations between mortality and registered nurse (RN) staffing in English hospital trusts taking account of medical and healthcare support worker (HCSW) staffing. Setting Secondary care provided in acute hospital National Health Service (NHS) trusts in England. Participants Two data sets are examined: Administrative data from 137 NHS acute hospital trusts (staffing measured as beds per staff member). A cross-sectional survey of 2917 registered nurses in a subsample of 31 trusts (measured patients per ward nurse). Outcome measure Risk-adjusted mortality rates for adult patients (administrative data). Results For medical admissions, higher mortality was associated with more occupied beds per RN (RR 1.22, 95% CI 1.04 to 1.43, p=0.02) and per doctor (RR 1.10, 95% CI 1.05 to 1.15, p <0.01) employed by the trust whereas, lower HCSW staffing was associated with lower mortality (RR 0.95, 95% CI 0.91 to 1.00, p=0.04). In multivariable models the relationship was statistically significant for doctors (RR 1.08, 95% CI 1.02 to 1.15, p=0.02) and HCSWs (RR 0.93, 95% CI 0.89 to 0.98, p<01) but not RNs (RR 1.14, 95% CI 0.95 to 1.38, p=0.17). Trusts with an average of ≤6 patients per RN in medical wards had a 20% lower mortality rate compared to trusts with >10 patients per nurse (RR 0.80, 95% CI 0.76 to 0.85, p<0.01). The relationship remained significant in the multivariable model (RR 0.89, 95% CI 0.83 to 0.95, p<0.01). Results for surgical wards/admissions followed a similar pattern but with fewer significant results. Conclusions Ward-based RN staffing is significantly associated with reduced mortality for medical patients. There is little evidence for beneficial associations with HCSW staffing. Higher doctor staffing levels is associated with reduced mortality. The estimated association between RN staffing and mortality changes when medical and HCSW staffing is considered and depending on whether ward or trust wide staffing levels are considered. PMID

  6. Trade unions and local bargaining in the NHS.

    PubMed

    Corby, S; Blundell, B

    1997-01-01

    Examines some effects of NHS Trusts moving away at varying speeds from complex national arrangements for determining terms and conditions towards local bargaining. Notes that while there has been some research into the extent and nature of this decentralization, the impact on trade unions has largely been ignored. This research suggests that, far from marginalizing stewards, senior managers have involved them in joint discussions. Although there has not been a renewal of local trade unionism, there has not been a decline, as membership has held up. Moreover, stewards have coped remarkably well with their enhanced roles, even though faced with the increasing and conflicting demands of their work and their union duties, compounded by problems in obtaining time off work because of lack of cover. PMID:10167874

  7. 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. PMID:15317341

  8. 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

  9. 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. PMID:19496472

  10. Supplying commercial biomedical companies from a human tissue bank in an NHS hospital--a view from personal experience.

    PubMed Central

    Gray, N; Womack, C; Jack, S J

    1999-01-01

    NHS histopathology laboratories are well placed to develop banks of surgically removed surplus human tissues to meet the increasing demands of commercial biomedical companies. The ultimate aim could be national network of non-profit making NHS tissue banks conforming to national minimum ethical, legal, and quality standards which could be monitored by local research ethics committees. The Nuffield report on bioethics provides ethical and legal guidance but we believe that the patient should be fully informed and the consent given explicit. Setting up a tissue bank requires enthusiasm, hard work, and determination as well as coordination between professionals in the NHS trust and in the commercial sector. The rewards are exiting new collaborations with commercial biomedical companies which could help secure our future. PMID:10474514

  11. Tackling Work Related Stress in a National Health Service Trust

    ERIC Educational Resources Information Center

    Vick, Donna; Whyatt, Hilary

    2004-01-01

    The challenge of tackling the problem of coping with work related stress in a National Health Service (NHS) Trust was undertaken. Ideas were developed within the context of two different action learning sets and led to actions resulting in a large therapy Taster Session event and the establishment of a centre offering alternative therapies and…

  12. 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

  13. NHS failing its black and minority workforce.

    PubMed

    2016-06-01

    The findings are in and are far from surprising. The first report of the NHS Workforce Race Equality Standard (WRES) was published on June 2 and contains a highly predictable litany of woe: black and minority ethnic (BME) staff are more likely than white staff to be bullied or abused, wherever they work. PMID:27286582

  14. Assessing the impact of a new health sector pay system upon NHS staff in England

    PubMed Central

    Buchan, James; Evans, David

    2008-01-01

    Background Pay and pay systems are a critical element in any health sector human resource strategy. Changing a pay system can be one strategy to achieve or sustain organizational change. This paper reports on the design and implementation of a completely new pay system in the National Health Service (NHS) in England. 'Agenda for Change' constituted the largest-ever attempt to introduce a new pay system in the UK public services, covering more than one million staff. Its objectives were to improve the delivery of patient care as well as enhance staff recruitment, retention and motivation, and to facilitate new ways of working. Methods This study was the first independent assessment of the impact of Agenda for Change at a local and national level. The methods used in the research were a literature review; review of 'grey' unpublished documentation provided by key stakeholders in the process; analysis of available data; interviews with key national informants (representing government, employers and trade unions), and case studies conducted with senior human resource managers in ten NHS hospitals in England Results Most of the NHS trust managers interviewed were in favour of Agenda for Change, believing it would assist in delivering improvements in patient care and staff experience. The main benefits highlighted were: 'fairness', moving different staff groups on to harmonized conditions; equal pay claim 'protection'; and scope to introduce new roles and working practices. Conclusion Agenda for Change took several years to design, and has only recently been implemented. Its very scale and central importance to NHS costs and delivery of care argues for a full assessment at an early stage so that lessons can be learned and any necessary changes made. This paper highlights weaknesses in evaluation and limitations in progress. The absence of systematically derived and applied impact indicators makes it difficult to assess impact and impact variations. Similarly, the lack of

  15. Sending NHS Patients for Operations Abroad: Is the Holiday Over?

    PubMed Central

    Hanna, Sammy A; Saksena, Joyti; Legge, Stella; Ware, Howard E

    2009-01-01

    INTRODUCTION The UK Department of Health, in its attempt to help NHS trusts reduce long elective waiting lists, set up the overseas commissioning scheme in 2002. This allowed hospitals to send their patients abroad for their surgery. In theory, this was a win-win situation, where pressures upon surgeons were reduced, and trusts could reach UK Government targets and avoid breaches. At our hospital, a significant number of patients, who had undergone a total joint replacement abroad, were discharged after only one postoperative review and often had very little physiotherapy. A few presented to our clinic with more serious problems. PATIENTS AND METHODS This is a retrospective review of two matched groups of patients (22 each), all of whom underwent a total knee replacement in 2003. The first group (abroad, Belgium) included 10 males and 12 females with a mean age of 74.5 years and a mean follow-up of 37 months. The second group (local institution) included 10 males and 12 females with a mean age of 71.4 years and a mean follow-up of 34 months. All patients were evaluated using the Oxford Knee Score (OKS), Knee Society Score (KSS), and SF-12 systems. RESULTS OKS and KSS were similar in the two groups. However, SF-12 figures revealed a statistically significant difference in both the physical (PCS) and mental components (MCS). Belgium group – mean PCS 40, mean MCS 48: local group – mean PCS 47, mean MCS 57; P < 0.05. CONCLUSIONS The results demonstrate that, although the majority of patients operated upon abroad got comparable functional results to patients operated locally, they often felt dissatisfied with the overall experience of travelling for their operation. Furthermore, the issues of ‘patient ownership’ and long-term follow-up need to be fully addressed in order to safeguard the high standard of care we should offer our patients. PMID:19102820

  16. The NHS reforms. Conditions for successful change.

    PubMed

    Forster, D P; Hadley, R

    1989-10-01

    The NHS Review has proposed the most radical organisational change in health care since the inception of the service itself in 1948. Yet, the problems entailed in gaining acceptance for reforms of such magnitude are scarcely touched on in the white paper. The scale and strength of opposition which the proposals have subsequently met within the NHS have shown clearly that the issue of the management of change is likely to be central in the acceptance or otherwise of the proposals and subsequently their success or failure. Donald Forster and Roger Hadley outline the framework within which the issues posed by change can be analysed and assessed. In keeping with the government's preference for a management perspective, they emphasise insights from the literature on the management of change rather than the detail of the white paper. PMID:10296172

  17. 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. PMID:26328512

  18. Setting health care capitations through diagnosis-based risk adjustment: a suitable model for the English NHS?

    PubMed

    Asthana, Sheena; Gibson, Alex

    2011-07-01

    The English system of health resource allocation has been described as the apotheosis of the area-level approach to setting health care capitations. However, recent policy developments have changed the scale at which commissioning decisions are made (and budgets allocated) with important implications for resource allocation. Doubts concerning the legitimacy of applying area-based formulae used to distribute resources between Primary Care Trusts (PCTs) to the much smaller scale required by Practice Based Commissioning (PBC) led the English Department of Health (DH) to introduce a new approach to setting health care budgets. To this end, practice-level allocations for acute services are now calculated using a diagnosis-based capitation model of the kind used in the United States and several other systems of competitive social health insurance. The new Coalition Government has proposed that these budgets are directly allocated to GP 'consortia', the new commissioning bodies in the NHS. This paper questions whether this is an appropriate development for a health system in which the major objective of resource allocation is to promote equal opportunity of access for equal needs. The chief reservation raised is that of circularity and the perpetuation of resource bias, the concern being that an existing social, demographic and geographical bias in the use of health care resources will be reinforced through the use of historic utilisation data. Demonstrating that there are legitimate reasons to suspect that this will be the case, the paper poses the question whether health systems internationally should more openly address the key limitations of empirical methods that select risk adjusters on the basis of existing patterns of health service utilisation. PMID:21093953

  19. Managing the new NHS: breathing new life into the NHS reforms.

    PubMed

    Best, G; Knowles, D; Mathew, D

    1994-03-26

    The essence of the NHS reforms is that they bring market forces to bear on organisations providing public services, while allowing those organisations more freedom to respond in ways that will improve the efficiency, effectiveness, and appropriateness of their services. The new structural changes to the NHS--a leaner management executive and fewer, slimmer regions--could be used either to strengthen these features of the reforms or frustrate them by allowing ministers and top management to intervene even more at local level and "overmanage" the market. To ensure that the aims of the reforms are not frustrated ministers and the management executive must restrict themselves to laying down clear strategies and then allow purchasers and providers to meet those strategies in their own ways. They also need to ensure that the whole NHS can learn and benefit from local experimentation and devise ways of managing the crises that will inevitably arise; otherwise they might be tempted to become involved in managing the market at too local a level, and the NHS will suffer the worst of both worlds: stifling bureaucracy at the top and parochial self interest locally. PMID:8167495

  20. Improving acute medical management: Junior Doctor Emergency Prescription Cards

    PubMed Central

    Hutton, Joe; Gingell, Megan; Hutchinson, Lisa

    2016-01-01

    Doctors commencing Foundation Year (FY) training face many stresses and challenges. FY doctors are often the first point of contact for acutely unwell and deteriorating patients. Trust guidelines are used to aid acute medical management. Accessing guidelines is often fraught with barriers. Evidence suggests aide-memoire cards can provide easier access to guidelines and management pathways. We aimed to improve prescribing accuracy and efficiency of FY doctors for acute medical conditions within Gloucestershire trust by improving access to and usability of trust guidelines. Questionnaires were distributed to FY doctors to identify acute medical conditions to include on the emergency prescription cards (EPCs). Two small double-sided cards were created containing bullet pointed trust guidelines for: hyper/hypokalaemia, status epilepticus, diabetic emergencies, arrhythmias, myocardial infarction, acute asthma, pulmonary oedema, anaphylaxis and a ward-round checklist. Feedback was used to improve EPCs prior to distribution. Pre (N=53) and post-intervention (N=46) written questionnaires were completed by FY doctors. These assessed acute clinical management including use of guidance, confidence in management, speed of prescribing and EPC “usability”. To assess prescribing accuracy, prescriptions for acute medical conditions were reviewed pre (N=8) and post-intervention (N=12). The EPCs were well received (80% quite/very useful) and found “easy to use” (83%). The introduction of EPCs increased guidance use (pre-intervention 58.8%, post-intervention 71.7%), increased confidence (pre-intervention 79%, post-intervention 89%) and significantly improved prescribing speed (p=0.05). There was a significant correlation with confidence and prescribing speed (p = 0.023). The accuracy of prescribed doses improved (pre-intervention 62.5%, post-intervention 87.5% accurate) as did details regarding route / additional required information (pre-intervention 75%, post

  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. Pandora's Box: clinical directorates and the NHS.

    PubMed

    Corbridge, C

    1995-01-01

    Reports on the research concerning the current debate surrounding the maturity of clinical directorates. Indicates that there is some ambiguity as to how directorates should be structured and strategically managed. Finds evidence that trust executive boards need to involve clinicians in setting strategy and to support clinical directors with suitable business managers to manage the boundary between strategic and operational issues. PMID:10161271

  3. The NHS R&D Information Systems Strategy (ISS).

    PubMed

    Ennis, J; Cooper, A; Henshall, C; Jacques, J; Zaman, N

    1994-12-01

    Following a strategy study which reported in August 1992 the NHS R&D Information Systems Strategy (ISS), a strategic framework for information systems, has been developed to support research and development in the NHS. This paper summarizes its main features, illustrates the benefits which specific information systems will bring, and outlines how the products of the programme are disseminated and accessed. PMID:10141710

  4. Step up in orthopaedic care for Stockport Trust.

    PubMed

    Baillie, Jonathan

    2009-04-01

    Specialist in the design and construction of modular healthcare buildings MTX Contracts has recently completed, on time and on budget, Stockport NHS Foundation Trust's impressive new four-storey orthopaedic and surgical facility at Stepping Hill Hospital. The company claims the new facility offers a quality of build and finish "as close to that of traditional build as is possible using modular construction techniques". Jonathan Baillie reports. PMID:19452799

  5. 'The Sister' in the early days of the NHS.

    PubMed

    Ellis, Harold

    2016-04-01

    All the readers of this journal will have read and heard about the ward and operating theatre sisters in 'the old days'. What were they really like, and what was it like to work with them in the hospitals of those far-off times? I entered the old Radcliffe Infirmary Oxford in the summer of 1945, just as World War II was drawing to a close, as a 19 year old student to start my clinical training. I then qualified in July 1948, the very month the NHS came into being, and started my surgical career as house surgeon. The Radcliffe was the only acute hospital in the town and dealt with all emergency admissions. In addition, we worked at the Churchill Hospital, then a hutted hospital, erected during the War to deal with Canadian military casualties and now handed over for civilian use. Elective orthopaedics was carried out at the Wingfield Morris Hospital, later the Nuffield Orthopaedic Centre. The patients here were mostly children with bone and joint tuberculosis or poliomyelitis. The Slade Isolation Hospital dealt with the infectious fevers; I was admitted there twice as a student, with first chicken pox and then measles, both caught from my patients! PMID:27290759

  6. 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. PMID:23159305

  7. Real world evaluation of three models of NHS smoking cessation service in England

    PubMed Central

    2012-01-01

    Background NHS Stop Smoking Services provide various options for support and counselling. Most services have evolved to suit local needs without any retrospective evaluation of their efficiency. Three local service evaluations were carried out at Bournemouth & Poole Teaching Primary Care Trust (PCT) (PCT1), NHS South East Essex (PCT2) and NHS Warwickshire (PCT3) to describe the structure and outcomes associated with different services. Result Standardised interviews with key personnel in addition to analysis of data from 400 clients accessing the service after 1st April 2008 in each PCT. The PCTs varied in geography, population size and quit rate (47%-63%). Services were delivered by PCT-led specialist teams (PCT1), community-based healthcare providers (PCT3) and a combination of the two (PCT2) with varying resources and interventions in each. Group support resulted in the highest quit rates (64.3% for closed groups v 42.6% for one-to-one support (PCT1)). Quit rates were higher for PCT (75.0%) v GP (62.0%) and pharmacist-delivered care (41.0%) where all existed in the same model (PCT2). The most-prescribed therapy was NRT (55.8%-65.0%), followed by varenicline (24.5%-34.3%), counselling alone (6.0%-7.8%) and bupropion (2.0%-4.0%). Conclusion The results suggest that service structure, method of support, healthcare professional involved and pharmacotherapy all play a role in a successful quit. Services must be tailored to support individual needs with patient choice and access to varied services being key factors. PMID:22226240

  8. Culture, compassion and clinical neglect: probity in the NHS after Mid Staffordshire.

    PubMed

    Newdick, Christopher; Danbury, Christopher

    2015-12-01

    Speaking of the public response to the deaths of children at the Bristol Royal Infirmary before 2001, the BMJ commented that the NHS would be 'all changed, changed utterly'. Today, two inquiries into the Mid Staffordshire Foundation Trust suggest nothing changed at all. Many patients died as a result of their care and the stories of indifference and neglect there are harrowing. Yet Bristol and Mid Staffordshire are not isolated reports. In 2011, the Health Services Ombudsman reported on the care of elderly and frail patients in the NHS and found a failure to recognise their humanity and individuality and to respond to them with sensitivity, compassion and professionalism. Likewise, the Care Quality Commission and Healthcare Commission received complaints from patients and relatives about the quality of nursing care. These included patients not being fed, patients left in soiled bedding, poor hygiene practices, and general disregard for privacy and dignity. Why is there such tolerance of poor clinical standards? We need a better understanding of the circumstances that can lead to these outcomes and how best to respond to them. We discuss the findings of these and other reports and consider whether attention should be devoted to managing individual behaviour, or focus on the systemic influences which predispose hospital staff to behave in this way. Lastly, we consider whether we should look further afield to cognitive psychology to better understand how clinicians and managers make decisions? PMID:23704781

  9. Interregional Patient Mobility in the Italian NHS: A Case of Badly-Managed Decentralization

    PubMed Central

    Neri, Stefano

    2015-01-01

    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). PMID:26673474

  10. The NHS Health Check programme: implementation in east London 2009–2011

    PubMed Central

    Robson, John; Dostal, Isabel; Madurasinghe, Vichithranie; Sheikh, Aziz; Hull, Sally; Boomla, Kambiz; Page, Helen; Griffiths, Chris; Eldridge, Sandra

    2015-01-01

    Objectives To describe implementation and results from the National Health Service (NHS) Health Check programme. Design Three-year observational open cohort study: 2009–2011. Participants People of age 40–74 years eligible for an NHS Health Check. Setting 139/143 general practices in three east London primary care trusts (PCTs) serving an ethnically diverse and socially disadvantaged population. Method Implementation was supported with education, IT support and performance reports. Tower Hamlets PCT additionally used managed practice networks and prior-stratification to call people at higher cardiovascular (CVD) risk first. Main outcomes measures Attendance, proportion of high-risk population on statins and comorbidities identified. Results Coverage 2009, 2010, 2011 was 33.9% (31 878/10 805), 60.6% (30 757/18 652) and 73.4% (21 194/28 890), respectively. Older people were more likely to attend than younger people. Attendance was similar across deprivation quintiles and was in accordance with population distributions of black African/Caribbean, South Asian and White ethnic groups. 1 in 10 attendees were at high-CVD risk (20% or more 10-year risk). In the two PCTs stratifying risk, 14.3% and 9.4% of attendees were at high-CVD risk compared to 8.6% in the PCT using an unselected invitation strategy. Statin prescription to people at high-CVD risk was higher in Tower Hamlets 48.9%, than in City and Hackney 23.1% or Newham 20.2%. In the 6 months following an NHS Health Check, 1349 new cases of hypertension, 638 new cases of diabetes and 89 new cases of chronic kidney disease (CKD) were diagnosed. This represents 1 new case of hypertension per 38 Checks, 1 new case of diabetes per 80 Checks and 1 new case of CKD per 568 Checks. Conclusions Implementation of the NHS Health Check programme in these localities demonstrates limited success. Coverage and treatment of those at high-CVD risk could be improved. Targeting invitations to people at high-CVD risk

  11. Going private? Exploring the drift away from the NHS.

    PubMed

    Silvester, S; Calnan, M; Manley, G; Taylor-Gooby, P

    2000-04-01

    The perception that dentistry is being privatised is widespread. A two-phase study was undertaken to investigate the factors influencing dentists' decisions to practise in the public and or private sectors. In phase I a national postal survey of general dental practitioners (n = 1011) explored differences in working practices and experience of NHS and non-NHS work. Survey data were supplemented in phase II by in-depth interviews with four subsamples of dentists in two regions. The survey found that although the majority of dentists continued to treat the majority of their patients within the NHS since the introduction of the 1990 contract patterns of practice have changed. Where private dentistry was increasing, it was regionally variable and arose mainly from concerns with financial security, maintaining quality of work and autonomy. Ideological differences were apparent in relation to differences in practice mix. Those who continued to work in the NHS, because of insufficient demand for private dentistry, did so in order to provide access to treatment and to maintain a reliable source of income and pension rights. Dentists interviewed expressed reluctance in withdrawing from NHS practice. Disillusionment with government policy and recognition of the marginal nature of dental health issues suggests that current trends will continue. PMID:11404966

  12. 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

  13. Assessing an adherent silicone foam dressing: a clinical evaluation across five NHS trusts.

    PubMed

    Stephen-Haynes, Jackie; Callaghan, Rosie; Bethell, Elaine; Linthwaite, Adele; Bullough, Lindsey; Armstrong, Jayne

    2015-12-01

    The wound contact layer of UrgoTul Absorb Border (Urgo Medical) foam dressing contains a Technology Lipido Colloid (TLC) Healing Matrix, which includes hydrocolloid and lipophilic substances designed to stimulate fibroblast proliferation and thus promote granulation tissue formation. A multicentre, noncomparative, clinical evaluation of UrgoTul Absorb Border investigated whether use of the dressing promoted granulation tissue formation and the management of wound exudate. Other parameters evaluated included: pain-free dressing changes, protection and improvement of surrounding tissue, ease of application, conformability, ability to remain in place, wear time, effect on peri-wound skin, durability, ease of removal, and patient comfort. There were 43 patients recruited into the evaluation. Results show that 8 wounds (19%) achieved full epithelialisation and 34 (81%) improved. All participating clinicians rated the dressing's overall performance, including its ability to manage exudate, as excellent, very good, or good. PMID:26639071

  14. Improving patient safety incident reporting systems by focusing upon feedback - lessons from English and Welsh trusts.

    PubMed

    Wallace, Louise M; Spurgeon, Peter; Benn, Jonathan; Koutantji, Maria; Vincent, Charles

    2009-08-01

    This paper describes practical implications and learning from a multi-method study of feedback from patient safety incident reporting systems. The study was performed using the Safety Action and Information Feedback from Incident Reporting model, a model of the requirements of the feedback element of a patient safety incident reporting and learning system, derived from a scoping review of research and expert advice from world leaders in safety in high-risk industries. We present the key findings of the studies conducted in the National Health Services (NHS) trusts in England and Wales in 2006. These were a survey completed by risk managers for 351 trusts in England and Wales, three case studies including interviews with staff concerning an example of good practice feedback and an audit of 90 trusts clinical risk staff newsletters. We draw on an Expert Workshop that included 71 experts from the NHS, from regulatory bodies in health care, Royal Colleges, Health and Safety Executive and safety agencies in health care and high-risk industries (commercial aviation, rail and maritime industries). We draw recommendations of enduring relevance to the UK NHS that can be used by trust staff to improve their systems. The recommendations will be of relevance in general terms to health services worldwide. PMID:19633181

  15. Lifestyle treatments in cystic fibrosis: The NHS should pay.

    PubMed

    Ketchell, Robert Ian

    2016-08-01

    With the NHS under increasing financial pressure and healthcare costs soaring year on year, it is perhaps not surprising that assessment agencies focus on cost-effectiveness analysis when assessing new therapies. Such an approach does not however, always take sufficient account of treatment burden, lifestyle and patient choice and therefore new equally effective but perhaps "easier to take" formulations and faster delivery systems for current therapies do not always take precedence in current treatment guidelines. In arguing that the NHS should pay for so-called lifestyle treatments in cystic fibrosis the counterintuitive nature of some of the current decision making is discussed and a more holistic approach to improve NHS efficiency is presented. PMID:27373763

  16. 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?

  17. Lifestyle treatments in cystic fibrosis: The NHS should not pay.

    PubMed

    Hull, Jeremy

    2016-08-01

    Lifestyle treatments can be defined as those which may have in impact on quality of life but do not affect health outcomes. Particular treatment options may be preferred by patients because they are for example, easier to use, take up less time or taste better. The impact on adherence needs to be considered. Treatment options that promote greater adherence to therapy are likely to be more efficacious and so are not, by definition, lifestyle treatments. The NHS is facing unprecedented financial pressure and resources are limited. When lifestyle treatments are more expensive than standard therapy, they should not be funded by the NHS. PMID:27349724

  18. 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. PMID:24756135

  19. Evidence and values: paying for end-of-life drugs in the British NHS.

    PubMed

    Chalkidou, Kalipso

    2012-10-01

    In January 2009, Britain's National Institute for Health and Clinical Excellence (NICE), following a very public debate triggered by its decision, six months earlier, provisionally to rule against the adoption by the National Health Service (NHS) of an expensive drug for advanced renal cancer, introduced a new policy for evaluating pharmaceuticals for patients nearing the end of their lives. NICE's so-called end-of-life (EOL) guidance for its Committees effectively advises them to deviate from the Institute's threshold range and to value the lives of (mostly) dying cancer patients more than the lives of those suffering from other, potentially curable, chronic or acute conditions. This article tells the story of the EOL guidance. Through looking at specific EOL decisions between 2009 and 2011 and the reactions by stakeholders to these decisions and the policy itself, it discusses the triggers for NICE's EOL guidance, the challenges NICE faces in implementing it and the policy's putative implications for the future role of NICE in the NHS, especially in the context of value-based reforms in the pricing and evaluation of pharmaceuticals, currently under consideration. PMID:23079299

  20. Where should health services go: local authorities versus the NHS?

    PubMed

    Pollock, A M

    1995-06-17

    The Association of Metropolitan Authorities has recently proposed that responsibility for the NHS should pass from health authorities to local authorities. One of the fiercest debates at the outset of the NHS was whether the hospitals should be run by local authorities. In the end the minister for health, Aneurin Bevan, decided against local democracy and in favour of a national health service. His arguments included the fact that equality of treatment could not be guaranteed if facilities varied with local finances and that even the largest authorities were not big enough to pool risks and expertise. All these arguments still apply today, and the recent changes in community care provide an insight into how a market model of local authority control might work. The changes have been accompanied by a shift from public to private sector provision and the introduction of charges for services that the NHS once provided free. As important, the willingness and ability of local authorities to raise extra revenue from local taxes and charges affect the service they can provide, so leading to inequalities of provision. Local authorities have yet to make the case that they can preserve the fundamental principles and benefits of the NHS, including its reliance on central taxation and unified funding formulas. PMID:7787651

  1. Changing cultures--determining domains in the NHS.

    PubMed

    Mark, A; Scott, H

    1991-11-01

    This article explores changes in the National Health Service (NHS) as an organisation, in the context of the emerging managerial culture. This new culture is also seeking to influence the other forms of organisational culture which have co-existed until now in the NHS; its success in doing so is limited by the lack of a shared value system within the new management culture. The issue is explored with reference to domain theory as suggested by Kouze and Mico (1979), and subsequently amended by others, to fit the developments occurring in the NHS. Consideration is given to the following issues with reference to the three domains of politics, management and professions. Can we establish: the continued existence of each domain; the changing location of groups between each domain; the interrelationship between the domains: the location of issues within or between the domains. The theory is then located within the broader discipline of organizational behaviour to provide a revised model for thinking about and acting upon the cultural change in the new NHS; the organizational learning now required is shown to require the following activities by each domain; identification, interpretation and communication. PMID:10118701

  2. 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

  3. Workplace bullying in the UK NHS: a questionnaire and interview study on prevalence, impact and barriers to reporting

    PubMed Central

    Carter, Madeline; Thompson, Neill; Crampton, Paul; Morrow, Gill; Burford, Bryan; Gray, Christopher; Illing, Jan

    2013-01-01

    Objectives To examine the prevalence and impact of bullying behaviours between staff in the National Health Service (NHS) workplace, and to explore the barriers to reporting bullying. Design Cross-sectional questionnaire and semi-structured interview. Setting 7 NHS trusts in the North East of England. Participants 2950 NHS staff, of whom 43 took part in a telephone interview. Main outcome measures Prevalence of bullying was measured by the revised Negative Acts Questionnaire (NAQ-R) and the impact of bullying was measured using indicators of psychological distress (General Health Questionnaire, GHQ-12), intentions to leave work, job satisfaction and self-reported sickness absence. Barriers to reporting bullying and sources of bullying were also examined. Results Overall, 20% of staff reported having been bullied by other staff to some degree and 43% reported having witnessed bullying in the last 6 months. Male staff and staff with disabilities reported higher levels of bullying. There were no overall differences due to ethnicity, but some differences were detected on several negative behaviours. Bullying and witnessing bullying were associated with lower levels of psychological health and job satisfaction, and higher levels of intention to leave work. Managers were the most common source of bullying. Main barriers to reporting bullying were the perception that nothing would change, not wanting to be seen as a trouble-maker, the seniority of the bully and uncertainty over how policies would be implemented and bullying cases managed. Data from qualitative interviews supported these findings and identified workload pressures and organisational culture as factors contributing to workplace bullying. Conclusions Bullying is a persistent problem in healthcare organisations which has significant negative outcomes for individuals and organisations.

  4. 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

  5. Is compassion possible in a market-led NHS?

    PubMed

    Flynn, Maria; Mercer, Dave

    The principle of compassionate care is increasingly seen as the core element of good nursing practice. However, recent media reports have focused on the "compassion deficit". We carried out a review of national and international evidence on core professional values, which showed that caring and compassion are inherent nursing values. While the development of these values is influenced by training and role modelling, the main influence is the organisation and culture in which nurses work. This article discusses the findings of the review in relation to the national debate around compassionate care within an NHS that is being fundamentally changed. We suggest any failure in compassion is more likely to be due to government health policy and NHS organisational culture than to any shortcomings of nurses or nursing practice. PMID:23513933

  6. 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. PMID:26806451

  7. What have NHS managers ever done for us?

    PubMed Central

    2010-01-01

    The image of the UK National Health Service manager has not always been positive. Like others in the public sector, NHS managers are sometimes associated in the media with waste and inefficiency, in contrast to those in ‘front line roles’. Thus healthcare professionals and members of the public might ask, in the tradition of Monty Python's Life of Brian, what NHS managers have ever done for us. In this short article, we outline some of the evidence from the literature on attitudes to, and role of, healthcare managers, before drawing on our own interview and observation based fieldwork with managers themselves. We argue that the role of the healthcare manager is not always well understood, and that in a sector facing ever more intense and large scale organisational challenges, managers should be seen as important partners in a health service focused on clinical outcomes. PMID:25949629

  8. 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

  9. 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}

  10. Coproduction in commissioning decisions: is there an association with decision satisfaction for commissioners working in the NHS? A cross-sectional survey 2010/2011

    PubMed Central

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

    2014-01-01

    Objectives To undertake an assessment of the association between coproduction and satisfaction with decisions made for local healthcare communities. Design A coproduction scale was developed and tested to measure individual National Health Service (NHS) commissioners’ satisfaction with commissioning decisions. Setting 11 English Primary Care Trusts in 2010–2011. Participants Staff employed at NHS band 7 or above involved in commissioning decisions in the NHS. 345/440 (78%) of participants completed part of all of the survey. Main outcome measure Reliability and validity of a coproduction scale were assessed using a correlation-based principal component analysis model with direct oblimin rotation. Multilevel modelling was used to predict decision satisfaction. Results The analysis revealed that coproduction consisted of three principal components: productive discussion, information and dealing with uncertainty. Higher decision satisfaction was associated with smaller decisions, more productive discussion, decisions where information was readily available to use and those where decision-making tools were more often used. Conclusions The research indicated that coproduction may be an important factor for satisfaction with decision-making in the commissioning of healthcare services. PMID:24902728

  11. 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)

  12. 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…

  13. Trust versus Manipulation

    ERIC Educational Resources Information Center

    Lewis, Anne C.

    2005-01-01

    This article discusses the issue of trust in the education system. What is different about the issue of trust in the education system is the assault upon it, sometimes overt but most often subtle. There is a difference between strong criticism and willful manipulation. The nation's schools are responding to the former--perhaps too slowly for…

  14. 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

  15. The enemies of trust.

    PubMed

    Galford, Robert; Drapeau, Anne Seibold

    2003-02-01

    Researchers have established that trust is critical to organizational effectiveness. Being trustworthy yourself, however, does not guarantee that you are capable of building trust in an organization. That takes old-fashioned managerial virtues like consistency, clear communication, and a willingness to tackle awkward questions. It also requires a good defense: You must protect trust from its enemies. Any act of bad management erodes trust, so the list of potential enemies is endless. Among the most common enemies of trust, though, are inconsistent messages from top management, inconsistent standards, a willingness to tolerate incompetence or bad behavior, dishonest feedback, a failure to trust others to do good work, a tendency to ignore painful or politically charged situations, consistent corporate underperformance, and rumors. Fending off these enemies must be at the top of every chief executive's agenda. But even with constant vigilance, an organization and its leaders will sometimes lose people's trust. During a crisis, managers should enlist the help of an objective third party--chances are you won't be thinking clearly--and be available physically and emotionally. If you "go dark" in the face of a crisis, employees will worry about the company's survival, about their own capacity to cope, and about your abilities as a leader. And if trust has broken down so badly that your only choice is to start over, you can do so by figuring out exactly how the breach of trust happened, ascertaining the depth and breadth of the loss, owning up to the loss instead of downplaying it, and identifying as precisely as possible the specific changes you must make to rebuild trust. PMID:12577656

  16. Evaluating the Labour Government's English NHS health system reforms: the 2008 Darzi reforms.

    PubMed

    Mays, Nicholas

    2013-10-01

    Starting in 2002, the UK Labour Government of 1997-2010 introduced a series of changes to the National Health Service (NHS) in England designed to increase patients' choices of the place of elective hospital care and encourage competition among public and private providers of elective hospital services for NHS-funded patients. In 2006, the Department of Health initiated the Health Reform Evaluation Programme (HREP) to assess the impact of the changes. In June 2008, the White Paper, High quality care for all, was published. It represented the government's desire to focus the next phase of health care system reform in England as much on the quality of care as on improving its responsiveness and efficiency. The 2008 White Paper led to the commissioning of a further wave of evaluative research under the auspices of HREP, as follows: an evaluation of the implementation and outcomes of care planning for people with long-term conditions; an evaluation of the personal health budget pilots; an evaluation of the implementation and outcomes of the Commissioning for Quality and Innovation (CQUIN) framework; and an evaluation of cultural and behavioural change in the NHS focused on ensuring high quality care for all. This Supplement includes papers from each project. The evaluations present a mixed picture of the impact and success of the 2008 reforms. All the studies identify some limitations of the policies in the White Paper. The introduction of personal health budgets appears to have been the least problematic and, depending on assumptions, likely to be cost-effective for the sorts of patients involved in the pilot. For the rest of the changes, impacts ranged from little or none (CQUIN and care planning for people with chronic conditions) to patchy and highly variable (instilling a culture of quality in acute hospitals) in the three years following the publication of the White Paper. On the other hand, each of the studies identifies important insights relevant to modifying

  17. Falls screening and assessment tools used in acute mental health settings: a review of policies in England and Wales

    PubMed Central

    Narayanan, V.; Dickinson, A.; Victor, C.; Griffiths, C.; Humphrey, D.

    2016-01-01

    Objectives There is an urgent need to improve the care of older people at risk of falls or who experience falls in mental health settings. The aims of this study were to evaluate the individual falls risk assessment tools adopted by National Health Service (NHS) mental health trusts in England and healthcare boards in Wales, to evaluate the comprehensiveness of these tools and to review their predictive validity. Methods All NHS mental health trusts in England (n = 56) and healthcare boards in Wales (n = 6) were invited to supply their falls policies and other relevant documentation (e.g. local falls audits). In order to check the comprehensiveness of tools listed in policy documents, the risk variables of the tools adopted by the mental health trusts’ policies were compared with the 2004 National Institute for Health and Care Excellence (NICE) falls prevention guidelines. A comprehensive analytical literature review was undertaken to evaluate the predictive validity of the tools used in these settings. Results Falls policies were obtained from 46 mental health trusts. Thirty-five policies met the study inclusion criteria and were included in the analysis. The main falls assessment tools used were the St. Thomas’ Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY), Falls Risk Assessment Scale for the Elderly, Morse Falls Scale (MFS) and Falls Risk Assessment Tool (FRAT). On detailed examination, a number of different versions of the FRAT were evident; validated tools had inconsistent predictive validity and none of them had been validated in mental health settings. Conclusions Falls risk assessment is the most commonly used component of risk prevention strategies, but most policies included unvalidated tools and even well validated tool such as the STRATIFY and the MFS that are reported to have inconsistent predictive accuracy. This raises questions about operational usefulness, as none of these tools have been tested in acute mental health

  18. The impact of electronic prescribing systems on pharmacists’ time and workflow: protocol for a time-and-motion study in English NHS hospitals

    PubMed Central

    Schofield, Behnaz; Cresswel, Kathrin; Westbrook, Johanna; Slee, Ann; Girling, Alan; Shah, Sonal; Coleman, Jamie; Sheikh, Aziz

    2015-01-01

    Introduction Electronic prescribing (ePrescribing) systems are rapidly being introduced into National Health Systems (NHS) hospitals in England following their widespread earlier adoption into primary care settings. Such systems require substantial changes in the way pharmacists organise their work and perform their roles. There is however as yet limited evidence on the extent to which these changes may support or compromise efficient and safe working practices by pharmacists. Identifying and quantifying these changes, and their effects, is central to informing system and work practice design, as well as informing training and implementation processes. This protocol describes a study to measure the impact of ePrescribing systems on pharmacists’ time and workflow. Methods and analysis A direct observational controlled pre–post implementation time-and-motion study will be conducted in six wards at one NHS Trust over two observational periods. Pharmacists will be shadowed and details of all work tasks performed will be collected and time-stamped. Task distribution, frequency and duration will be measured and changes in these measures preimplementation and postimplementation, and between control and intervention wards will be measured. Interviews with pharmacists will investigate their perceptions of the impact of the ePrescribing systems on their work and will be conducted in both periods. The extent to which pharmacists’ expectations of the impact of the ePrescribing systems on their work with postimplementation reports will be qualitatively explored, as will any differences between perceptions and results from the time-and-motion analysis. Ethics and dissemination Institutional research ethics approval has been obtained from The University of Edinburgh. Local approval from the participating NHS Trust and informed consent from participating pharmacists have been obtained, while also complying with local governance requirements. The results of the study will be

  19. 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. PMID:26668168

  20. Building a Culture of Trust.

    ERIC Educational Resources Information Center

    Hoffman, James; And Others

    1994-01-01

    Identifies important aspects of faculty trust and school climate. Trust in the principal and trust in colleagues were aspects of faculty trust that were affected in this study of middle schools. The organizational climate factors of supportive, directive, and restrictive principal behavior and collegial, committed, and disengaged teacher behavior…

  1. 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

  2. A co-productive health leadership model to support the liberation of the NHS.

    PubMed

    Nicol, Edward; Sang, Bob

    2011-02-01

    Following the recent white paper - Equity and Excellence: Liberating the NHS - we need a 21st-century model of leadership in the NHS that re-focuses on the centrality of the relationship between clinicians and patients. This paper argues the case for co-productive 'Health Leadership' that can meet the challenges set by the current Big Society agenda, Darzi and Wanless, so that we achieve a sustainable, high quality NHS, fit for the 21st century. PMID:21282796

  3. 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. PMID:10134705

  4. NHS reforms reduce length of waiting lists but create widespread unease.

    PubMed Central

    Gray, C

    1996-01-01

    Reforms involving the National Health Service (NHS) have greatly reduced the length of waiting lists in the United Kingdom. The key to the reductions was additional funding from the government, the chief executive of the NHS said during a recent visit to Ottawa. Decreasing the size of the waiting lists created intense stress for NHS personnel, who had to work longer hours, and it also lowered demand for private-sector care. PMID:8943941

  5. Illness prevention in the NHS five year forward view.

    PubMed

    Fuller, Sabrina

    2015-06-01

    Illness prevention is a priority for the NHS Mandate and the Five Year Forward View, and offers a means to maintain sustainable health and social care services in the context of an ageing population and the growth of behaviour-related illness. The National Institute for Health and Care Excellence guidance recommends a structured approach to embedding behaviour change interventions into clinical care, and effective implementation requires organisational support. This article describes how nurse leaders, managers and commissioners can ensure this implementation through setting objectives for staff, training and development, as well as supporting staff to adopt healthier lifestyles. PMID:26014792

  6. The rationing agenda in the NHS. Rationing Agenda Group.

    PubMed Central

    New, B.

    1996-01-01

    The Rationing Agenda Group has been founded to deepen the British debate on rationing health care. It believes that rationing in health care is inevitable and that the public must be involved in the debate about issues relating to rationing. The group comprises people from all parts of health care, none of whom represent either their group or their institutions. RAG has begun by producing this document, which attempts to set an agenda of all the issues that need to be considered when debating the rationing of health care. We hope for responses to the document. The next stage will be to incorporate the responses into the agenda. Then RAG will divide the agenda into manageable chunks and commission expert, detailed commentaries. From this material a final paper will be published and used to prompt public debate. This stage should be reached early in 1997. While these papers are being prepared RAG is developing ways to involve the public in the debate and evaluate the whole process. We present as neutrally as possible all the issues related to rationing and priority setting in the NHS. We focus on the NHS for two reasons. Firstly, for those of us resident in the United Kingdom the NHS is the health care system with which we are most familiar and most concerned. Secondly, focusing on one system alone allows more coherent analysis than would be possible if issues in other systems were included as well. Our concern is with the delivery of health care, not its finance, though we discuss the possible effects of changing the financing system of the NHS. Finally, though our position is neutral, we hold two substantive views--namely, that rationing is unavoidable and that there should be more explicit debate about the principles and issues concerned. We consider the issues under four headings: preliminaries, ethics, democracy, and empirical questions. Preliminaries deal with the semantics of rationing, whether rationing is necessary, and with the range of services to which

  7. The rationing agenda in the NHS. Rationing Agenda Group.

    PubMed

    New, B

    1996-06-22

    The Rationing Agenda Group has been founded to deepen the British debate on rationing health care. It believes that rationing in health care is inevitable and that the public must be involved in the debate about issues relating to rationing. The group comprises people from all parts of health care, none of whom represent either their group or their institutions. RAG has begun by producing this document, which attempts to set an agenda of all the issues that need to be considered when debating the rationing of health care. We hope for responses to the document. The next stage will be to incorporate the responses into the agenda. Then RAG will divide the agenda into manageable chunks and commission expert, detailed commentaries. From this material a final paper will be published and used to prompt public debate. This stage should be reached early in 1997. While these papers are being prepared RAG is developing ways to involve the public in the debate and evaluate the whole process. We present as neutrally as possible all the issues related to rationing and priority setting in the NHS. We focus on the NHS for two reasons. Firstly, for those of us resident in the United Kingdom the NHS is the health care system with which we are most familiar and most concerned. Secondly, focusing on one system alone allows more coherent analysis than would be possible if issues in other systems were included as well. Our concern is with the delivery of health care, not its finance, though we discuss the possible effects of changing the financing system of the NHS. Finally, though our position is neutral, we hold two substantive views--namely, that rationing is unavoidable and that there should be more explicit debate about the principles and issues concerned. We consider the issues under four headings: preliminaries, ethics, democracy, and empirical questions. Preliminaries deal with the semantics of rationing, whether rationing is necessary, and with the range of services to which

  8. 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.

  9. Computationally modeling interpersonal trust

    PubMed Central

    Lee, Jin Joo; Knox, W. Bradley; Wormwood, Jolie B.; Breazeal, Cynthia; DeSteno, David

    2013-01-01

    We present a computational model capable of predicting—above human accuracy—the degree of trust a person has toward their novel partner by observing the trust-related nonverbal cues expressed in their social interaction. We summarize our prior work, in which we identify nonverbal cues that signal untrustworthy behavior and also demonstrate the human mind's readiness to interpret those cues to assess the trustworthiness of a social robot. We demonstrate that domain knowledge gained from our prior work using human-subjects experiments, when incorporated into the feature engineering process, permits a computational model to outperform both human predictions and a baseline model built in naiveté of this domain knowledge. We then present the construction of hidden Markov models to investigate temporal relationships among the trust-related nonverbal cues. By interpreting the resulting learned structure, we observe that models built to emulate different levels of trust exhibit different sequences of nonverbal cues. From this observation, we derived sequence-based temporal features that further improve the accuracy of our computational model. Our multi-step research process presented in this paper combines the strength of experimental manipulation and machine learning to not only design a computational trust model but also to further our understanding of the dynamics of interpersonal trust. PMID:24363649

  10. TrustBuilder2

    2007-07-20

    TrustBuilder2 is a flexible framework for supporting research in the area trust negotiation protocols, designed to allow researchers to quickly prototype and experiment with various approaches to trust negotiation. In Trustbuilder2, the primary components of a trust negotiation system are represented using abstract interfaces. Any or all of these components can be implemented or extended by users of the TrustBuilder2 system, thereby making the system's functionality easily extensible. The TrustBuilder2 configuration files can be modifiedmore » to load these custom components in place of the default system components; this facilitates the use of new features without modifications to the underlying runtime system. In our implementation, we provide support for one negotiation strategy, a policy compliance checker based on Jess (the Java Expert System Shell), query interfaces enabling access to disk-based credential and policy repositories, a credential chain construction algorithm, two credential chain verification routines, and both graphical and text-based logging facilities. Trustbuilder2 also supports the interposition of user-defined plug-ins at communication points between system components to allow for easy monitoring of system activity or the modification of messages passed between components.« less

  11. 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.

  12. 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…

  13. 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. PMID:20950178

  14. British National Health Service trust chief executives on nurse education: corporate instrumentalism and doubts on quasi-market structure.

    PubMed

    Humphreys, J

    1996-01-01

    The funding of nurse education through Working Paper 10 arrangements is susceptible to analysis as a 'quasi-market' in which regional purchasers (in England) commission education and training services on behalf of National Health Service (NHS) trusts. In this context, some regions have developed ways of managing the demand side of the market in such a way as to enable NHS trust involvement in purchasing decisions, sometimes through consortium configurations. This paper reports the findings of an empirical study of the views of NHS trust chief executives on nurse education. The investigation was conducted to provide the information base for a consortium development reported earlier in the Journal of Advanced Nursing. The consensus views of chief executives revealed an ideological stance, referred to as corporate instrumentalism. This was shown to be derived from the position of trusts as newly corporate organizations undergoing considerable change in a volatile and competitive environment. Education was seen as potentially capable of contributing significantly to both health service quality and organizational change. Chief executives described an ideal of collaboration in which college providers are highly responsive to their needs, but doubted that the current quasi-market arrangements can in fact deliver this. A comparison of chief executive and senior executive nurse views revealed some significant differences of emphasis, and a mechanism is provisionally suggested by which educational innovation could be suppressed. Finally the education quasi-market was analysed in terms of both its implications for the professional status of nurses and its potential to facilitate NHS reform. PMID:8708212

  15. The NHS: assessing new technologies, NICE and value for money.

    PubMed

    Stevens, A; Chalkidou, K; Littlejohns, P

    2011-06-01

    The healthcare system in the UK, essentially the NHS, is an open economic system subject to the same pressures as any other economic system. The pressures concern limited resources coupled with powerful drivers for increasing spending: invention, demography and inflation. There have only ever been three types of economic system: steady state (everything, as in a feudal system, stays as it was the year before), market capitalism (supply and demand are allowed to find their own equilibrium) and some version of central planning. In healthcare, most advanced countries favour the last of the three. This is for three reasons: distribution (not only are the poor less able to pay for sickness, but sickness exacerbates poverty), information (markets operate poorly when providers can easily outsmart customers) and externalities (it is in the interest of everyone that infectious diseases and the other knock-on consequences of ill health are ameliorated). So in the UK, the state, with a good deal of cross-party consensus, directs most of health service supply. This system has become more complex over the decades since the formation of the NHS in 1948. A notable element of the complexity is the regulation of the introduction of new technologies. A key element of the regulatory system has been the National Institute for Health and Clinical Excellence (NICE), and a key aspect of NICE's decisions has been not just value, but also value for money. This has not been without controversy. PMID:21902077

  16. NHS dental professionals' evaluation of a child protection learning resource.

    PubMed

    Harris, J C; Bradbury, J; Porritt, J; Nilchian, F; Franklin, C D

    2011-01-22

    The aim of this survey was to evaluate the impact of an educational child protection resource which had been developed and made available, free of charge, to all NHS dental practices and salaried primary dental care services in England and concurrently published online. A postal questionnaire was sent to a random sample of 1000 NHS dental practices to assess whether the learning objectives of the educational resource had been met. A total of 467 questionnaires were completed (46.7% response rate). Almost two thirds of participants (63.4%) remembered receiving the Child Protection and Dental Team (CPDT) handbook or seeing the website and almost all of them had used (looked at or read) it and felt able to access it if needed. Of the 265 users, 76.2% felt it had improved their knowledge of child protection, 60.5% had adopted a child protection policy, 53.7% had identified a child protection lead and 25.8% had arranged further training as a result of using the educational resource. The findings from the evaluation indicated that the learning objectives of the CPDT educational resource had been met and highlighted ways in which the resource could be further improved to effectively meet the needs of dental professionals. PMID:21252889

  17. Building trust to work with children after a severe traumatic accident.

    PubMed

    Hall, Julianne; Nayar, Shoba

    2014-01-01

    Trust is integral to nursing; yet little is known about how nurses establish trust when working with patients. This grounded theory study explored nurses' perspectives of how to build trust with a child and family in the context of paediatric acute health care. Seven paediatric acute care nurses were asked what they did when they cared for a child admitted to an acute care ward from emergency department or intensive care unit following a severe traumatic accident. Building trust emerged as the basic social process for an effective working relationship between a nurse and family to promote the rehabilitation of the child. This paper argues that building trust is critical to nurses developing a working relationship with both child and family to promote optimal health, and enables nurses to effectively step out and handover the care of the child to the family. PMID:24787249

  18. Trust transitivity in social networks.

    PubMed

    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

  19. 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

  20. The limits of market-based reforms in the NHS: the case of alternative providers in primary care

    PubMed Central

    2013-01-01

    Background Historically, primary medical care in the UK has been delivered by general practitioners who are independent contractors, operating under a contract, which until 2004 was subject to little performance management. In keeping with the wider political impetus to introduce markets and competition into the NHS, reforms were introduced to allow new providers to bid for contracts to provide primary care services in England. These contracts known as ‘Alternative Provider Medical Services’, were encouraged by two centrally-driven rounds of procurement (2007/8 and 2008/9). This research investigated the commissioning and operation of such Alternative Providers of Primary Care (APPCs). Methods Two qualitative case studies were undertaken in purposively sampled English Primary Care Trusts (PCTs) and their associated APPCs over 14 months (2009-10). We observed 65 hours of meetings, conducted 23 interviews with PCT and practice staff, and gathered relevant associated documentation. Results and conclusions We found that the procurement and contracting process was costly and time-consuming. Extensive local consultation was undertaken, and there was considerable opposition in some areas. Many APPCs struggled to build up their patient list sizes, whilst over-performing on walk-in contracts. Contracting for APPCs was ‘transactional’, in marked contrast to the ‘relational’ contracting usually found in the NHS, with APPCs subject to tight performance management. These complicated and costly processes contrast to those experienced by traditionally owned GP partnerships. However, managers reported that the perception of competition had led existing practices to improve their services. The Coalition Government elected in 2010 is committed to ‘Any Qualified Provider’ of secondary care, and some commentators argue that this should also be applied to primary care. Our research suggests that, if this is to happen, a debate is needed about the operation of a market

  1. 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.

  2. Managing healthcare information: analyzing trust.

    PubMed

    Söderström, Eva; Eriksson, Nomie; Åhlfeldt, Rose-Mharie

    2016-08-01

    Purpose - The purpose of this paper is to analyze two case studies with a trust matrix tool, to identify trust issues related to electronic health records. Design/methodology/approach - A qualitative research approach is applied using two case studies. The data analysis of these studies generated a problem list, which was mapped to a trust matrix. Findings - Results demonstrate flaws in current practices and point to achieving balance between organizational, person and technology trust perspectives. The analysis revealed three challenge areas, to: achieve higher trust in patient-focussed healthcare; improve communication between patients and healthcare professionals; and establish clear terminology. By taking trust into account, a more holistic perspective on healthcare can be achieved, where trust can be obtained and optimized. Research limitations/implications - A trust matrix is tested and shown to identify trust problems on different levels and relating to trusting beliefs. Future research should elaborate and more fully address issues within three identified challenge areas. Practical implications - The trust matrix's usefulness as a tool for organizations to analyze trust problems and issues is demonstrated. Originality/value - Healthcare trust issues are captured to a greater extent and from previously unchartered perspectives. PMID:27477934

  3. Controlling healthcare-associated infections in the NHS.

    PubMed

    Duerden, Brian

    2008-04-01

    The prevention and control of healthcare-associated infection (HCAI) is a priority for the NHS. The delivery of national targets for reducing methicillin resistant Staphylococcus aureus bacteraemias and Clostridium difficile infection are supported by enhanced mandatory surveillance through the Health Protection Agency and a Department of Health improvement programme that promotes policies and protocols for enhancing clinical procedures and places infection prevention and control at the centre of clinical and corporate governance. The Health Act 2006 Code of Practice makes such policies and protocols a legal requirement and compliance will be assessed by the Healthcare Commission. Clinicians must recognise their responsibilities for patient safety and take a lead role in ensuring good practice to reduce HCAI. PMID:18478854

  4. 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

  5. Trust in Anonymity Networks

    NASA Astrophysics Data System (ADS)

    Sassone, Vladimiro; Hamadou, Sardaouna; Yang, Mu

    Anonymity is a security property of paramount importance, as we move steadily towards a wired, online community. Its import touches upon subjects as different as eGovernance, eBusiness and eLeisure, as well as personal freedom of speech in authoritarian societies. Trust metrics are used in anonymity networks to support and enhance reliability in the absence of verifiable identities, and a variety of security attacks currently focus on degrading a user's trustworthiness in the eyes of the other users. In this paper, we analyse the privacy guarantees of the Crowds anonymity protocol, with and without onion forwarding, for standard and adaptive attacks against the trust level of honest users.

  6. The mutuality metaphor: understanding healthcare provision in NHS Scotland.

    PubMed

    Howieson, Brian

    2016-06-20

    Purpose - Better Health, Better Care Action Plan (Scottish Government, 2007) sets out how the Scottish Government intends to strengthen public ownership of the National Health Service in Scotland. The purpose of this paper is to advance extant knowledge by understanding how a state-led mutual health policy may be interpreted, and importantly, communicated. Design/methodology/approach - The definitional problem of mutuality will be discussed and analysed in terms of how it is (or perhaps should be) communicated? will be offered. Findings - It actually may be more instructive to think of, and communicate, mutuality as a metaphor to aid understanding of the openness and fluidity found in NHS Scotland. Research limitations/implications - The existence of paradox and ambiguity does not, however, negate the usefulness of the term "mutuality". Quite the opposite in fact: it is precisely by examining healthcare and its delivery through the lens of mutuality (rather than rejecting its complexity as a failure) that this amorphousness can be better appreciated. Practical implications - There is a need for more public, professional, and academic debate to explore and clarify its implementation, and how it is to be led. This must be provided whilst recognising the daily imperatives that NHS leaders must face. This would suggest, therefore, that a dual development path may help. Originality/value - Although Better Health, Better Care Action Plan was published in 2007, some eight years on there is still confusion and misunderstanding as to what mutuality in healthcare is, not only in policy and theory, but also in practice. It is hoped that this analysis will help address, in part, some of this confusion and misunderstanding. PMID:27296885

  7. Trust metrics in information fusion

    NASA Astrophysics Data System (ADS)

    Blasch, Erik

    2014-05-01

    Trust is an important concept for machine intelligence and is not consistent across many applications. In this paper, we seek to understand trust from a variety of factors: humans, sensors, communications, intelligence processing algorithms and human-machine displays of information. In modeling the various aspects of trust, we provide an example from machine intelligence that supports the various attributes of measuring trust such as sensor accuracy, communication timeliness, machine processing confidence, and display throughput to convey the various attributes that support user acceptance of machine intelligence results. The example used is fusing video and text whereby an analyst needs trust information in the identified imagery track. We use the proportional conflict redistribution rule as an information fusion technique that handles conflicting data from trusted and mistrusted sources. The discussion of the many forms of trust explored in the paper seeks to provide a systems-level design perspective for information fusion trust quantification.

  8. 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.…

  9. 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…

  10. 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: ...

  11. 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…

  12. A new model for quality improvement in acute inpatient psychiatry: observational data from an acute assessment unit

    PubMed Central

    Hayes, Joseph; Gibbons, Rachel; Outim, Faizal; Tang, Sylvia; Chakraborty, Apu

    2012-01-01

    Objectives There is little research into the constituents of effective psychiatric inpatient care. The aim of this study was to assess the effectiveness of a newly adopted model of inpatient care; the acute assessment ward. Design Review of data collected over a year-long period. Setting Acute assessment ward in North London. Participants All Admissions between 8 October 2009 and 7 October 2010. Main outcome measures Duration of stay, need for readmission, patient satisfaction and frequency of conflict behaviours. Results A total of 485 admissions over the yearlong study period. The median stay to discharge from the assessment ward was 6 days, whereas in those transferred it was 19 days. Readmission within 28 days following discharge from the assessment ward was 13.9%, whereas those discharged from other wards was 9.2% (P = 0.1). Patient satisfaction was no lower, for all domains, than for other wards in the trust. Frequency of conflict behaviour was equal to previous studies,1 but self harm was significantly less common (P = 0.01). Conclusions Our data show that focusing on the ‘point of entry’ to inpatient services means that some admission times can be reduced without an increase in 28-day readmission rates or conflict behaviours. The acute assessment model attempts to address the need for the NHS to deliver more for less, whilst remaining focused on service-user and staff satisfaction. Research into which areas of this complex intervention are effective is challenging, but we would urge others who run services with novel structures to publish data about their functioning. PMID:23323205

  13. Lessons from 2012: What the NHS Can Learn from Britain's Olympic Success.

    PubMed

    Maile, Edward J; Blake, Alastair M

    2013-01-01

    The 2012 London Olympic and Paralympic Games were widely regarded as an organisational and sporting success for the United Kingdom. Therefore, it is prudent to consider what other large, public endeavours might learn from the Games' success. Team GB worked to develop a positive team culture based around shared values. This is something the National Health Service (NHS) could learn from, as an organisation which can appear to lack this culture. The NHS should also work harder to adopt evidence-based practices, and to adopt them quickly, as is often the case in sport. Sport is the ultimate example of transparent results reporting, and the NHS ought to consider systematic reporting of risk-adjusted performance data, which may drive improved performance. The NHS should pay attention to the experiences of successful Olympic sports with centralised centres of excellence, and to medical data which suggests that better outcomes result from centres of excellence. The NHS and wider government should look to Olympic athletes and place more emphasis on prevention of disease by encouraging positive lifestyle choices. Finally, the NHS should develop private sector partnerships carefully. We must look to gather knowledge and ideas from every area of life in pursuit of excellence in the NHS. Experience of the Olympics offers a number of instructive lessons. PMID:25737779

  14. 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. PMID:24146907

  15. Homo Economicus Belief Inhibits Trust

    PubMed Central

    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. PMID:24146907

  16. Clinical audit of core podiatry treatment in the NHS

    PubMed Central

    Farndon, Lisa; Barnes, Andrew; Littlewood, Keith; Harle, Justine; Beecroft, Craig; Burnside, Jaclyn; Wheeler, Tracey; Morris, Selwyn; Walters, Stephen J

    2009-01-01

    Background Core podiatry involves treatment of the nails, corns and callus and also giving footwear and foot health advice. Though it is an integral part of current podiatric practice little evidence is available to support its efficacy in terms of research and audit data. This information is important in order to support the current NHS commissioning process where services are expected to provide data on standards including outcomes. This study aimed to increase the evidence base for this area of practice by conducting a multi-centre audit in 8 NHS podiatry departments over a 1-year period. Methods The outcome measure used in this audit was the Podiatry Health Questionnaire which is a self completed short measure of foot health including a pain visual analogue scale and a section for the podiatrist to rate an individual's foot health based on their podiatric problems. The patient questionnaire was completed by individuals prior to receiving podiatry care and then 2 weeks after treatment to assess the effect of core podiatry in terms of pain and foot health. Results 1047 patients completed both questionnaires, with an age range from 26–95 years and a mean age of 72.9 years. The podiatrists clinical rating at baseline showed 75% of patients had either slight or moderate podiatric problems. The differences in questionnaire and visual analogue scores before and after treatment were determined according to three categories – better, same, worse and 75% of patients' scores either remained the same or improved after core podiatry treatment. A student t-test showed a statistical significant difference in pre and post treatment scores where P < 0.001, though the confidence interval indicated that the improvement was relatively small. Conclusion Core podiatry has been shown to sustain or improve foot health and pain in 75% of the patients taking part in the audit. Simple outcome measures including pain scales should be used routinely in podiatric practice to assess the

  17. The neurobiology of trust.

    PubMed

    Zak, Paul J; Kurzban, Robert; Matzner, William T

    2004-12-01

    This is the first report that endogenous oxytocin in humans is related to social behaviors, which is consistent with a large animal literature. Subjects are put into a social dilemma in which absent communication, cooperative behavior can benefit both parties randomly assigned to a dyad. The dilemma arises because one participant must make a monetary sacrifice to signal the degree of trust in the other before the other's behavioral response is known. We show that receipt of a signal of trust is associated with a higher level of peripheral oxytocin than that in subjects receiving a random monetary transfer of the same average amount. Oxytocin levels were also related to trustworthy behavior (sharing a greater proportion of the monetary gains). We conclude that oxytocin may be part of the human physiology that motivates cooperation. PMID:15677415

  18. Saving the NHS one blood test at a time

    PubMed Central

    Akhtar, Waqas; Chung, Yooyun

    2014-01-01

    As a team of junior doctors our aim has been to save costs in day to day work so that money can be reallocated to improving nursing staff levels on our wards. Stem cell units have regular blood collection schedules in order to monitor organ response to chemotherapy and to look for complications in immunocompromised patients. We set out to reduce the number of biochemical investigations to a minimum that would be clinically indicated. We designed a new blood collection proforma for nursing staff to follow and audited all blood tests taken during a 2 week period before and after its introduction. The number of inappropriate blood tests were recorded as those that were not clinically indicated or not present on the collection schedule. After the introduction of the change the number of inappropriate tests were reduced by 937 over the 2 week period, with a cost saving of £1,478.42. Similar strategies for reducing unnecessary investigations and focusing on tests that will change management could help the NHS cope with a difficult financial future and provide continued safe staffing levels and quality care. PMID:26734249

  19. 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

  20. 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. PMID:27409782

  1. Present dangers and future threats: some perverse incentives in the NHS reforms.

    PubMed Central

    Paton, C.

    1995-01-01

    The NHS reforms have come to mean all things to all men (and women). Identifying a market oriented purchaser-provider split as the conceptual heart of the reforms is still, however, useful. There are important perverse incentives in and around the NHS that are associated with the reforms; furthermore, many reactions to the resulting problems are paradoxical and often counterproductive. Hitherto most criticism of the reforms from the health policy and management community (as opposed to the professions and the public) has been tactical rather than fundamental. There are serious problems for the NHS associated both with the NHS market and with current, often tacit, strategies for the future of the service. Images p1247-a FIGURE 1 PMID:7767197

  2. Do the poor cost much more? The relationship between small area income deprivation and length of stay for elective hip replacement in the English NHS from 2001 to 2008.

    PubMed

    Cookson, Richard; Laudicella, Mauro

    2011-01-01

    The Blair/Brown reforms of the English NHS in the early to mid 2000s gave hospitals strong new incentives to reduce waiting times and length of stay for elective surgery. One concern was that these efficiency-oriented reforms might harm equity, by giving hospitals new incentives to select against socio-economically disadvantaged patients who stay longer and cost more to treat. This paper aims to assess the magnitude of these new selection incentives in the test case of hip replacement. Anonymous hospital records are extracted on 274,679 patients admitted to English NHS Hospital Trusts for elective total hip replacement from 2001/2 through 2007/8. The relationship between length of stay and small area income deprivation is modelled allowing for other patient characteristics (age, sex, number and type of diagnoses, procedure type) and hospital effects. After adjusting for these factors, we find that patients from the most deprived tenth of areas stayed just 6% longer than others in 2001/2, falling to 2% by 2007/8. By comparison, patients aged 85 or over stayed 57% longer than others in 2001/2, rising to 71% by 2007/8, and patients with seven or more diagnoses stayed 58% longer than others in 2001/2, rising to 73% by 2007/8. We conclude that the Blair/Brown reforms did not give NHS hospitals strong new incentives to select against socio-economically deprived hip replacement patients. PMID:21131119

  3. 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

  4. New strategy for NHS procurement Manchester Conference Centre, 17 April 2012.

    PubMed

    Scott, Dawn

    2012-07-01

    Through the QIPP agenda, the NHS is expected to deliver procurement savings of pounds 1.2 bn by 2014/15. The question at the conference was--is that enough? The NHS as a whole is expected to deliver efficiencies of some pounds 20 bn, which implies that, if procurement was to take its fair share, savings of some pounds 3 bn-3.5 bn would be needed. PMID:22919770

  5. 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. PMID:23910844

  6. 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. PMID:24624524

  7. 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

  8. 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. PMID:27140657

  9. Achieving progress through clinical governance? A national study of health care managers' perceptions in the NHS in England

    PubMed Central

    Freeman, T; Walshe, K

    2004-01-01

    Background: A national cross sectional study was undertaken to explore the perceptions concerning the importance of, and progress in, aspects of clinical governance among board level and directorate managers in English acute, ambulance, and mental health/learning disabilities (MH/LD) trusts. Participants: A stratified sample of acute, ambulance, and mental health/learning disabilities trusts in England (n = 100), from each of which up to 10 board level and 10 directorate level managers were randomly sampled. Methods: Fieldwork was undertaken between April and July 2002 using the Organisational Progress in Clinical Governance (OPCG) schedule to explore managers' perceptions of the importance of, and organisational achievement in, 54 clinical governance competency items in five aggregated domains: improving quality; managing risks; improving staff performance; corporate accountability; and leadership and collaboration. The difference between ratings of importance and achievement was termed a shortfall. Results: Of 1916 individuals surveyed, 1177 (61.4%) responded. The competency items considered most important and recording highest perceived achievement related to corporate accountability structures and clinical risks. The highest shortfalls between perceived importance and perceived achievement were reported in joint working across local health communities, feedback of performance data, and user involvement. When aggregated into domains, greatest achievement was perceived in the assurance related areas of corporate accountability and risk management, with considerably less perceived achievement and consequently higher shortfalls in quality improvement and leadership and collaboration. Directorate level managers' perceptions of achievement were found to be significantly lower than those of their board level colleagues on all domains other than improving performance. No differences were found in perceptions of achievement between different types of trusts, or between

  10. 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…

  11. Trust-Effectiveness Patterns in Schools

    ERIC Educational Resources Information Center

    Forsyth, Patrick B.; Barnes, Laura L. B.; Adams, Curt M.

    2006-01-01

    Purpose: To investigate the consequences of relational trust, especially parent measured trust, for desirable school outcomes. Design/methodology/approach: Using a US Midwestern state sample of 79 schools, parent and teacher trust data are used to derive a trust-effectiveness typology. Trust was conceptualized as one party's willingness to be…

  12. 26 CFR 26.2654-1 - Certain trusts treated as separate trusts.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 14 2010-04-01 2010-04-01 false Certain trusts treated as separate trusts. 26... 1986 § 26.2654-1 Certain trusts treated as separate trusts. (a) Single trust treated as separate trusts—(1) Substantially separate and independent shares—(i) In general. If a single trust consists...

  13. 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…

  14. 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…

  15. Examining the role of Scotland's telephone advice service (NHS 24) for managing health in the community: analysis of routinely collected NHS 24 data

    PubMed Central

    Elliott, Alison M; McAteer, Anne; Heaney, David; Ritchie, Lewis D; Hannaford, Philip C

    2015-01-01

    Objectives To examine the type, duration and outcome of the symptoms and health problems Scotland's nurse-led telephone advice service (NHS 24) is contacted about and explore whether these vary by time of contact and patient characteristics. Design Analysis of routinely collected NHS 24 data. Setting Scotland, UK. Participants Users of NHS 24 during 2011. Main outcome measures Proportion of the type, duration and outcome of the symptoms and health problems NHS 24 is contacted about. Results 82.6% of the calls were made out-of-hours and 17.4% in-hours. Abdominal problems accounted for the largest proportion of calls (12.2%) followed by dental (6.8%) and rash/skin problems (6.0%). There were differences in the type of problems presented in-hours and out-of-hours. Most problems (62.9%) had lasted <24 h before people contacted NHS 24. Out-of-hours calls tended to be for problems of shorter duration. Problems reported out-of-hours most commonly resulted in advice to visit an out-of-hours centre and in-hours advice to contact a general practitioner. Most of the service users were female and from more affluent areas. Use of the service declined with age in those over 35 years. The characteristics of users varied according to when NHS 24 was contacted. The number of calls made by an individual in the year ranged from 1 to 866, although most users (69.2%) made only one call. The type of problem presented varied by age and deprivation, but was broadly similar by gender, rural/urban status and geographic area. Call outcomes also varied by user characteristics. Conclusions This is the first study to examine how the public uses NHS 24. It has identified the patterns of problems which the service must be equipped to deal with. It has also provided important information about who uses the service and when. This information will help future planning and development of the service. PMID:26310396

  16. 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

  17. Building Organizational Capacity through Trust

    ERIC Educational Resources Information Center

    Cosner, Shelby

    2009-01-01

    This article explores the cultivation of collegial trust as a central feature of the capacity-building work of 11 high school principals, nominated for their expertise with capacity building. This qualitative study examined interview data and school documents collected over 18 months. Principals regarded trust as critical and were motivated to…

  18. Contribution of a government target to controlling Clostridium difficile in the NHS in England.

    PubMed

    Duerden, Brian I

    2011-08-01

    The introduction of mandatory surveillance of Clostridium difficile infection (CDI) in 2004 showed the scale of the challenge: cases in patients >64 years old reached 55,681 in 2006. The first type 027 outbreaks had been in 2005 and CDI was a headline issue. The prevention and control of CDI requires a tripartite partnership between clinicians, health service managers, and the government/Department of Health which needs to set standards, ensure that CDI is a priority, set targets and monitor outcome. Government can also legislate; the Health Act 2006 introduced a statutory Code of Practice for infection prevention and control for the NHS and extended to all independent health and care settings in 2010. In 2008, a national target was set for a 30% reduction in CDI by 2010-11 (baseline 2007-8). It was population-based and set a standard (ceiling) rate/10,000 in each area, within which acute hospitals had a target/1000 admissions (diagnosed after day 3). In the first year (2008-9), a 35% reduction was achieved from 55,499 to 36,079 cases in all ages and in 2009-10 the total was 25,604, a 54% reduction from 2007-8. However, in 2009, cases >64 years old were 29% down from 2008 but only 9% down in the 2-64 year old group; also, by this stage, cases in acute hospitals and in other settings were almost equal. Death certification showing CDI fell for the first time in 2008 and in 2009 there were 3550 total mentions (7816 in 2007) of which 1510 (42%) were as underlying cause (3875, 49%, in 2007). The reductions in CDI have been achieved by a raft of measures. Crucially, the targets focused management emphasis on infection prevention and control. This was supported by enhanced surveillance. Clinical practice protocols were implemented through the high impact interventions (care bundle) approach, and there was a major emphasis on cleanliness and hygiene (particularly hand washing for clinical staff and environmental cleaning and disinfection in patient areas). Achievement of

  19. Commissioning healthcare for people with long term conditions: the persistence of relational contracting in England’s NHS quasi-market

    PubMed Central

    2013-01-01

    Background Since 1991, there has been a series of reforms of the English National Health Service (NHS) entailing an increasing separation between the commissioners of services and a widening range of public and independent sector providers able to compete for contracts to provide services to NHS patients. We examine the extent to which local commissioners had adopted a market-oriented (transactional) model of commissioning of care for people with long term conditions several years into the latest period of market-oriented reform. The paper also considers the factors that may have inhibited or supported market-oriented behaviour, including the presence of conditions conducive to a health care quasi-market. Methods We studied the commissioning of services for people with three long term conditions - diabetes, stroke and dementia - in three English primary care trust (PCT) areas over two years (2010-12). We took a broadly ethnographic approach to understanding the day-to-day practice of commissioning. Data were collected through interviews, observation of meetings and from documents. Results In contrast to a transactional, market-related approach organised around commissioner choice of provider and associated contracting, commissioning was largely relational, based on trust and collaboration with incumbent providers. There was limited sign of commissioners significantly challenging providers, changing providers, or decommissioning services. In none of the service areas were all the conditions for a well functioning quasi-market in health care in place. Choice of provider was generally absent or limited; information on demand and resource requirements was highly imperfect; motivations were complex; and transaction costs uncertain, but likely to be high. It was difficult to divide care into neat units for contracting purposes. As a result, it is scarcely surprising that commissioning practice in relation to all six commissioning developments was dominated by a

  20. 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. PMID:24701149

  1. 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

  2. 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

  3. The NHS and market forces in healthcare: the need for organisational ethics.

    PubMed

    Frith, Lucy

    2013-01-01

    The NHS in England is an organisation undergoing substantial change. The passage of the Health and Social Care Act 2012, consolidates and builds on previous health policies and introduces further 'market-style' reforms of the NHS. One of the main aspects of these reforms is to encourage private and third sector providers to deliver NHS services. The rationale for this is to foster a more competitive market in healthcare to encourage greater efficiency and innovation. This changing healthcare environment in the English NHS sharpens the need for attention to be paid to the ethical operation of healthcare organisations. All healthcare organisations need to consider the ethical aspects of their operation, whether state or privately run. However, the changes in the type of organisations used to provide healthcare (such as commercial companies) can create new relationships and ethical tensions. This paper will chart the development of organisational ethics as a concern in applied ethics and how it arose in the USA largely owing to changes in the organisation of healthcare financing and provision. It will be argued that an analogous transition is happening in the NHS in England. The paper will conclude with suggestions for the development of organisational ethics programmes to address some of the possible ethical issues raised by this new healthcare environment that incorporates both private and public sector providers. PMID:23087185

  4. '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. PMID:23393404

  5. Solution Versus Gas-Phase Modification of Peptide Cations with NHS-Ester Reagents

    NASA Astrophysics Data System (ADS)

    Mentinova, Marija; Barefoot, Nathan Z.; McLuckey, Scott A.

    2012-02-01

    A comparison between solution and gas phase modification of primary amine sites in model peptide cations with N-hydroxysuccinimide (NHS) ester reagents is presented. In all peptides, the site of modification in solution was directed to the N-terminus by conducting reactions at pH = 5, whereas for the same peptides, a lysine residue was preferentially modified in the gas phase. The difference in pKa values of the N-terminus and ɛ-amino group of the lysine allows for a degree of control over sites of protonation of the peptides in aqueous solution. With removal of the dielectric and multiple charging of the peptide ions in the gas phase, the accommodation of excess charge can affect the preferred sites of reaction. Interaction of the lone pair of the primary nitrogen with a proton reduces its nucleophilicity and, as a result, its reactivity towards NHS-esters. While no evidence for reaction of the N-terminus with sulfo-NHS-acetate was noted in the model peptide cations, a charge inversion experiment using bis[sulfosuccinimidyl] suberate, a cross-linking reagent with two sulfo-NHS-ester functionalities, showed modification of the N-terminus. Hence, an unprotonated N-terminus can serve as a nucleophile to displace NHS, which suggests that its lack of reactivity with the peptide cations is likely due to the participation of the N-terminus in solvating excess charge.

  6. 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

  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. 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. PMID:26630611

  9. 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

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

    PubMed

    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

  11. 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. PMID:26407380

  12. 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. PMID:12683435

  13. 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

  14. Trust Building in Virtual Communities

    NASA Astrophysics Data System (ADS)

    Mezgár, István

    By using different types of communication networks various groups of people can come together according to their private or business interest forming a Virtual Community. In these communities cooperation and collaboration plays an important role. As trust is the base of all human interactions this fact is even more valid in case of virtual communities. According to different experiments the level of trust in virtual communities is highly influenced by the way/mode of communication and by the duration of contact. The paper discusses the ways of trust building focusing on communication technologies and security aspects in virtual communities.

  15. Telemedicine and Older Neurology Outpatients: Use of NHS Direct and of the Internet in the UK.

    PubMed

    Larner, Aj

    2011-12-01

    Telemedicine is one potential approach to address the under-serviced health needs of older people. This article presents data from a project investigating neurology patients' awareness and use of the NHS Direct telephone helpline and the Internet over a 10-year period (2001-2010). Older people's awareness and use of the NHS Direct telephone helpline was low compared to other age groups and did not change with time. Although Internet access and use was also low compared to other age groups, access did increase over time. Hence, future generations of older people may be amenable to health contacts and inputs via cyberspace. PMID:23251322

  16. Reducing waste in the NHS: an overview of the literature and challenges for the nursing profession.

    PubMed

    Minogue, Virginia; Wells, Bill

    2016-07-01

    Waste in the NHS is estimated to account for 20% of health expenditure. This article examines the literature on reducing waste, analyses some approaches to waste reduction, and identifies the role that nurses and other health professionals can play in developing a sustainable NHS. For the purposes of the article, and to inform nursing practice, the definition of, and discussion about, waste is broader than that outlined by the Department for Environment, Food and Rural Affairs (Defra) controlled waste regulations, and the Royal College of Nursing classification. It includes clinical waste, waste arising out of clinical practice, service delivery and care, infrastructure, and carbon emissions. PMID:27369724

  17. Revealing Preconditions for Trustful Collaboration in CSCL

    ERIC Educational Resources Information Center

    Gerdes, Anne

    2010-01-01

    This paper analyses preconditions for trust in virtual learning environments. The concept of trust is discussed with reference to cases reporting trust in cyberspace and through a philosophical clarification holding that trust in the form of self-surrender is a common characteristic of all human co-existence. In virtual learning environments,…

  18. 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…

  19. 43 CFR 426.7 - Trusts.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... criteria, the land held in trust will be ineligible to receive irrigation water until all of the criteria..., then irrigation water will not be made available to the land held in trust until the trust satisfies... charge the full-cost rate for irrigation water delivered to any land held by the trust that exceeds...

  20. Does Trust Beget Trustworthiness? Trust and Trustworthiness in Two Games and Two Cultures: A Research Note

    ERIC Educational Resources Information Center

    Kiyonari, Toko; Yamagishi, Toshio; Cook, Karen S.; Cheshire, Coye

    2006-01-01

    An important unanswered question in the empirical literature on trust is whether trusting begets trustworthiness. In two experimental games, with Japanese and American participants, respectively, we compared trust and trustworthiness to provide an answer to this question. The trustee in the standard Trust Game knows that he or she is trusted,…

  1. 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. PMID:22855879

  2. Wolves and Big Yellow Taxis: How Would Be Know If the NHS Is at Death’s Door?

    PubMed Central

    Greener, Ian

    2015-01-01

    Martin Powell suggests that the death of the English National Health Service (NHS) has been announced so many times we are at risk of not noticing should it actually happen. He is right. If we ‘cry wolf’ too many times, we risk losing sight of what is important about the NHS and why. PMID:26673181

  3. 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,…

  4. 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.

  5. 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.

  6. 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…

  7. 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. PMID:10351254

  8. 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…

  9. Patient record access: making it work for you and the NHS

    PubMed Central

    2011-01-01

    Background Patient record access is NHS policy. It is now a reality in the UK, although it remains a rarity. Setting This article summarises the current state of patient record access in the UK, focusing on a particular system for which there is most data available. It also explores possibilities for expanded functionality in the near future. This will offer both patients and the NHS a more interactive approach that offers significant benefits to both. Results Patient record access not only appears safe, but also offers benefits to patients. These include improved safety; a more accurate record; better relationships between patients and clinicians; better data sharing and integration across the NHS; improved self-care and shared decision-making; and better compliance. Practices gain by saving time. In addition, they gain by having empowered patients who can do more for themselves. However, clinicians in general, and GPs in particular, are anxious about enabling record access, fearing loss of control, litigation and breaches of the daa protection act. Conclusions Patient record access with added transactional services is likely to benefit patients and practices across the NHS. It supports QIPP. It is likely to become routine, but cannot substitute for good traditional communication with and support for patients. PMID:25949647

  10. Giving night shift staff healthy food choices is a priority, says NHS chief.

    PubMed

    Kleebauer, Alistair

    2014-11-01

    Night shift staff will have access to healthy food options as part of a drive to improve the health of hospital staff in England, NHS chief executive Simon Stevens said as he announced his vision for the health service last week. PMID:25351052

  11. 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. PMID:20018987

  12. 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. PMID:20864204

  13. 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

    2006-12-01

    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. PMID:17228622

  14. NHS health checks through general practice: randomised trial of population cardiovascular risk reduction

    PubMed Central

    2012-01-01

    Background The global burden of the major vascular diseases is projected to rise and to remain the dominant non-communicable disease cluster well into the twenty first century. The Department of Health in England has developed the NHS Health Check service as a policy initiative to reduce population vascular disease risk. The aims of this study were to monitor population changes in cardiovascular disease (CVD) risk factors over the first year of the new service and to assess the value of tailored lifestyle support, including motivational interview with ongoing support and referral to other services. Methods Randomised trial comparing NHS Health Check service only with NHS Health Check service plus additional lifestyle support in Stoke on Trent, England. Thirty eight general practices and 601 (365 usual care, 236 additional lifestyle support) patients were recruited and randomised independently between September 2009 and February 2010. Changes in population CVD risk between baseline and one year follow-up were compared, using intention-to-treat analysis. The primary outcome was the Framingham 10 year CVD risk score. Secondary outcomes included individual modifiable risk measures and prevalence of individual risk categories. Additional lifestyle support included referral to a lifestyle coach and free sessions as needed for: weight management, physical activity, cook and eat and positive thinking. Results Average population CVD risk decreased from 32.9% to 29.4% (p <0.001) in the NHS Health Check only group and from 31.9% to 29.2% (p <0.001) in the NHS Health Check plus additional lifestyle support group. There was no significant difference between the two groups at either measurement point. Prevalence of high blood pressure, high cholesterol and smoking were reduced significantly (p <0.01) in both groups. Prevalence of central obesity was reduced significantly (p <0.01) in the group receiving additional lifestyle support but not in the NHS Health Check only group

  15. Elimination of Subjectivity from Trust Recommendation

    NASA Astrophysics Data System (ADS)

    Hasan, Omar; Brunie, Lionel; Pierson, Jean-Marc; Bertino, Elisa

    In many distributed applications, a party who wishes to make a transaction requires that it has a certain level of trust in the other party. It is frequently the case that the parties are unknown to each other and thus share no pre-existing trust. Trust-based systems enable users to establish trust in unknown users through trust recommendation from known users. For example, Bob may choose to trust an unknown user Carol when he receives a recommendation from his friend Alice that Carol’s trustworthiness is 0.8 on the interval [0,1].

  16. 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. PMID:21371053

  17. 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

  18. 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.

  19. 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. PMID:22681564

  20. 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

    2015-01-01

    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). PMID:26673474

  1. Online Health Information: Can You Trust It?

    MedlinePlus

    ... trust the health information I get on the Internet?” There are thousands of medical websites. Some provide ... trust is an important part of using the Internet. How Do I Find Reliable Health Information Online? ...

  2. 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.

  3. 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. PMID:23786170

  4. 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…

  5. 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...

  6. Assessment of Organizational Trust: Italian Adaptation and Factorial Validity of the Organizational Trust Inventory

    ERIC Educational Resources Information Center

    Vidotto, Giulio; Vicentini, Marco; Argentero, Piergiorgio; Bromiley, Philip

    2008-01-01

    Trust influences interactions among individuals and organizations but has been an elusive concept to define and measure. The Organizational Trust Inventory (OTI) measures three dimensions of organizational trust, as defined by Cummings and Bromiley (in: Kramer and Tyler (eds) Trust in Organizations, 1996), believing or feeling that others: keep…

  7. Dynamic consent: a possible solution to improve patient confidence and trust in how electronic patient records are used in medical research.

    PubMed

    Williams, Hawys; Spencer, Karen; Sanders, Caroline; Lund, David; Whitley, Edgar A; Kaye, Jane; Dixon, William G

    2015-01-01

    With one million people treated every 36 hours, routinely collected UK National Health Service (NHS) health data has huge potential for medical research. Advances in data acquisition from electronic patient records (EPRs) means such data are increasingly digital and can be anonymised for research purposes. NHS England's care.data initiative recently sought to increase the amount and availability of such data. However, controversy and uncertainty following the care.data public awareness campaign led to a delay in rollout, indicating that the success of EPR data for medical research may be threatened by a loss of patient and public trust. The sharing of sensitive health care data can only be done through maintaining such trust in a constantly evolving ethicolegal and political landscape. We propose that a dynamic consent model, whereby patients can electronically control consent through time and receive information about the uses of their data, provides a transparent, flexible, and user-friendly means to maintain public trust. This could leverage the huge potential of the EPR for medical research and, ultimately, patient and societal benefit. PMID:25586934

  8. 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.

  9. 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... A to Part 285 RULES OF THE SECURITIES INVESTOR PROTECTION CORPORATION Accounts of âseparateâ Customers of Sipc Members § 300.104 Trust accounts. (a) A trust account held with a member shall be deemed...

  10. 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... A to Part 285 RULES OF THE SECURITIES INVESTOR PROTECTION CORPORATION Accounts of âseparateâ Customers of Sipc Members § 300.104 Trust accounts. (a) A trust account held with a member shall be deemed...

  11. 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.)…

  12. Enhancing Trust in SOA Based Collaborative Environments

    NASA Astrophysics Data System (ADS)

    Boursas, Latifa; Bourimi, Mohamed; Hommel, Wolfgang; Kesdogan, Dogan

    Considering trust and privacy requirements for online and collaborative distance learning environments, this paper discusses potential extensions of SOA based applications to simultaneously support authentication and authorization services, and offering mutual trust to both learners and service providers. This study shows that the security mechanisms integrated in the SOA platform can be effectively extended and correlated with a trust model.

  13. 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…

  14. Patient choice for older people in english NHS primary care: theory and practice.

    PubMed

    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

  15. Tracing experiences of NHS change in England: a process philosophy perspective.

    PubMed

    McMurray, Robert

    2010-01-01

    For over three decades public services have been the subject of unprecedented change. Nowhere has this been more evident than in the English National Health Service (NHS) where despite the effort expended on change there is growing evidence that such restructuring is largely ineffective. Drawing on a study of culture modification in the English NHS, this paper utilizes Chia's (1999) account of the metaphysics of processual change to consider why attempts to restructure public services are not always successful. The paper contributes to our understanding of public management reform by considering how an ontology of becoming, and a loosening of control, might alter how we approach reforming. Further, the paper offers a theoretical justification for the use of standard research methods for novel processual ends. The paper concludes with a reflection on the implications of a processual perspective for the future management, organization and study of change in public administration. PMID:20919431

  16. Systematic Investigation of EDC/sNHS-Mediated Bioconjugation Reactions for Carboxylated Peptide Substrates.

    PubMed

    Totaro, Kyle A; Liao, Xiaoli; Bhattacharya, Keshab; Finneman, Jari I; Sperry, Justin B; Massa, Mark A; Thorn, Jennifer; Ho, Sa V; Pentelute, Bradley L

    2016-04-20

    1-Ethyl-3-(3-(dimethylamino)propyl)carbodiimide (EDC) bioconjugations have been utilized in preparing variants for medical research. While there have been advances in optimizing the reaction for aqueous applications, there has been limited focus toward identifying conditions and side reactions that interfere with product formation. We present a systematic investigation of EDC/N-hydroxysulfosuccinimide (sNHS)-mediated bioconjugations on carboxylated peptides and small proteins. We identified yet-to-be-reported side products arising from both the reagents and substrates. Model peptides used in this study illustrate particular substrates are more susceptible to side reactions than others. From our studies, we found that bioconjugations are more efficient with high concentrations of amine nucleophile but not sNHS. Performing bioconjugations on a model affibody protein show that the trends established with model peptides hold for more complex systems. PMID:26974183

  17. Changing domains in the management process. Radiographers as managers in the NHS.

    PubMed

    Forbes, T; Prime, N

    1999-01-01

    Examines a group of radiographers developing management roles within the backdrop of a changing NHS. A comparative study of 25 Scottish and English radiographer managers were interviewed using semi-structured interviews. Interviews were based on a number of issues associated with moving from a clinical professional to a clinical manager and were analysed using domain theory. The interviews formed a number of emerging themes, which included management, professionalism, management style, conflicts between the role of both manager and professional, and role change. Radiographer managers are forming new "hybrid" manager roles, which have been developing within a changing NHS. A definite tension was seen in this role change. This transition was not easy for this group of radiographer managers. However, they have shown resilience in undertaking both operational and strategic management decisions, while using their clinical background to inform their decision making. PMID:10747440

  18. The changing context of employment in the NHS: some legal implications of changes to employment contracts.

    PubMed

    Desombre, T; Benny, R

    1998-01-01

    The NHS has undergone and continues to undergo rapid change. As a result of this, the duties and responsibilities of employees will also change. Managers within the NHS have a responsibility to ensure that appropriate contracts of employment are held by employees and that, where required, variations in these contracts are documented. This paper uses the example of the changing role of the Executive Nurse Director to highlight the importance of this need. It concludes by warning that failure to consider both the legal duties placed on employers when implementing contractual variations and the legal implications of adopting an unlawful method of variation, might lead to large legal bills and a demand on managerial time dealing with any legal claim against the employer. PMID:10346297

  19. 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". PMID:12870249

  20. The Administrative Team, Trust & Gender.

    ERIC Educational Resources Information Center

    Garfinkel, Elliot Z.

    This paper describes the first phase of a research study that examined (1) how superintendents define and select their administrative teams; (2) how team values are conceptualized by superintendents; (3) how "trust" is defined and its value perceived by superintendents; and (4) whether or not gender influences the way superintendents define "team"…

  1. 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)

  2. 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…

  3. 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…

  4. 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…

  5. Using programme budgeting and marginal analysis (PBMA) to set priorities: reflections from a qualitative assessment in an English Primary Care Trust.

    PubMed

    Goodwin, Elizabeth; Frew, Emma J

    2013-12-01

    In England from 2002 to 2013, Primary Care Trusts (PCTs) were responsible for commissioning healthcare for their local populations. The NHS has recently undergone rapid organisational change whereby clinicians have assumed responsibility for local commissioning decisions. This change in commissioning arrangements alongside the current financial pressures facing the NHS provides an impetus for considering the use of technical prioritisation methods to enable the identification of savings without having a detrimental effect on the health of the population. This paper reports on the design and implementation of a technical prioritisation method termed PBMA applied within NHS Plymouth, an English PCT responsible for commissioning services for a population of approximately 270,000. We evaluated the effectiveness of the process, the extent to which it was appropriate for local healthcare commissioning and whether it identified budget savings. Using qualitative research methodology, we found the process produced clear strategic and operational priorities for 2010/11, providing staff with focus and structure, and delivered a substantial planned reduction in hospital activity levels. Participants expressed satisfaction with the process. NHS Plymouth adhered to the PBMA process, although concerns were raised about the evidence for some priorities, decibel rationing, and a lack of robust challenge at priority-setting meetings. Further work is required to enhance participants' understanding of marginal analysis. Participants highlighted several external benefits, particularly in terms of cultural change, and felt the process should encompass the whole local health and social care community. This evaluation indicates that the prioritisation method was effective in producing priorities for NHS Plymouth, and that PBMA provides an appropriate method for allocating resources at a local level. In order for PBMA to identify savings, cultural and structural barriers to disinvestment

  6. Questions about the NHS Supply Chain's generic specifications project arise at TVS 2016.

    PubMed

    Fronzo, C

    2016-05-01

    The last session at this year's Tissue Viability Society (TVS) conference was a debate surrounding the Government's proposed NHS Supply Chain generics programme. In one corner explaining the full proposal, how it will work and who will be involved was Mandie Sunderland, and in the other was Richard White, who had a number of questions to ask. Here Camila Fronzo, JWC Chief Sub Editor, summarises the main points of the debate and the questions still to be addressed. PMID:27169336

  7. Making health care more sustainable: the case of the English NHS.

    PubMed

    Pencheon, David

    2015-10-01

    The NHS is the most revered organisation in Britain: 'the proudest achievement of our modern society'. It is certainly the largest, although since its inception in 1948 it has operated in a government-funded environment of restricted resources. Nevertheless, it has also benefitted from a generally effective model of intervention centred on a hospital care system integrating specialist and emergency care and a primary care system which functions as both a source of treatment and a gatekeeper to specialist care. New circumstances, including environmentally-generated risk and a shifting disease reality, challenges the adequacy of this model. This paper argues that these new circumstances, some of which have seen a legislative response by government, mean that the NHS has to apply sustainable development thinking programmatically throughout its management and operations. It is also argued that the organisation needs to refocus towards prevention particularly in order to stem the rising tide of non-communicable disease. This paper sets out the thinking and actions of the Sustainable Development Unit, which has the task of developing and implanting sustainability concepts in the NHS. It is argued that the cause of sustainable development calls for a mix of cultural and technological shifts, new incentives and a rolling programme of innovative change. Some examples of success are presented. PMID:26410181

  8. Creating a patient-led NHS: some ethical and epistemological challenges.

    PubMed

    Owens, John

    2012-01-01

    This article responds to the Coalition government's recent Open Public Services White Paper and to proposals which call for the creation of a 'patient-led NHS' which will, wherever possible, seek to give patients direct control over the services they receive, through a greater degree of choice and participation. Its central contention is that affording patients greater influence over the consultation and commissioning processes will require the NHS to accommodate and respond to the beliefs, values and agendas of patients, as well as those of medical professionals and policy makers. Since it cannot be assumed that professionals and patients will share the same beliefs, values and agendas, the creation of a system of patient-led services has the potential to bring disagreement between professionals and patients to a head, particularly within the consultation and commissioning processes. Thus, a set of complex epistemic and ethical challenges accompanies the proposed creation of a 'patient-led NHS', greater awareness of which will be necessary for the successful implementation of such reforms. PMID:26265952

  9. Healthcare financing reform in Latvia: switching from social health insurance to NHS and back?

    PubMed

    Mitenbergs, Uldis; Brigis, Girts; Quentin, Wilm

    2014-11-01

    In the 1990s, Latvia aimed at introducing Social Health Insurance (SHI) but later changed to a National Health Service (NHS) type system. The NHS is financed from general taxation, provides coverage to the entire population, and pays for a basic service package purchased from independent public and private providers. In November 2013, the Cabinet of Ministers passed a draft Healthcare Financing Law, aiming at increasing public expenditures on health by introducing Compulsory Health Insurance (CHI) and linking entitlement to health services to the payment of income tax. Opponents of the reform argue that linking entitlement to health services to the payment of income tax does not have the potential to increase public expenditures on health but that it can contribute to compromising universal coverage and access to health services of certain population groups. In view of strong opposition, it is unlikely that the law will be adopted before parliamentary elections in October 2014. Nevertheless, the discussion around the law is interesting because of three main reasons: (1) it can illustrate why the concept of SHI remains attractive - not only for Latvia but also for other countries, (2) it shows that a change from NHS to SHI does not imply major institutional reforms, and (3) it demonstrates the potential problems of introducing SHI, i.e. of linking entitlement to health services to the payment of contributions. PMID:25445111

  10. Estimating the financial cost of chronic kidney disease to the NHS in England

    PubMed Central

    Kerr, Marion; Bray, Benjamin; Medcalf, James; O'Donoghue, Donal J.; Matthews, Beverley

    2012-01-01

    Background Chronic kidney disease (CKD) is a major challenge for health care systems around the world, and the prevalence rates appear to be increasing. We estimate the costs of CKD in a universal health care system. Methods Economic modelling was used to estimate the annual cost of Stages 3–5 CKD to the National Health Service (NHS) in England, including CKD-related prescribing and care, renal replacement therapy (RRT), and excess strokes, myocardial infarctions (MIs) and Methicillin-Resistant Staphylococcus Aureus (MRSA) infections in people with CKD. Results The cost of CKD to the English NHS in 2009–10 is estimated at £1.44 to £1.45 billion, which is ∼1.3% of all NHS spending in that year. More than half this sum was spent on RRT, which was provided for 2% of the CKD population. The economic model estimates that ∼7000 excess strokes and 12 000 excess MIs occurred in the CKD population in 2009–10, relative to an age- and gender-matched population without CKD. The cost of excess strokes and MIs is estimated at £174–£178 million. Conclusions The financial impact of CKD is large, with particularly high costs relating to RRT and cardiovascular complications. It is hoped that these detailed cost estimates will be useful in analysing the cost-effectiveness of treatments for CKD. PMID:22815543

  11. Nhs: Network-based Hierarchical Segmentation for Cryo-EM Density Maps

    PubMed Central

    Burger, Virginia; Chennubhotla, Chakra

    2012-01-01

    Electron cryo-microscopy (cryo-EM) experiments yield low-resolution (3–30Å) 3D-density maps of macromolecules. These density maps are segmented to identify structurally distinct proteins, protein domains, and sub-units. Such partitioning aids the inference of protein motions and guides fitting of high-resolution atomistic structures. Cryo-EM density map segmentation has traditionally required tedious and subjective manual partitioning or semi-supervised computational methods, while validation of resulting segmentations has remained an open problem in this field. Our network-based bias-free segmentation method for cryo-EM density map segmentation, Nhs (Network-based hierarchical segmentation), provides the user with a multi-scale partitioning, reflecting local and global clustering, while requiring no user input. This approach models each map as a graph, where map voxels constitute nodes and edges connect neighboring voxels. Nhs initiates Markov diffusion (or random walk) on the weighted graph. As Markov probabilities homogenize through diffusion, an intrinsic segmentation emerges. We validate the segmentations with ground-truth maps based on atomistic models. When implemented on density maps in the 2010 Cryo-EM Modeling Challenge, Nhs efficiently and objectively partitions macromolecules into structurally and functionally relevant sub-regions at multiple scales. PMID:22696408

  12. Toward the differentiation of trust in supervisor and trust in organization.

    PubMed

    Tan, H H; Tan, C S

    2000-05-01

    Trust in supervisor and trust in organization are argued to be distinct but related constructs, each with its own set of antecedents and outcomes. Empirical field results supported the proposition. Although trust in supervisor and trust in organization were positively and significantly correlated, trust in supervisor was more strongly associated with proximal variables (ability, benevolence, and integrity of supervisor), whereas trust in organization was more strongly correlated with global variables (perceived organizational support and justice). This conclusion held despite the inclusion of proximal variables in the regression on trust in organization and the inclusion of global variables in the regression on trust in supervisor. In addition to the differential antecedents of trust in supervisor and trust in organization, the outcomes for both variables were different. Trust in supervisor was related to increased innovative behavior and satisfaction with supervisor, and trust in organization was related to higher organizational commitment and lower intention to leave. Therefore, the authors provide clear preliminary data on the distinctiveness of trust in supervisor and trust in organization. One implication of this set of results is that organizations should adopt a more holistic approach in building trust, which can be achieved by focusing on the various constituents of the organization and the various levels (e.g., the supervisor level and the organizational level). PMID:10846623

  13. 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. PMID:25602121

  14. Money and trust among strangers

    PubMed Central

    Camera, Gabriele; Casari, Marco; Bigoni, Maria

    2013-01-01

    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. PMID:23980139

  15. 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. PMID:26680285

  16. 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. PMID:26599529

  17. Increasing interpersonal trust through divergent thinking

    PubMed Central

    Sellaro, Roberta; Hommel, Bernhard; de Kwaadsteniet, Erik W.; van de Groep, Suzanne; Colzato, Lorenza S.

    2014-01-01

    Interpersonal trust is an essential ingredient of many social relationships but how stable is it actually, and how is it controlled? There is evidence that the degree of trust into others might be rather volatile and can be affected by manipulations like drawing attention to personal interdependence or independence. Here we investigated whether the degree of interpersonal trust can be biased by inducing either a more integrative or a more focused/exclusive cognitive control mode by means of a creativity task requiring divergent or convergent thinking, respectively. Participants then performed the trust game, which provides an index of interpersonal trust by assessing the money units one participant (the trustor) transfers to another (the trustee). As expected, trustors transferred significantly more money to trustees after engaging in divergent thinking as compared to convergent thinking. This observation provides support for the idea that interpersonal trust is controlled by domain-general (i.e., not socially dedicated) cognitive states. PMID:24936194

  18. 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. PMID:26267958

  19. The clinical director in the NHS: utilizing a role-theory perspective.

    PubMed

    Willcocks, S

    1994-01-01

    Reviews the role of the clinical director in the NHS, based on data collected in a qualitative research study. Utilizes role theory to invite insight into a relatively new but important managerial role. Suggests that effectiveness in the role may be measured by the extent to which managers are able to meet the expectations of their role set, and also that the overall effectiveness of the clinical direction may be the extent to which he or she is able to influence, adapt, modify or change these role expectations. PMID:10161168

  20. Assessing knowledge skills in the NHS: a training needs analysis approach.

    PubMed

    Hamilton, Seona

    2013-06-01

    This feature discusses the use of a training needs analysis exercise carried out by library staff at the NHS Greater Glasgow & Clyde (NHSGGC) Library Network to support the development of a fit for purpose programme of information skills training. A survey was designed based on a well-known information skills competency framework and used to gain an understanding of the knowledge skills needed by staff and how library training could best support these. The survey received a good response rate and led to the successful writing of a training plan for the Library Network for the delivery of information skills training. H.S. PMID:23692458

  1. 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

  2. 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.

  3. 5 CFR 2634.403 - Qualified blind trusts.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 3 2012-01-01 2012-01-01 false Qualified blind trusts. 2634.403 Section... Qualified blind trusts. (a) Definition. A qualified blind trust is a trust in which the filer, his spouse... instrument which establishes a blind trust must adhere substantively to model drafts circulated by the...

  4. 5 CFR 2634.403 - Qualified blind trusts.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 3 2011-01-01 2011-01-01 false Qualified blind trusts. 2634.403 Section... Qualified blind trusts. (a) Definition. A qualified blind trust is a trust in which the filer, his spouse... instrument which establishes a blind trust must adhere substantively to model drafts circulated by the...

  5. 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

  6. 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

  7. Is It a Trust Issue? Factors That Influence Trust for Persons Living With HIV/AIDS.

    PubMed

    Krause, Denise D; May, Warren L

    2016-09-01

    Trust in one's health care provider, trust in the health care system in general, and even trust in one's community affects engagement in HIV-related health care. This article examines the issue of trust among a random sample of HIV-infected individuals residing in Mississippi, an area hard-hit by the HIV/AIDS epidemic. Five constructs based on survey responses from these individuals were developed: (1) trust in one's provider to offer the best possible medical care, (2) trust in one's provider to protect patient privacy, (3) willingness to disclose HIV status to one's provider, (4) trust in the health care system, and (5) trust in one's community. Findings suggest that interventions to improve trust in providers to deliver the highest quality of care should be targeted to young people, African Americans, and the more highly educated. Interventions to increase trust in providers to protect privacy should focus on creating and strengthening social support groups or networks that build relationships and foster trust. Interventions aimed to increase community trust also should be targeted to young people. This information is useful to researchers, policy makers, health care providers, and organizations interested in prioritizing interventions and strategies that have the greatest potential to reduce health disparities in HIV diagnosis and treatment in the Deep South. PMID:27095034

  8. 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…

  9. Fear, Trust, and Negotiating Safety

    PubMed Central

    Epperson, Matthew W.; Platais, Ingrida; Valera, Pamela; Barbieri, Raye; Gilbert, Louisa; El-Bassel, Nabila

    2010-01-01

    Through in-depth interviews, this study examined the relational context of sexual HIV risk for 10 Black women aged 18–30 who were defendants in a community court setting. A qualitative data analysis identified themes of actual and feared intimate partner violence (IPV) and the expectations of demonstrating trust in a relationship as obstacles to negotiating the use of condoms. The findings speak to the broader structural factors and consequences of IPV and drug use. The article discusses the implications for HIV prevention for Black women who are involved in the criminal justice system. PMID:20445827

  10. Cost-effectiveness of Collagen Crosslinking for Progressive Keratoconus in the UK NHS

    PubMed Central

    Salmon, Andrew; Chalk, Daniel; Stein, Ken; Frost, Andrew

    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, which is 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 to standard management at an incremental cost of £3,174 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 to standard management, for the treatment of progressive keratoconus. However, further research to explore its efficacy beyond five years is desirable. PMID:26315704

  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. 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

  13. The medicalisation of health inequalities and the English NHS: the role of resource allocation.

    PubMed

    Asthana, Sheena; Gibson, Alex; Halliday, Joyce

    2013-04-01

    Tackling health inequalities (HI) has become a key policy objective in England in recent years. Yet, despite the wide-ranging policy response of the 1997-2010 Labour Government, socio-economic variations in health continued to widen. In this paper, we seek to explore why. We propose that a meta-narrative has emerged in which the health problems facing England's most deprived areas, and the solution to those problems, have increasingly come to be linked to levels of National Health Service (NHS) funding. This has been, in part, a response to key shortcomings in previous rounds of resource allocation. The very significant sums of money allocated with respect to 'health inequalities' reflects and reinforces the belief that the NHS can and should play a central role in promoting health equity. This medicalisation of HI focuses attention on the role of individual risk factors that lend themselves to medical management, but effectively sidelines the macroprocesses of social inequality, legitimising the kind of society that neo-liberal government has produced in the United Kingdom - one in which health (like other assets) has become a matter of individual and not collective responsibility. PMID:22947257

  14. Current cost of medical negligence in NHS hospitals: analysis of claims database

    PubMed Central

    Fenn, Paul; Diacon, Stephen; Gray, Alastair; Hodges, Ron; Rickman, Neil

    2000-01-01

    Objectives To identify trends in the incidence and cost of clinical negligence claims. To determine the current annual cost to the NHS as a whole in terms of cash paid out to patients and their solicitors and the defence costs incurred. Design Analysis of records on database. Setting A well defined group of hospitals within one health authority which collected information on a consistent basis over many years. Main outcome measures Data on individual claims. Trends in incidence of claims and costs identified independently from organisational reforms and changes in accounting practices. Results The rate of litigation increased from 0.46 to 0.81 closed claims per 1000 finished consultant episodes between 1990 and 1998. Overall expenditure on clinical negligence by the NHS in England in 1998 was estimated at £84 million (95% confidence interval £48 million to £130 million). Conclusions After adjustment for hospital activity, the rate of closed claims increased during the 1990s by about 7% per annum, a substantial rate of growth but not the uncontrolled explosion sometimes alluded to in the wider media. More coordination and openness are needed in data collection. PMID:10845963

  15. On the Efficiency of NHS Ester Cross-Linkers for Stabilizing Integral Membrane Protein Complexes

    NASA Astrophysics Data System (ADS)

    Chen, Fan; Gerber, Sabina; Korkhov, Volodymyr M.; Mireku, Samantha; Bucher, Monika; Locher, Kaspar P.; Zenobi, Renato

    2015-03-01

    We have previously presented a straightforward approach based on high-mass matrix-assisted laser desorption/ionization (MALDI) mass spectrometry (MS) to study membrane proteins. In addition, the stoichiometry of integral membrane protein complexes could be determined by MALDI-MS, following chemical cross-linking via glutaraldehyde. However, glutaraldehyde polymerizes in solution and reacts nonspecifically with various functional groups of proteins, limiting its usefulness for structural studies of protein complexes. Here, we investigated the capability of N-hydroxysuccinimide (NHS) esters, which react much more specifically, to cross-link membrane protein complexes such as PglK and BtuC2D2. We present clear evidence that NHS esters are capable of stabilizing membrane protein complexes in situ, in the presence of detergents such as DDM, C12E8, and LDAO. The stabilization efficiency strongly depends on the membrane protein structure (i.e, the number of primary amine groups and the distances between primary amines). A minimum number of primary amine groups is required, and the distances between primary amines govern whether a cross-linker with a specific spacer arm length is able to bridge two amine groups.

  16. 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.

  17. Chemical cross-linking with NHS esters: a systematic study on amino acid reactivities.

    PubMed

    Mädler, Stefanie; Bich, Claudia; Touboul, David; Zenobi, Renato

    2009-05-01

    Structure elucidation of tertiary or quaternary protein structures by chemical cross-linking and mass spectrometry (MS) has recently gained importance. To locate the cross-linker modification, dedicated software is applied to analyze the mass or tandem mass spectra (MS/MS). Such software requires information on target amino acids to limit the data analysis time. The most commonly used homobifunctional N-hydroxy succinimide (NHS) esters are often described as reactive exclusively towards primary amines, although side reactions with tyrosine and serine have been reported. Our goal was to systematically study the reactivity of NHS esters and derive some general rules for their attack of nucleophilic amino acid side chains in peptides. We therefore studied the cross-linking reactions of synthesized and commercial model peptides with disuccinimidyl suberate (DSS). The first reaction site in all cases was expectedly the alpha-NH(2)-group of the N-terminus or the epsilon-NH(2)-group of lysine. As soon as additional cross-linkers were attached or loops were formed, other amino acids were also involved in the reaction. In addition to the primary amino groups, serine, threonine and tyrosine showed significant reactivity due to the effect of neighboring amino acids by intermediate or permanent Type-1 cross-link formation. The reactivity is highly dependent on the pH and on adjacent amino acids. PMID:19132714

  18. Trust: the sublime duty in health care leadership.

    PubMed

    Piper, Llewellyn E

    2010-01-01

    Trust is the essence of human social existence. From the moment of birth, trust is the basic component in any human relationship and interaction. Trust is the Holy Grail for human confidence in others. From human survival to organizational survival, trust is the primordial bond. No organization is more dependent on trust than health care. This article views trust as the most basic fundamental quality for leadership. Trust is a sublime duty of a leader and the leadership of an organization. Leadership sets the culture of trust. Trust is the one quality that is essential for guiding an organization toward serving others. This article addresses trust from many perspectives. Trust is viewed from our subordinates, our peers, our superiors, and the public we serve. This article postulates how trust in an organization is the sublime duty of leadership that unites all human understanding and without it destroys all human relationships. PMID:20145465

  19. UK doctors and equal opportunities in the NHS: national questionnaire surveys of views on gender, ethnicity and disability

    PubMed Central

    Surman, Geraldine; Goldacre, Michael

    2014-01-01

    Objectives To seek doctors’ views about the NHS as an employer, our surveys about doctors’ career intentions and progression, undertaken between 1999 and 2013, also asked whether the NHS was, in their view, a good ‘equal opportunities’ employer for women doctors, doctors from ethnic minority groups and doctors with disabilities. Design and Setting Surveys undertaken in the UK by mail and Internet. Participants UK medical graduates in selected graduation years between 1993 and 2012. Main outcome measures Respondents were asked to rate their level of agreement with three statements starting ‘The NHS is a good equal opportunities employer for…’ and ending ‘women doctors’, ‘doctors from ethnic minorities’ and ‘doctors with disabilities’. Results Of first-year doctors surveyed in 2013, 3.6% (78/2158) disagreed that the NHS is a good equal opportunities employer for women doctors (1.7% of the men and 4.7% of the women); 2.2% (44/1968) disagreed for doctors from ethnic minorities (0.9% of white doctors and 5.8% of non-white doctors) and 12.6% (175/1387) disagreed for doctors with disabilities. Favourable perceptions of the NHS in these respects improved substantially between 1999 and 2013; among first-year doctors of 2000–2003, combined, the corresponding percentages of disagreement were 23.5% for women doctors, 23.1% for doctors from ethnic minorities and 50.6% for doctors with disabilities. Conclusions Positive views about the NHS as an equal opportunities employer have increased in recent years, but the remaining gap in perception of this between women and men, and between ethnic minority and white doctors, is a concern. PMID:25271275

  20. 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. PMID:17405387

  1. 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.

  2. 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…

  3. 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…

  4. 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…

  5. 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…

  6. 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…

  7. 7 CFR 46.46 - Statutory trust.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... commodities in whatever form, documentary or electronic, for billing or invoicing purposes. (b) Trust assets..., whether in documentary or electronic form, to preserve trust benefits. Alternately, the licensee's invoice... the affected transactions occur. (4) If the invoice or other billing statement is in electronic...

  8. Trusting Transformational Principals: An Empirical Surprise.

    ERIC Educational Resources Information Center

    Mannion, Patrick T.

    This study explored the relationship between transformational leadership and trust in schools. The central thesis is that high levels of trust should significantly correlate with transformational leadership behaviors by school principals. The study involved a sample of 451 teachers in 39 public secondary schools located in four suburban areas…

  9. 26 CFR 301.7701-4 - Trusts.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) PROCEDURE AND ADMINISTRATION PROCEDURE AND ADMINISTRATION Definitions § 301.7701-4 Trusts. (a) Ordinary trusts. In general, the term... the release of substances, preventing future releases of substances, and collecting amounts...

  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. Trust and the Development of Distributed Leadership

    ERIC Educational Resources Information Center

    Smylie, Mark A.; Mayrowetz, David; Murphy, Joseph; Louis, Karen Seashore

    2007-01-01

    This article examines the relationship between trust and the development of distributed leadership. It presents a theoretical argument with supporting evidence from longitudinal fieldwork examining distributed leadership development in comparative cases of two secondary schools. The analysis suggests that trust matters in the design, performance,…

  12. 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…

  13. 76 FR 60757 - Executive Branch Qualified Trusts

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-30

    ... qualified trusts provisions for the executive branch in subparts D and E of 5 CFR part 2634 (see 57 FR 11800.... 12674, 54 FR 15159, 3 CFR, 1989 Comp., p. 215, as modified by E.O. 12731, 55 FR 42547, 3 CFR, 1990 Comp... the use of a qualified blind trust is the lack of knowledge, or actual ``blindness,'' by an...

  14. 43 CFR 2532.2 - Trust patent.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Trust patent. 2532.2 Section 2532.2 Public... OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) INDIAN ALLOTMENTS Allotments § 2532.2 Trust patent... patent will be suspended for a period of 2 years from date of settlement; but in those cases where...

  15. 43 CFR 2532.2 - Trust patent.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Trust patent. 2532.2 Section 2532.2 Public... OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) INDIAN ALLOTMENTS Allotments § 2532.2 Trust patent... patent will be suspended for a period of 2 years from date of settlement; but in those cases where...

  16. 43 CFR 2532.2 - Trust patent.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Trust patent. 2532.2 Section 2532.2 Public... OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) INDIAN ALLOTMENTS Allotments § 2532.2 Trust patent... patent will be suspended for a period of 2 years from date of settlement; but in those cases where...

  17. 43 CFR 2532.2 - Trust patent.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Trust patent. 2532.2 Section 2532.2 Public... OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) INDIAN ALLOTMENTS Allotments § 2532.2 Trust patent... patent will be suspended for a period of 2 years from date of settlement; but in those cases where...

  18. 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…

  19. Trust in prescription drug brand websites: website trust cues, attitude toward the website, and behavioral intentions.

    PubMed

    Huh, Jisu; Shin, Wonsun

    2014-01-01

    Direct-to-consumer (DTC) prescription drug brand websites, as a form of DTC advertising, are receiving increasing attention due to the growing number and importance as an ad and a consumer information source. This study examined consumer trust in a DTC website as an important factor influencing consumers' attitude toward the website and behavioral intention. Applying the conceptual framework of website trust, the particular focus of investigation was the effect of the website trust cue factor on consumers' perceived DTC website trust and subsequent attitudinal and behavioral responses. Results show a significant relation between the website trust cue factor and consumers' perceived DTC website trust. Perceived DTC website trust, in turn, was found to be significantly associated with consumers' attitude toward the DTC website and behavioral intention. PMID:24094133

  20. 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.

  1. The lack of integration of clinical audit and the maintenance of medical dominance within British hospital trusts.

    PubMed

    McErlain-Burns, T L; Thomson, R

    1999-08-01

    Concerns have been expressed repeatedly about the effectiveness of clinical audit. Some have argued that this is limited by the lack of integration within day-to-day practice and with other NHS policy initiatives. We aimed to explore what mechanisms were being used to develop annual clinical audit programmes within NHS Trusts, and to describe the influence of other initiatives on this; to understand how such influences are exerted; and to understand the role of key players, in order to inform future programme development. Semi-structured face-to-face interviews were performed with Chairs of Clinical Audit Committees, Clinical Audit Managers and Co-ordinators (N = 15) in the former Yorkshire Region of the NHS in England. Concerns about the development, planning and integration of clinical audit focused upon an almost exclusive medical dominance and upon how audit leadership could be delivered within the context of hospital management structures. The lack of an overall plan for the development of clinical audit in most sites was seen as enabling the doctors' agenda to dominate. Purchasing authorities were recognized as being important, but often with limited influence. Other influences on the audit agenda, such as research and development (R&D) and clinical risk management, were rarely well co-ordinated. These findings concur with previous studies in identifying a wide range of constraints on the progress of audit. Several of these constraints operate within the internal environment, for example the doctors' agenda, and concerns about management involvement. Such constraints require resolution in order to facilitate the integration of audit with other initiatives and to achieve the goals of audit effectively. Clinical effectiveness and clinical governance may offer a means of facilitating this integration. PMID:10461584

  2. Trust method for multi-agent consensus

    NASA Astrophysics Data System (ADS)

    Mikulski, Dariusz G.; Lewis, Frank L.; Gu, Edward Y.; Hudas, Greg R.

    2012-06-01

    The consensus problem in multi-agent systems often assumes that all agents are equally trustworthy to seek agreement. But for multi-agent military applications - particularly those that deal with sensor fusion or multi-robot formation control - this assumption may create the potential for compromised network security or poor cooperative performance. As such, we present a trust-based solution for the discrete-time multi-agent consensus problem and prove its asymptotic convergence in strongly connected digraphs. The novelty of the paper is a new trust algorithm called RoboTrust, which is used to calculate trustworthiness in agents using observations and statistical inferences from various historical perspectives. The performance of RoboTrust is evaluated within the trust-based consensus protocol under different conditions of tolerance and confirmation.

  3. Wolves and Big Yellow Taxis: How Would Be Know If the NHS Is at Death's Door?: Comment on "Who killed the English National Health Service?".

    PubMed

    Greener, Ian

    2015-10-01

    Martin Powell suggests that the death of the English National Health Service (NHS) has been announced so many times we are at risk of not noticing should it actually happen. He is right. If we 'cry wolf' too many times, we risk losing sight of what is important about the NHS and why. PMID:26673181

  4. 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…

  5. Gillick reinstated: judging mid-childhood competence in healthcare law: an NHS Trust v ABC & A Local Authority [2014] EWHC 1445 (Fam).

    PubMed

    Moreton, Kirsty L

    2015-01-01

    This case commentary discusses a recent case concerning the competence of a 13-year-old girl to consent to the termination of her pregnancy. It critically analyses four specific elements of the judgment--Gillick competence, the impact of best interests, judicial deference to medical opinion, and individualism and the construction of undue influence. It concludes by commending the approach taken by the court as a reinstatement of the law as originally intended in Gillick but is nonetheless cautious as to its likely overall effect upon child decision-making. PMID:25425326

  6. 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. PMID:25488707

  7. 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

  8. Maintaining standards of aesthetic practice in trainees subject to NHS restrictions.

    PubMed

    Paterson, P; Allison, K

    2006-01-01

    The Specialist Advisory Committee (SAC) in plastic surgery within the United Kingdom (UK) recommends a modular training programme to include aesthetic surgery. The intercollegiate board examinations test candidates on all aspects of aesthetic practice yet there is no formal, national aesthetic training in the UK. Closure of National Health Service (NHS) private patient facilities has reduced training opportunity [Nicolle FV. Sir Harold Gillies Memorial Lecture; Aesthetic plastic surgery and the future plastic surgeon. Br J Plast Surg 1998;51:419-24.] Calmanisation [Hospital doctors: training for the future. The Report of the Working Group on Specialist Medical Training (The Calman Report). London: HMSO; 1993.], the European Working Time Directive (EWTD) [; Phillips H, Fleet Z, Bowman K. The European Working time Directive-interim report and guidance from The Royal College of Surgeons of England working party chaired by Mr Hugh Phillips; 2003 []; Chesser S, Bowman K, Phillips H. The European Working Time Directive and the training of surgeons. BMJ Careers Focus 2002;s69-7.], and more importantly the implementation of "local" aesthetic guidelines have placed further pressures on training. Reductions of NHS case mix will ultimately lead to a reduction in trainee experience. With increasing regulatory pressure from the Commission for Healthcare Improvement, standards of aesthetic practice can only be maintained by increasing private/independent sector involvement. At present a disparity exists between the demand and provision of aesthetic surgery training in the UK. Aesthetic surgery forms part of the training curriculum for plastic surgery and as such remains a training issue. A review of aesthetic surgery training is needed in the UK through consultation with trainers and trainee representatives. PMID:16876084

  9. Method of invitation and geographical proximity as predictors of NHS Health Check uptake

    PubMed Central

    Gidlow, Christopher; Ellis, Naomi; Randall, Jason; Cowap, Lisa; Smith, Graham; Iqbal, Zafar; Kumar, Jagdish

    2015-01-01

    Background Uptake of NHS Health Checks remains below the national target. Better understanding of predictors of uptake can inform targeting and delivery. We explored invitation method and geographical proximity as predictors of uptake in deprived urban communities. Methods This observational cohort study used data from all 4855 individuals invited for an NHS Health Check (September 2010–February 2014) at five general practices in Stoke-on-Trent, UK. Attendance/non-attendance was the binary outcome variable. Predictor variables included the method of invitation, general practice, demographics, deprivation and distance to Health Check location. Results Mean attendance (61.6%) was above the city and national average, but varied by practice (47.5–83.3%; P < 0.001). Telephone/verbal invitations were associated with higher uptake than postal invitations (OR = 2.87, 95% CI = 2.26–3.64), yet significant practice-level variation remained. Distance to Health Check was not associated with attendance. Increasing age (OR = 1.04, 95% CI = 1.03–1.04), female gender (OR = 1.48, 95% CI = 1.30–1.68) and living in the least deprived areas (OR = 1.59, 95% CI = 1.23–2.05) were all independent positive predictors of attendance. Conclusions Using verbal or telephone invitations should be considered to improve Health Check uptake. Other differences in recruitment and delivery that might explain remaining practice-level variation in uptake warrant further exploration. Geographical proximity may not be an important predictor of uptake in urban populations. PMID:25427882

  10. Trust and cooperation: a new experimental approach.

    PubMed

    Acedo, Cristina; Gomila, Antoni

    2013-09-01

    Several theories within different disciplines emphasize the role of trust in fostering cooperation in human social life. Despite differences, the core of these notions of trust is affectively motivated loyalty, which makes the individuals feel mutually committed and willing to accept vulnerability because of positive expectations about each other's behavior. In evolutionary game theory and experimental economics, the notion of trust is much simpler: it is an expectation about another's behavior, a kind of wager, in which the sense of mutual commitment and vulnerability is completely absent. In order to extend the paradigm of trust games typical in those fields to explore the fuller sense of trust relationships, we have developed a new experimental design, in which an iterated prisoner dilemma is played by participants who do or do not hold a trusting personal relationship, while anonymity is preserved. We present here the results of our two pilot studies, which indicate the relevance of personal trust in fostering cooperation and suggest the influence of the structure of social networks on the degree of cooperation achieved. PMID:25708082

  11. 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

  12. 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:…

  13. Healthcare identities at the crossroads of service modernisation: the transfer of NHS clinicians to the independent sector?

    PubMed

    Waring, Justin; Bishop, Simon

    2011-07-01

    Health policies increasingly support private businesses to take an active role in the organisation and delivery of public healthcare services. For the English NHS, this is exemplified by the introduction of Independent Sector Treatment Centres. A number of these facilities involve the wholesale secondment of NHS clinicians to the private sector which, we suggest, raises important questions about the identities of healthcare professionals accustomed to working in the public sector. Our paper investigates this transition highlighting three prominent discontinuities in clinical work: the ethos of private sector ownership, new lines of authority and fragmented relationships. Drawing on Giddens, we examine how clinicians experience and interpret these changes and how they keep their biographical 'narrative going'. The 'pioneers' interpreted the independent sector as an opportunity to re-invigorate their practice through new roles, relationships and higher quality care; the 'guardians' as an opportunity to replicate and protect the customs and standards of the NHS in the private sector; whilst the 'marooned' longed to return to the NHS. Our study illustrates how the sectoral context can shape healthcare identities, and how contemporary reforms aimed at promoting partnerships across public and private sectors can have profound implications for clinicians. PMID:21314688

  14. 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. PMID:15899535

  15. Leadership development in UK companies at the beginning of the twenty-first century: lessons for the NHS?

    PubMed

    Alimo-Metcalfe, B; Lawler, J

    2001-01-01

    States that the development of leadership in the NHS is currently high on the agenda of the Department of Health, the government and local health sector organisations. Reports the findings of a study of public and private sector organisations, exploring the development of their in-house leadership skills. Outlines the findings in depth and discusses the implications for health organisations. PMID:11765321

  16. A systematic analysis of DMTMM vs EDC/NHS for ligation of amines to hyaluronan in water.

    PubMed

    D'Este, Matteo; Eglin, David; Alini, Mauro

    2014-08-01

    The activation of carboxyl groups with N-(3-dimethylaminopropyl)-N'-ethylcarbodiimide hydrochloride and N-hydroxysuccinimide (EDC/NHS) for amide formation is the standard method for amine ligation to hyaluronan (HA), and a very well established wide-ranging bioconjugation method. In this paper we compare 4-(4,6-dimethoxy-1,3,5-triazin-2-yl)-4-methylmorpholinium chloride (DMTMM) to EDC/NHS activation chemistry for HA ligation using an array of substrates including small, large and functional molecules. For all the substrates tested DMTMM yields were superior at parity of feed ratio. DMTMM chemistry resulted effective also in absence of pH control, which is essential for EDC/NHS conjugation. Overall our results demonstrate that DMTMM is more efficient than EDC/NHS for ligation of amines to HA and does not require accurate pH control or pH shift during the reaction to be effective. DMTMM-mediated ligation is a new promising chemical tool to synthesize HA derivatives for biomedical and pharmaceutical applications. PMID:24751270

  17. Corneal Stromal Cell Growth on Gelatin/Chondroitin Sulfate Scaffolds Modified at Different NHS/EDC Molar Ratios

    PubMed Central

    Lai, Jui-Yang

    2013-01-01

    A nanoscale modification strategy that can incorporate chondroitin sulfate (CS) into the cross-linked porous gelatin materials has previously been proposed to give superior performance for designed corneal keratocyte scaffolds. The purpose of this work was to further investigate the influence of carbodiimide chemistry on the characteristics and biofunctionalities of gelatin/CS scaffolds treated with varying N-hydroxysuccinimide (NHS)/1-ethyl-3-(3-dimethyl aminopropyl) carbodiimide hydrochloride (EDC) molar ratios (0–1) at a constant EDC concentration of 10 mM. Results of Fourier transform infrared spectroscopy and dimethylmethylene blue assays consistently indicated that when the NHS to EDC molar ratio exceeds a critical level (i.e., 0.5), the efficiency of carbodiimide-mediated biomaterial modification is significantly reduced. With the optimum NHS/EDC molar ratio of 0.5, chemical treatment could achieve relatively high CS content in the gelatin scaffolds, thereby enhancing the water content, glucose permeation, and fibronectin adsorption. Live/Dead assays and interleukin-6 mRNA expression analyses demonstrated that all the test samples have good cytocompatibility without causing toxicity and inflammation. In the molar ratio range of NHS to EDC from 0 to 0.5, the cell adhesion ratio and proliferation activity on the chemically modified samples significantly increased, which is attributed to the increasing CS content. Additionally, the materials with highest CS content (0.143 ± 0.007 nmol/10 mg scaffold) showed the greatest stimulatory effect on the biosynthetic activity of cultivated keratocytes. These findings suggest that a positive correlation is noticed between the NHS to EDC molar ratio and the CS content in the biopolymer matrices, thereby greatly affecting the corneal stromal cell growth. PMID:23337203

  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. 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. PMID:26421343

  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. 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)

  2. Trust Building via Risk Taking: A Cross-Societal Experiment

    ERIC Educational Resources Information Center

    Cook, Karen S.; Yamagishi, Toshio; Cheshire, Coye; Cooper, Robin; Matsuda, Masafumi; Mashima, Rie

    2005-01-01

    The role of risk taking in building trust relations has largely been overlooked in the burgeoning literature on trust in the social sciences; yet it is central to understanding how trust develops. We argue that a series of risk-taking behaviors is indispensable to building a trust relation. We conducted experiments in Japan and the United States…

  3. 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…

  4. Principal Leadership: Building Trust to Support School Improvement

    ERIC Educational Resources Information Center

    Hallam, Pamela; Mathews, Joseph L.

    2008-01-01

    To develop trust, leaders must understand the determinants of a trusting organization. This study examined how an elementary school principal, new to a school that had been designated "in need of improvement," reacted to this status and worked to develop trust in a climate of low trust and increasing public accountability. Hoy and Tschannen-Moran…

  5. Collective Trust: Why Schools Can't Improve without It

    ERIC Educational Resources Information Center

    Forsyth, Patrick B.; Adams, Curt M.; Hoy, Wayne K.

    2011-01-01

    The culmination of nearly three decades of research, "Collective Trust" offers new insight and practical knowledge on the social construction of trust for school improvement. The authors argue that "collective trust" is not merely an average trust score for a group, but rather an independent concept with distinctive origins and consequences. The…

  6. An Investigation of Teacher Trust in the Principal

    ERIC Educational Resources Information Center

    Makiewicz, Monica Kathleen

    2011-01-01

    The purpose of this work was to understand the concept of trust, its meaning, antecedents, and outcomes as they applied to teacher trust in principals. Since there are very few in-depth studies specifically on trust in a school principal, research on trust from an organizational perspective was consulted. This body of research has numerous and…

  7. 12 CFR 330.10 - Revocable trust accounts.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... are commonly referred to as living trusts or family trusts. (Example 1: Account Owner “A” has a living... beneficiary in more than one revocable trust account, whether it be a payable-on-death account or living trust account, does not increase the total coverage amount.) (Example 3: Account Owner “A” establishes a...

  8. 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...

  9. 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...

  10. 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...

  11. 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…

  12. The work of commissioning: a multisite case study of healthcare commissioning in England's NHS

    PubMed Central

    Shaw, Sara E; Smith, Judith A; Porter, Alison; Rosen, Rebecca; Mays, Nicholas

    2013-01-01

    Objective To examine the work of commissioning care for people with long-term conditions and the factors inhibiting or facilitating commissioners making service change. Design Multisite mixed methods case study research, combining qualitative analysis of interviews, documents and observation of meetings. Participants Primary care trust managers and clinicians, general practice-based commissioners, National Health Service trust and foundation trust senior managers and clinicians, voluntary sector and local government representatives. Setting Three ‘commissioning communities’ (areas covered by a primary care trust) in England, 2010–2012. Results Commissioning services for people with long-term conditions was a long drawn-out process involving a range of activities and partners. Only some of the activities undertaken by commissioners, such as assessment of local health needs, coordination of healthcare planning and service specification, appeared in the official ‘commissioning cycle’ promoted by the Department of Health. Commissioners undertook a significant range of additional activities focused on reviewing and redesigning services and providing support for implementation of new services. These activities often involved partnership working with providers and other stakeholders and appeared to be largely divorced from contracting and financial negotiations. At least for long-term condition services, the time and effort involved in such work appeared to be disproportionate to the anticipated or likely service gains. Commissioners adopting an incremental approach to service change in defined and manageable areas of work appeared to be more successful in terms of delivering planned changes in service delivery than those attempting to bring about wide-scale change across complex systems. Conclusions Commissioning for long-term condition services challenges the conventional distinction between commissioners and providers with a significant amount of work focused

  13. Online health information - what can you trust?

    MedlinePlus

    ... detective work, you can find information you can trust. Search for websites of well-known health institutions. Medical schools, professional health organizations, and hospitals often provide online health content. Look ...

  14. 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. PMID:18361127

  15. Estate Planning: The Role of Trust Funds.

    ERIC Educational Resources Information Center

    Neidermeyer, Ellen; Neidermeyer, Adolph

    1985-01-01

    The authors present estate planning suggestions that address concerns about lifetime care for the disabled children of aging parents. Aspects covered include disinheriting children, trust funds, and medical and legal assistance and food stamps. (CL)

  16. 26 CFR 1.401(a)-50 - Puerto Rican trusts; election to be treated as a domestic trust.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 5 2010-04-01 2010-04-01 false Puerto Rican trusts; election to be treated as a... Plans, Etc. § 1.401(a)-50 Puerto Rican trusts; election to be treated as a domestic trust. (a) In... have made the election referred to in section 1022(i)(2) are to be treated as trusts created...

  17. 43 CFR 30.180 - May I give up an inherited interest in trust or restricted property or trust personalty?

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 43 Public Lands: Interior 1 2014-10-01 2014-10-01 false May I give up an inherited interest in trust or restricted property or trust personalty? 30.180 Section 30.180 Public Lands: Interior Office of... I give up an inherited interest in trust or restricted property or trust personalty? You...

  18. 43 CFR 30.180 - May I give up an inherited interest in trust or restricted property or trust personalty?

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 43 Public Lands: Interior 1 2013-10-01 2013-10-01 false May I give up an inherited interest in trust or restricted property or trust personalty? 30.180 Section 30.180 Public Lands: Interior Office of... I give up an inherited interest in trust or restricted property or trust personalty? You...

  19. 43 CFR 30.180 - May I give up an inherited interest in trust or restricted property or trust personalty?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false May I give up an inherited interest in trust or restricted property or trust personalty? 30.180 Section 30.180 Public Lands: Interior Office of... I give up an inherited interest in trust or restricted property or trust personalty? You...

  20. 43 CFR 30.180 - May I give up an inherited interest in trust or restricted property or trust personalty?

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 43 Public Lands: Interior 1 2012-10-01 2011-10-01 true May I give up an inherited interest in trust or restricted property or trust personalty? 30.180 Section 30.180 Public Lands: Interior Office of... I give up an inherited interest in trust or restricted property or trust personalty? You...

  1. 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…

  2. 25 CFR 115.813 - Is there a limit to the amount of trust funds OTFM will disburse from a tribal trust account?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... Investing and Managing Tribal Trust Funds § 115.813 Is there a limit to the amount of trust funds OTFM will... a tribal trust account. If a tribe's trust funds are invested in securities that have not...

  3. 25 CFR 115.813 - Is there a limit to the amount of trust funds OTFM will disburse from a tribal trust account?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... Investing and Managing Tribal Trust Funds § 115.813 Is there a limit to the amount of trust funds OTFM will... a tribal trust account. If a tribe's trust funds are invested in securities that have not...

  4. 25 CFR 115.813 - Is there a limit to the amount of trust funds OTFM will disburse from a tribal trust account?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Investing and Managing Tribal Trust Funds § 115.813 Is there a limit to the amount of trust funds OTFM will... a tribal trust account. If a tribe's trust funds are invested in securities that have not...

  5. 25 CFR 115.813 - Is there a limit to the amount of trust funds OTFM will disburse from a tribal trust account?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... Investing and Managing Tribal Trust Funds § 115.813 Is there a limit to the amount of trust funds OTFM will... a tribal trust account. If a tribe's trust funds are invested in securities that have not...

  6. 25 CFR 115.813 - Is there a limit to the amount of trust funds OTFM will disburse from a tribal trust account?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... Investing and Managing Tribal Trust Funds § 115.813 Is there a limit to the amount of trust funds OTFM will... a tribal trust account. If a tribe's trust funds are invested in securities that have not...

  7. [Trust and conflicts in care, legal elements].

    PubMed

    Decroix, Germain

    2013-10-01

    Trust is essential in all forms of medical care. It first appears when the patient chooses the professional, then when the latter suggests a treatment. This medical contract can be broken by both parties, if this trust disappears. The ultimate situation is the occurrence of complications, which can lead to a real distrust of the professional with a complaint made against him or her. PMID:24245040

  8. 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

  9. Establishing trust in decentralized smart sensor networks

    NASA Astrophysics Data System (ADS)

    Vagts, H.; Cosar, T.; Beyerer, J.

    2011-06-01

    Smart sensors can gather all kind of information and process it. Cameras are still dominating and smart cameras can offer services for face recognition or person tracking. Operators are building collaborations to cover a larger area, to save costs and to add more and different sensors. Cryptographic methods may achieve integrity and confidentiality between operators, but not trust. Even if a partner or one of his sensors is authenticated, no statements can be made about the quality of the sensor data. Hence, trust must be established between the partners and their sensors. Trust can be built based on past experience. A reputation system collects opinions of operators about the behavior of sensors and calculates trust based on these opinions. Many reputation systems have been proposed, e.g., for authentication of files in peer-topeer networks. This work presents a new reputation system, which is designed to calculate the trustworthiness of smart sensors and smart sensor systems. A new trust model, including functions to calculate and update trust on past experiences, is proposed. When fusing information of multiple sensors, it cannot always be reconstructed, which information led to a bad result. Hence, an approach for fair rating is shown. The proposed system has been realized in a Service-Oriented Architecture for easy integration in existing smart sensor systems, e.g., smart surveillance systems. The model itself can be used in every decentralized heterogeneous smart sensor network.

  10. A proposed instrument for the assessment of job satisfaction in Greek mental NHS hospitals.

    PubMed

    Labiris, Georgios; Gitona, Kleoniki; Drosou, Vasiliki; Niakas, Dimitrios

    2008-08-01

    Since its introduction in 1983, the Greek NHS is under an almost constant reform, aiming improvement on the efficiency and the quality of provided services. The national program of psychiatric reform "Psychargos" introduced new models of therapeutic approach to the care of the mentally ill, that required expansion of the existing roles and development of new roles of the healthcare staff. Consequently, the efficient management of the healthcare workforce in Greek mental facilities was identified as a primary determinant of the successful implementation of the program. Primary objective of this study was the development of a research framework for the assessment of job satisfaction in Greek Mental Health Hospitals. Among the objectives was the evaluation of the capacity of the underlying motivators and hygiene factors and the identification of potential correlations of the global job satisfaction and the motivation and retention factors with the demographic, social and occupational characteristics of the employees. A custom questionnaire was developed, based on Herzberg two-factor theory, after a systematic review of the relevant literature. The instrument was constructed by two parts and 37 items. Ten items addressed the sociodemographic characteristics of the subjects, while the remaining 27 items were distributed in 11 subscales which addressed the global satisfaction index and the "retention" and the "motivation" variables. The instrument was validated by means of the Cronbach alpha for each subscale and by confirmatory factor analysis. The study was conducted at the Public Mental Hospital of Chania (PMHC). From the 300 employees of the PMHC, 133 subjects successfully responded to the questionnaire (response rate, 44.3%). In accordance to former surveys, subjects presented average scores in the global satisfaction index (GSI). The professional category of the employee was identified as the primary determinant of the GSI. Nurses presented statistically

  11. 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. PMID:26669793

  12. 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…

  13. Foundation trusts. Bradford: how the trust and the regulator finally fell out.

    PubMed

    Mooney, Helen

    2005-02-10

    Foundation regulator Bill Moyes gradually lost confidence in recovery plans put forward by Bradford Teaching Hospitals trust in a series of meetings last November and December. Papers released under the Freedom of Information Act show it accused the trust of not taking 'timely or appropriate action' to resolve the crisis, and not settling disputes with local PCTs. PMID:15736590

  14. 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…

  15. Relational Trust and Knowledge Sharing: An Investigation of Principal Trust and School Social Networks

    ERIC Educational Resources Information Center

    Liou, Yi-Hwa

    2010-01-01

    Trust among teachers is an important aspect of the capacity for reform in schools. In previous research, trust has traditionally been considered as a monolithic variable that characterizes this special element as a relationship across a school (Bryk & Schneider, 2002, 2003; Goddard, 2003; Kochanek, 2005). However, this study proposes that the…

  16. The Cognitive Basis of Trust. The Relation between Education, Cognitive Ability, and Generalized and Political Trust

    ERIC Educational Resources Information Center

    Hooghe, Marc; Marien, Sofie; de Vroome, Thomas

    2012-01-01

    Previous research has established convincingly that there is a strong positive relation between educational attainment and trust. There is less agreement however, about the precise determinants of this relation. In this article, we assess how education is related to generalized and political trust, controlling for cognitive ability and…

  17. 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…

  18. Acute Bronchitis

    MedlinePlus

    ... or though physical contact (for example, on unwashed hands). Being exposed to tobacco smoke, air pollution, dusts, vapors, and fumes can also cause acute bronchitis. Less often, bacteria can also cause acute bronchitis. To diagnose acute ...

  19. Cystitis - acute

    MedlinePlus

    Uncomplicated urinary tract infection; UTI - acute; Acute bladder infection; Acute bacterial cystitis ... control. Menopause also increases the risk for a urinary tract infection. The following also increase your chances of having ...

  20. Chimpanzees trust conspecifics to engage in low-cost reciprocity

    PubMed Central

    Engelmann, Jan M.; Herrmann, Esther; Tomasello, Michael

    2015-01-01

    Many of humans' most important social interactions rely on trust, including most notably among strangers. But little is known about the evolutionary roots of human trust. We presented chimpanzees (Pan troglodytes) with a modified version of the human trust game—trust in reciprocity—in which subjects could opt either to obtain a small but safe reward on their own or else to send a larger reward to a partner and trust her to reciprocate a part of the reward that she could not access herself. In a series of three studies, we found strong evidence that in interacting with a conspecific, chimpanzees show spontaneous trust in a novel context; flexibly adjust their level of trust to the trustworthiness of their partner and develop patterns of trusting reciprocity over time. At least in some contexts then, trust in reciprocity is not unique to humans, but rather has its evolutionary roots in the social interactions of humans' closest primate relatives. PMID:25589606

  1. 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. PMID:26511424

  2. Treatments of low-priority and the Patient Mobility Directive 2011, an end to legal uncertainty for the English NHS?

    PubMed

    Sheppard, Maria K

    2013-06-01

    The patient mobility case law of the Court of Justice of the European Union created legal uncertainty for the healthcare systems of EU Member States. The Patient Mobility Directive setting out patients' cross-border rights was adopted to end this uncertainty. With the Directive to be transposed into national law by October 2013 this article discusses whether the Directive achieves this objective for the English NHS. It contrasts the legal position of the NHS patient under case law and under the Directive regarding the need for prior authorisation of cross-border treatment, the level of reimbursement and the ambit of the healthcare benefits basket. It is argued that the risk of legal challenge may persist under the Directive, specifically regarding treatments which are classified by health authorities as low priority, namely treatments which are either not 'generally' available or only available subject to certain clinical criteria or access thresholds. PMID:23984495

  3. 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. PMID:22942683

  4. Mentally abnormal prisoners on remand: I—Rejected or accepted by the NHS?

    PubMed Central

    Coid, Jeremy W

    1988-01-01

    Increasing numbers of mentally abnormal offenders are sentenced to prison. The decision to treat or imprison them is influenced by the attitudes of consultant psychiatrists and their staff. The process whereby those decisions were made and the willingness of consultants to offer treatment were investigated. A retrospective survey of all (362) mentally abnormal men remanded to Winchester prison for psychiatric reports over the five years 1979-83 showed that one in five were rejected for treatment by the NHS consultant psychiatrist responsible for their care. Those with mental handicaps, organic brain damage, or a chronic psychotic illness rendering them unable to cope independently in the community were the most likely to be rejected. They posed the least threat to the community in terms of their criminal behaviour yet were more likely to be sentenced to imprisonment. Such subjects were commonly described by consultants as too disturbed or potentially dangerous to be admitted to hospital or as criminals and unsuitable for treatment. Consultants in mental hospitals were most likely and those in district general hospitals and academic units least likely to accept prisoners. The fact that many mentally ill and mentally handicapped patients can receive adequate care and treatment only on reception into prison raises serious questions about the adequacy of current management policies and the range of facilities provided by regional health authorities. PMID:3136837

  5. Creating a patient-led NHS: some ethical and epistemological challenges

    PubMed Central

    2012-01-01

    This article responds to the Coalition government's recent Open Public Services White Paper and to proposals which call for the creation of a ‘patient-led NHS’ which will, wherever possible, seek to give patients direct control over the services they receive, through a greater degree of choice and participation. Its central contention is that affording patients greater influence over the consultation and commissioning processes will require the NHS to accommodate and respond to the beliefs, values and agendas of patients, as well as those of medical professionals and policy makers. Since it cannot be assumed that professionals and patients will share the same beliefs, values and agendas, the creation of a system of patient-led services has the potential to bring disagreement between professionals and patients to a head, particularly within the consultation and commissioning processes. Thus, a set of complex epistemic and ethical challenges accompanies the proposed creation of a ‘patient-led NHS’, greater awareness of which will be necessary for the successful implementation of such reforms. PMID:26265952

  6. 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. PMID:19094421

  7. Environmental aspects of health care in the Grampian NHS region and the place of telehealth

    PubMed Central

    Wootton, Richard; Tait, Alex; Croft, Amanda

    2010-01-01

    Detailed information about the composition of the carbon footprint of the NHS in the Grampian health region, and in Scotland generally, is not available at present. Based on the limited information available, our best guess is that travel emissions in Grampian are substantial, perhaps 49,000 tonnes CO2 per year. This is equivalent to 233 million km of car travel per year. A well-established telemedicine network in the Grampian region, which saves over 2000 patient journeys a year from community hospitals, avoids about 260,000 km travel per year, or about 59 tonnes CO2 per year. Therefore using telehealth as it has been used historically (primarily to facilitate hospital-to-hospital interactions) seems unlikely to have a major environmental impact – although of course there may be other good reasons for persevering with conventional telehealth. On the other hand, telehealth might be useful in reducing staff travel and to a lesser extent, visitor travel. It looks particularly promising for reducing outpatient travel, where substantial carbon savings might be made by reconfiguring the way that certain services are provided. PMID:20511579

  8. Environmental aspects of health care in the Grampian NHS region and the place of telehealth.

    PubMed

    Wootton, Richard; Tait, Alex; Croft, Amanda

    2010-01-01

    Detailed information about the composition of the carbon footprint of the NHS in the Grampian health region, and in Scotland generally, is not available at present. Based on the limited information available, our best guess is that travel emissions in Grampian are substantial, perhaps 49,000 tonnes CO(2) per year. This is equivalent to 233 million km of car travel per year. A well-established telemedicine network in the Grampian region, which saves over 2000 patient journeys a year from community hospitals, avoids about 260,000 km travel per year, or about 59 tonnes CO(2) per year. Therefore using telehealth as it has been used historically (primarily to facilitate hospital-to-hospital interactions) seems unlikely to have a major environmental impact--although of course there may be other good reasons for persevering with conventional telehealth. On the other hand, telehealth might be useful in reducing staff travel and to a lesser extent, visitor travel. It looks particularly promising for reducing outpatient travel, where substantial carbon savings might be made by reconfiguring the way that certain services are provided. PMID:20511579

  9. 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

  10. 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. PMID:22167516

  11. Trust dynamics in multi-agent coalition formation

    NASA Astrophysics Data System (ADS)

    Mikulski, Dariusz G.; Lewis, Frank L.; Gu, Edward Y.; Hudas, Greg R.

    2011-05-01

    We present a rigorous treatment of coalition formation based on trust interactions in multi-agent systems. Current literature on trust in multi-agent systems primarily deals with trust models and protocols of interaction in noncooperative scenarios. Here, we use cooperative game theory as the underlying mathematical framework to study the trust dynamics between agents as a result of their trust synergy and trust liability in cooperative coalitions. We rigorously justify the behaviors of agents for different classes of games, and discuss ways to exploit the formal properties of these games for specific applications, such as unmanned cooperative control.

  12. 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

  13. 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. PMID:26438869

  14. Gas-Phase Intramolecular Protein Crosslinking via Ion/Ion Reactions: Ubiquitin and a Homobifunctional sulfo-NHS Ester

    PubMed Central

    Webb, Ian K.; Mentinova, Marija; McGee, William M.; McLuckey, Scott A.

    2013-01-01

    Gas-phase intra-molecular crosslinking of protein ubiquitin cations has been demonstrated via ion/ion reactions with anions of a homobifunctional N-hydroxysulfosuccinimide (sulfo-NHS) ester reagent. The ion/ion reaction between multiply-protonated ubiquitin and crosslinker monoanions produces a stable, charge reduced complex. Covalent crosslinking is indicated by the consecutive loss of two molecules of sulfo-NHS under ion trap collisional activation conditions. Covalent modification is verified by the presence of covalently crosslinked sequence ions produced by ion-trap collision-induced dissociation of the ion generated from the losses of sulfo-NHS. Analysis of the crosslinked sequence fragments allows for the localization of crosslinked primary amines, enabling proximity mapping of the gas-phase 3-D structures. The presence of two unprotonated reactive sites within the distance constraint of the crosslinker is required for successful crosslinking. The ability to covalently crosslink is therefore sensitive to protein charge state. As the charge state increases, fewer reactive sites are available and protein structure is more likely to become extended due to intramolecular electrostatic repulsion. At high charge states, the reagent shows little evidence for covalent crosslinking but does show evidence for ‘electrostatic crosslinking’ in that the binding of the sulfonate groups to the protein is sufficiently strong that backbone cleavages are favored over reagent detachment under ion trap collisional activation conditions. PMID:23463545

  15. Gas-phase intramolecular protein crosslinking via ion/ion reactions: ubiquitin and a homobifunctional sulfo-NHS ester.

    PubMed

    Webb, Ian K; Mentinova, Marija; McGee, William M; McLuckey, Scott A

    2013-05-01

    Gas-phase intra-molecular crosslinking of protein ubiquitin cations has been demonstrated via ion/ion reactions with anions of a homobifunctional N-hydroxysulfosuccinimide (sulfo-NHS) ester reagent. The ion/ion reaction between multiply-protonated ubiquitin and crosslinker monoanions produces a stable, charge-reduced complex. Covalent crosslinking is indicated by the consecutive loss of 2 molecules of sulfo-NHS under ion trap collisional activation conditions. Covalent modification is verified by the presence of covalently crosslinked sequence ions produced by ion-trap collision-induced dissociation of the ion generated from the losses of sulfo-NHS. Analysis of the crosslinked sequence fragments allows for the localization of crosslinked primary amines, enabling proximity mapping of the gas-phase 3-D structures. The presence of two unprotonated reactive sites within the distance constraint of the crosslinker is required for successful crosslinking. The ability to covalently crosslink is, therefore, sensitive to protein charge state. As the charge state increases, fewer reactive sites are available and protein structure is more likely to become extended because of intramolecular electrostatic repulsion. At high charge states, the reagent shows little evidence for covalent crosslinking but does show evidence for 'electrostatic crosslinking' in that the binding of the sulfonate groups to the protein is sufficiently strong that backbone cleavages are favored over reagent detachment under ion trap collisional activation conditions. PMID:23463545

  16. Controlling coupling reaction of EDC and NHS for preparation of collagen gels using ethanol/water co-solvents.

    PubMed

    Nam, Kwangwoo; Kimura, Tsuyoshi; Kishida, Akio

    2008-01-01

    To control the crosslinking rate of the collagen gel, ethanol/water co-solvent was adopted for the reaction solvent for the collagen microfibril crosslinking. Collagen gel was prepared by using EDC and NHS as coupling agents. Ethanol did not denaturate the helical structure of the collagen and prevented the hydrolysis of EDC, but showed the protonation of carboxylate anions. In order to control the intra- and interhelical crosslink of the collagen triple helix, variations of the mole ratio of carboxyl group/EDC/NHS, and of the ethanol mole concentration were investigated. Increase in the EDC ratio against the carboxyl group increased the crosslinking rate. Furthermore, an increase in the ethanol mole concentration resulted in an increase of the crosslinking rate until ethanol mole concentration was 0.12, but showed gradual decrease as the ethanol mole concentration was further increased. This is because the adsorption of solvent by the collagen gel, protonation of carboxylate anion, and hydrolysis of EDC is at its most optimum condition for the coupling reaction when the ethanol mole concentration is 0.12. The re-crosslinking of the collagen gel showed an increase in the crosslinking rate, but did not show further increase when the coupling reaction was executed for the third time. This implied that the highest possible crosslinking rate for the intra- and interhelical is approximately 60% when EDC/NHS is used. PMID:18023082

  17. Who Adolescents Trust May Impact Their Health: Findings from Baltimore.

    PubMed

    Mmari, Kristin; Marshall, Beth; Lantos, Hannah; Blum, Robert Wm

    2016-06-01

    This study is one of the first to explore the relevance of trust to the health of adolescents living in a disadvantaged urban setting. The primary objectives were to determine the differences in the sociodemographic characteristics between adolescents who do and do not trust and to examine the associations between trust and health. Data were drawn from the Well-Being of Adolescents in Vulnerable Environments (WAVE) study, which is a cross-sectional global study of adolescents in very low-income urban settings conducted in 2011-2013. This paper focused on 446 adolescents in Baltimore as it was the primary site where trust was explicitly measured. For the main analyses, six health outcomes were examined: (1) self-rated health; (2) violence victimization; (3) binge drinking; (4) marijuana use; (5) post-traumatic stress disorder (PTSD); and (6) condom use at last sex. Independent variables included sociodemographic variables (age, gender, current school enrolment, perceived relative wealth, and family structure) and two dimensions of trust: community trust (trust in individuals/groups within neighborhood) and institutional trust (trust in authorities). The results show that more than half the sample had no trust in police, and a high proportion had no trust in other types of authority. Among girls, those with higher levels of community trust were less likely to be victimized and involved in binge drinking. Meanwhile, girls with higher levels of institutional trust were more likely to use a condom and less likely to have used marijuana. Among boys, those with higher levels of community trust were more likely to use a condom, while those with higher levels of institutional trust were less likely to use marijuana, but more likely binge drink. Overall, this study highlights the importance of trust for adolescent health. Most surprising were the differences in the associations between boys and girls with regard to the type of trust and specific health outcome that was

  18. Surrogate Motherhood: A Trust-Based Approach.

    PubMed

    Beier, Katharina

    2015-12-01

    Because it is often argued that surrogacy should not be treated as contractual, the question arises in which terms this practice might then be couched. In this article, I argue that a phenomenology of surrogacy centering on the notion of trust provides a description that is illuminating from the moral point of view. My thesis is that surrogacy establishes a complex and extended reproductive unit--the "surrogacy triad" consisting of the surrogate mother, the child, and the intending parents--whose constituents are bound together by mutual trustful commitments. Even though a trust-based approach does not provide an ultimate answer to whether surrogacy should be sanctioned or prohibited, it allows for at least some practical suggestions. In particular, I will argue that, under certain conditions, surrogacy is tenable within familial or other significant relationships, and I will stress the necessity of acknowledging the new relationships and moral commitments that result from this practice. PMID:26449234

  19. 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

  20. Redefining genomic privacy: trust and empowerment.

    PubMed

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

    2014-11-01

    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

  1. 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.

  2. 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. PMID:20841767

  3. Morality and values in support of universal healthcare must be enshrined in law. Comment on "Morality and Markets in the NHS".

    PubMed

    Pollock, Allyson M

    2015-06-01

    This is a commentary on Gilbert and colleagues' (1) paper on morality and markets in the National Health Service (NHS). Morality and values are not ephemeral qualities and universal healthcare is not simply an aspiration; it has to be enshrined in law. The creation of the UK NHS in 1948 was underpinned by core legal duties which required a system of public funding and delivery to follow. The moral values of the citizens in support of social solidarity were thus transformed into a political and legal contract for citizens. The NHS still survives in Scotland, Wales and Northern Ireland but the coalition government abolished it in England in 2012, reducing the NHS to a funding stream, a logo and a set of market regulators. This paper describes and explains the Health and Social Care (HSC) Act 2012 in England and how the NHS is withering away and health services are being remodeled along US Health Maintenance Organization (HMO) lines. There was nothing moral about this extraordinary act of savagery and violence against the public in England, and against common values and widely held beliefs in public ownership funding and provision of universal healthcare. The public health consequences will be catastrophic which is why after the election on May seventh a new Bill is required to Reinstate the NHS and the Secretary of State's legal duty to provide listed health services throughout England. PMID:26029901

  4. 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. PMID:26502665

  5. Integrity Management Infrastructure for Trusted Computing

    NASA Astrophysics Data System (ADS)

    Munetoh, Seiji; Nakamura, Megumi; Yoshihama, Sachiko; Kudo, Michiharu

    Computer security concerns have been rapidly increasing because of repeated security breaches and leakages of sensitive personal information. Such security breaches are mainly caused by an inappropriate management of the PCs, so maintaining integrity of the platform configuration is essential, and, verifying the integrity of the computer platform and software becomes more significant. To address these problems, the Trusted Computing Group (TCG) has developed various specifications that are used to measure the integrity of the platform based on hardware trust. In the trusted computing technology, the integrity data of each component running on the platform is recorded in the security chip and they are securely checked by a remote attestation. The infrastructure working group in the TCG is trying to define an Integrity Management Infrastructure in which the Platform Trust Services (PTS) is a new key component which deals with an Integrity Report. When we use the PTS in the target platform, it is a service component that collects and measures the runtime integrity of the target platform in a secure way. The PTS can also be used to validate the Integrity Reports. We introduce the notion of the Platform Validation Authority, a trusted third party, which verifies the composition of the integrity measurement of the target platform in the Integrity Reports. The Platform Validation Authority complements the role of the current Certificate Authority in the Public Key Infrastructure which attests to the integrity of the user identity as well as to related artifacts such as digital signatures. In this paper, we cover the research topics in this new area, the relevant technologies and open issues of the trusted computing, and the detail of our PTS implementation.

  6. 78 FR 46596 - Secretarial Commission on Indian Trust Administration and Reform

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-01

    ... about the trust relationship, other trust models, and trust reform, and aspects of trust that are unique... efforts to empower Indian nations and strengthen nation-to-nation relationships. The Commission...

  7. 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)

  8. 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

  9. 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

  10. Trust that binds: the impact of collective felt trust on organizational performance.

    PubMed

    Salamon, Sabrina Deutsch; Robinson, Sandra L

    2008-05-01

    The impact of employees' collective perceptions of being trusted by management was examined with a longitudinal study involving 88 retail stores. Drawing on the appropriateness framework (March, 1994; Weber, Kopelman, & Messick, 2004), the authors develop and test a model showing that when employees in an organization perceive they are trusted by management, increases in the presence of responsibility norms, as well as in the sales performance and customer service performance of the organization, are observed. Moreover, the relationship between perceptions of being trusted and sales performance is fully mediated by responsibility norms. PMID:18457488

  11. Trust and trust relations from the providers' perspective: the case of the healthcare system in India.

    PubMed

    Kane, Sumit; Calnan, Michael; Radkar, Anjali

    2015-01-01

    Commentators suggest that there is an erosion of trust in the relations between different actors in the health system in India. This paper presents the results of an exploratory study of the situation of providers in an urban setting in western India, the nature of their relations in terms of trust and what influences these relations. The data on relationships of trust were collected through interviews and focus group discussions with key informants, including public and private providers, regulators, managers and societal actors, such as patients/citizens, politicians and the media. PMID:26228048

  12. Improving the trust algorithm of information in semantic web

    NASA Astrophysics Data System (ADS)

    Wan, Zong-bao; Min, Jiang

    2012-01-01

    With the rapid development of computer networks, especially with the introduction of the Semantic Web perspective, the problem of trust computation in the network has become an important research part of current computer system theoretical. In this paper, according the information properties of the Semantic Web and interact between nodes, the definition semantic trust as content trust of information and the node trust between the nodes of two parts. By Calculate the content of the trust of information and the trust between nodes, then get the final credibility num of information in semantic web. In this paper , we are improve the computation algorithm of the node trust .Finally, stimulations and analyses show that the improved algorithm can effectively improve the trust of information more accurately.

  13. Improving the trust algorithm of information in semantic web

    NASA Astrophysics Data System (ADS)

    Wan, Zong-Bao; Min, Jiang

    2011-12-01

    With the rapid development of computer networks, especially with the introduction of the Semantic Web perspective, the problem of trust computation in the network has become an important research part of current computer system theoretical. In this paper, according the information properties of the Semantic Web and interact between nodes, the definition semantic trust as content trust of information and the node trust between the nodes of two parts. By Calculate the content of the trust of information and the trust between nodes, then get the final credibility num of information in semantic web. In this paper , we are improve the computation algorithm of the node trust .Finally, stimulations and analyses show that the improved algorithm can effectively improve the trust of information more accurately.

  14. Trust in automation. Part II. Experimental studies of trust and human intervention in a process control simulation.

    PubMed

    Muir, B M; Moray, N

    1996-03-01

    Two experiments are reported which examined operators' trust in and use of the automation in a simulated supervisory process control task. Tests of the integrated model of human trust in machines proposed by Muir (1994) showed that models of interpersonal trust capture some important aspects of the nature and dynamics of human-machine trust. Results showed that operators' subjective ratings of trust in the automation were based mainly upon their perception of its competence. Trust was significantly reduced by any sign of incompetence in the automation, even one which had no effect on overall system performance. Operators' trust changed very little with experience, with a few notable exceptions. Distrust in one function of an automatic component spread to reduce trust in another function of the same component, but did not generalize to another independent automatic component in the same system, or to other systems. There was high positive correlation between operators' trust in and use of the automation; operators used automation they trusted and rejected automation they distrusted, preferring to do the control task manually. There was an inverse relationship between trust and monitoring of the automation. These results suggest that operators' subjective ratings of trust and the properties of the automation which determine their trust, can be used to predict and optimize the dynamic allocation of functions in automated systems. PMID:8849495

  15. Trust, trustworthiness, and trust propensity: a meta-analytic test of their unique relationships with risk taking and job performance.

    PubMed

    Colquitt, Jason A; Scott, Brent A; LePine, Jeffery A

    2007-07-01

    The trust literature distinguishes trustworthiness (the ability, benevolence, and integrity of a trustee) and trust propensity (a dispositional willingness to rely on others) from trust (the intention to accept vulnerability to a trustee based on positive expectations of his or her actions). Although this distinction has clarified some confusion in the literature, it remains unclear (a) which trust antecedents have the strongest relationships with trust and (b) whether trust fully mediates the effects of trustworthiness and trust propensity on behavioral outcomes. Our meta-analysis of 132 independent samples summarized the relationships between the trust variables and both risk taking and job performance (task performance, citizenship behavior, counterproductive behavior). Meta-analytic structural equation modeling supported a partial mediation model wherein trustworthiness and trust propensity explained incremental variance in the behavioral outcomes when trust was controlled. Further analyses revealed that the trustworthiness dimensions also predicted affective commitment, which had unique relationships with the outcomes when controlling for trust. These results generalized across different types of trust measures (i.e., positive expectations measures, willingness-to-be-vulnerable measures, and direct measures) and different trust referents (i.e., leaders, coworkers). PMID:17638454

  16. EDC/NHS cross-linked collagen foams as scaffolds for artificial corneal stroma.

    PubMed

    Vrana, N E; Builles, N; Kocak, H; Gulay, P; Justin, V; Malbouyres, M; Ruggiero, F; Damour, O; Hasirci, V

    2007-01-01

    In this study, a highly porous collagen-based biodegradable scaffold was developed as an alternative to synthetic, non-degradable corneal implants. The developed method involved lyophilization and subsequent stabilization through N-ethyl-N'-[3-dimethylaminopropyl] carbodiimide/N-hydroxy succinimide (EDC/NHS) cross-linking to yield longer lasting, porous scaffolds with a thickness similar to that of native cornea (500 microm). For collagen-based scaffolds, cross-linking is essential; however, it has direct effects on physical characteristics crucial for optimum cell behavior. Hence, the effect of cross-linking was studied by examining the influence of cross-linking on pore size distribution, bulk porosity and average pore size. After seeding the foam with human corneal keratocytes, cell proliferation, cell penetration into the scaffold and ECM production within the scaffold were studied. After a month of culture microscopical and immunohistochemical examinations showed that the foam structure did not undergo any significant loss of integrity, and the human corneal keratocytes populated the scaffold with cells migrating both longitudinally and laterally, and secreted some of the main constituents of the corneal ECM, namely collagen types I, V and VI. The foams had a layer of lower porosity (skin layer) both at the top and the bottom. Foams had an optimal porosity (93.6%), average pore size (67.7 microm), and chemistry for cell attachment and proliferation. They also had a sufficiently rapid degradation rate (73.6+/-1.1% in 4 weeks) and could be produced at a thickness close to that of the natural corneal stroma. Cells were seeded at the top surface of the foams and their numbers there was higher than the rest, basically due to the presence of the skin layer. This is considered to be an advantage when epithelial cells need to be seeded for the construction of hemi or full thickness cornea. PMID:17988518

  17. 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

  18. NHS funded fertility treatment--a national service in name only?

    PubMed

    O'Donnell, Claire; Manché, Marioth; Kingsland, Charles; Haddad, Nabil; Brickwood, Paul

    2005-12-01

    The variable nature of NHS provision of fertility services has again been highlighted by the response of commissioners to the recent guidance from the National Institute of Clinical Excellence. This paper describes an evidence-based model for policy aimed at minimising inequity across one Strategic Health Authority. The paper highlights the difficulties resulting from the current Department of Health guidance on targeting those in greatest need. A different way of describing this group is proposed, namely, defining childlessness in terms of parental status alone. This is clear to both patient and clinician at the outset, not subject to variable interpretation and because it is quantifiable for any given population, facilitates the commissioning of a level of service provision that reflects expressed need. A clinical audit suggests that the annual incidence of fertility problems prompting attendance at secondary care clinics is similar to levels observed nearly 20 years ago, at around 98 per 10,000 of the fertile population (proxy denominator, women aged 25 - 39). Our model further indicates that, for the more complex treatments, if both partners were required to be childless and treatments were to be delivered within 12 - 18 months of listing, commissioners would need to fund treatment for around 15 - 20 patients per 10,000 of the fertile population. If only one partner was required to be childless this figure would rise by 15 - 20%. We argue that despite the clinical guidelines, fertility treatments will remain a 'postcode lottery' unless central government addresses the priority to be given to fertility treatment on a national basis. PMID:16393821

  19. 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

  20. Managing resources in NHS dentistry: using health economics to inform commissioning decisions

    PubMed Central

    2011-01-01

    Background The aim of this study is to develop, apply and evaluate an economics-based framework to assist commissioners in their management of finite resources for local dental services. In April 2006, Primary Care Trusts in England were charged with managing finite dental budgets for the first time, yet several independent reports have since criticised the variability in commissioning skills within these organisations. The study will explore the views of stakeholders (dentists, patients and commissioners) regarding priority setting and the criteria used for decision-making and resource allocation. Two inter-related case studies will explore the dental commissioning and resource allocation processes through the application of a pragmatic economics-based framework known as Programme Budgeting and Marginal Analysis. Methods/Design The study will adopt an action research approach. Qualitative methods including semi-structured interviews, focus groups, field notes and document analysis will record the views of participants and their involvement in the research process. The first case study will be based within a Primary Care Trust where mixed methods will record the views of dentists, patients and dental commissioners on issues, priorities and processes associated with managing local dental services. A Programme Budgeting and Marginal Analysis framework will be applied to determine the potential value of economic principles to the decision-making process. A further case study will be conducted in a secondary care dental teaching hospital using the same approach. Qualitative data will be analysed using thematic analysis and managed using a framework approach. Discussion The recent announcement by government regarding the proposed abolition of Primary Care Trusts may pose challenges for the research team regarding their engagement with the research study. However, whichever commissioning organisations are responsible for resource allocation for dental services in the

  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, 2011 CFR

    2011-01-01

    ... 7 Agriculture 15 2011-01-01 2011-01-01 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. Trust an Essential Ingredient in Collaborative Decision Making

    ERIC Educational Resources Information Center

    Mitchell, Roxanne M.; Ripley, Joan; Adams, Curt; Raju, Dheeraj

    2011-01-01

    The following study explored the relationship between trust and collaboration in one Northeastern suburban district. In sum, 122 teachers responded to a trust and a collaboration survey. We hypothesized that the level of trust would be correlated with the level of collaboration. Bivariate and canonical correlations were used to analyze the…

  4. Trust in Organizations. Symposium 6. [AHRD Conference, 2001].

    ERIC Educational Resources Information Center

    2001

    This document contains three papers on human resource development (HRD) and trust in organizations. "Organizational Trust: An Orientation for the HRD Practitioner" (Christina L. Lafferty, Brad D. Lafferty) reviews research on organizational trust that was conducted with a focus on cognitive-based theories, affect-based theories, and combined…

  5. 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)...

  6. 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)...

  7. 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)...

  8. Faculty Trust in Colleagues: Linking the Principal with School Effectiveness.

    ERIC Educational Resources Information Center

    Hoy, Wayne K.; And Others

    1992-01-01

    A survey of teachers examined principals' roles in influencing school effectiveness, noting the influence of supportive leadership style on a culture of trust and perceived school effectiveness. Results indicated supportive principal leadership produced collegiality and trust in principals but not in colleagues. Teacher trust in colleagues…

  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. 26 CFR 1.664-1 - Charitable remainder trusts.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 26 Internal Revenue 8 2011-04-01 2011-04-01 false Charitable remainder trusts. 1.664-1 Section 1.664-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES (CONTINUED) Estates and Trusts Which May Accumulate Income Or Which Distribute Corpus § 1.664-1 Charitable remainder trusts....

  11. 5 CFR 2634.404 - Qualified diversified trusts.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... specifically identify current trust assets, or those assets which have been sold or disposed of from trust..., but not limited to, a preference for maximizing current income or long-term capital appreciation; or... information which might specifically identify current trust assets or those assets which have been sold...

  12. Trust in Online Collaborative Groups: A Constructivist Psychodynamic View

    ERIC Educational Resources Information Center

    Smith, Regina O.

    2011-01-01

    Trust represents one of the most critical issues facing online collaborative groups (OCG). The growth of online courses and programs and the growth of collaborative learning pedagogical strategies through the text-based online environment can make trust issues more salient. This paper examines trust issues in the OCG from a psychodynamic view;…

  13. 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…

  14. 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...

  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. 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...

  17. 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...

  18. 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...

  19. 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…

  20. A Response to Nicholson's "The Politics of Trust."

    ERIC Educational Resources Information Center

    Berry, Kathleen S.

    2002-01-01

    Notes a response to any discussion of trust is itself in danger of repeating the very problems that Helen Nicholson raises in her article "The Politics of Trust: Drama Education and the Ethics of Care" (2002). Agrees in part with the elaborations of her thesis, but admits to some serious hesitation regarding any discussion of trust as a guiding…

  1. 78 FR 21424 - Royce Value Trust, Inc., et al.;

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-10

    ... to be contributed to Global Trust and those to be retained by Value Trust; (c) the cost basis and... COMMISSION Royce Value Trust, Inc., et al.; Notice of Application April 4, 2013. AGENCY: Securities and...) and 12(d)(1)(C) of the Act, under section 17(b) of the Act granting an exemption from section 17(a)...

  2. The Development of an Instrument To Measure Organizational Trust.

    ERIC Educational Resources Information Center

    Taylor-Dunlop, Korynne; Lester, Paula E.

    An instrument to measure organizational trust was developed, and a pilot study was conducted to evaluate the instrument and make appropriate revisions. The 23-item Organizational Trust Measure (OTM) was developed based on the perceptions of 42 doctoral students regarding trust and its role in educational leadership. Content analysis procedures and…

  3. The Formation of Parent-School Trust: A Multilevel Analysis

    ERIC Educational Resources Information Center

    Adams, Curt M.; Forsyth, Patrick B.; Mitchell, Roxanne M.

    2009-01-01

    Purpose: The authors' focus was on understanding antecedents of parent trust toward schools. Two questions guided the inquiry: Is there a systematic difference in parent-school trust across schools? If so, what organizational conditions predict between-school variability in parent-school trust? Research Methods/Approach: Using multilevel modeling,…

  4. 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…

  5. Creativity and Self-Trust: A Field Study.

    ERIC Educational Resources Information Center

    Earl, William L.

    1987-01-01

    Attempted to separate out an entity defined as self-trust from more social components of self-function (self-esteem, social appropriateness). Subjects were 95 high school students, 45 emotionally disturbed girls, and 55 junior college students. Self-trust was differentiated from self-esteem by social feedback issues. Self-trust should contribute…

  6. 26 CFR 25.2702-5 - Personal residence trusts.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... personal residence trust, and the denominator of the fraction is the fair market value of the trust assets... 26 Internal Revenue 14 2010-04-01 2010-04-01 false Personal residence trusts. 25.2702-5 Section 25... GIFT TAXES GIFT TAX; GIFTS MADE AFTER DECEMBER 31, 1954 Special Valuation Rules § 25.2702-5...

  7. 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…

  8. 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…

  9. The Fragility of Trust in the World of School Principals

    ERIC Educational Resources Information Center

    Walker, Keith; Kutsyuruba, Benjamin; Noonan, Brian

    2011-01-01

    Purpose: The purpose of this paper is to examine the trust-related aspect of the work of school principals. The authors' exploratory examination of the Canadian school principals' perceptions of their moral agency and trust-brokering roles described their establishing, maintaining, and recovering of trust in schools. This article is delimited to…

  10. Middle School Climate, Faculty Trust, and Effectiveness: A Path Analysis.

    ERIC Educational Resources Information Center

    Tarter, C. John; And Others

    1995-01-01

    Reports a study that analyzed relationships among supportive principal behavior, faculty collegiality, faculty trust, and effectiveness. Data from 2,777 middle school teachers indicated that supportive principals, not teacher behavior, promoted trust in the principal. Teacher collegiality, not principal behavior, fostered trust among colleagues.…

  11. 24 CFR 92.500 - The HOME Investment Trust Fund.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 1 2011-04-01 2011-04-01 false The HOME Investment Trust Fund. 92... Urban Development HOME INVESTMENT PARTNERSHIPS PROGRAM Program Administration § 92.500 The HOME Investment Trust Fund. (a) General. A HOME Investment Trust Fund consists of the accounts described in...

  12. 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... Urban Development HOME INVESTMENT PARTNERSHIPS PROGRAM Program Administration § 92.500 The HOME Investment Trust Fund. (a) General. A HOME Investment Trust Fund consists of the accounts described in...

  13. 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…

  14. 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...

  15. 26 CFR 1.851-7 - Certain unit investment trusts.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 26 Internal Revenue 9 2014-04-01 2014-04-01 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...

  16. 26 CFR 1.851-7 - Certain unit investment trusts.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 26 Internal Revenue 9 2012-04-01 2012-04-01 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...

  17. 26 CFR 1.851-7 - Certain unit investment trusts.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 26 Internal Revenue 9 2013-04-01 2013-04-01 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...

  18. 26 CFR 1.851-7 - Certain unit investment trusts.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 9 2010-04-01 2010-04-01 false Certain unit investment trusts. 1.851-7 Section... (CONTINUED) INCOME TAXES 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 unit...

  19. 5 CFR 2634.310 - Trusts, estates, and investment funds.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 3 2011-01-01 2011-01-01 false Trusts, estates, and investment funds... EXECUTIVE BRANCH FINANCIAL DISCLOSURE, QUALIFIED TRUSTS, AND CERTIFICATES OF DIVESTITURE Contents of Public Reports § 2634.310 Trusts, estates, and investment funds. (a) In general. (1) Except as otherwise...

  20. 5 CFR 2634.310 - Trusts, estates, and investment funds.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 3 2013-01-01 2013-01-01 false Trusts, estates, and investment funds... EXECUTIVE BRANCH FINANCIAL DISCLOSURE, QUALIFIED TRUSTS, AND CERTIFICATES OF DIVESTITURE Contents of Public Reports § 2634.310 Trusts, estates, and investment funds. (a) In general. (1) Except as otherwise...

  1. 5 CFR 2634.310 - Trusts, estates, and investment funds.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 3 2014-01-01 2014-01-01 false Trusts, estates, and investment funds... EXECUTIVE BRANCH FINANCIAL DISCLOSURE, QUALIFIED TRUSTS, AND CERTIFICATES OF DIVESTITURE Contents of Public Reports § 2634.310 Trusts, estates, and investment funds. (a) In general. (1) Except as otherwise...

  2. 5 CFR 2634.310 - Trusts, estates, and investment funds.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 3 2012-01-01 2012-01-01 false Trusts, estates, and investment funds... EXECUTIVE BRANCH FINANCIAL DISCLOSURE, QUALIFIED TRUSTS, AND CERTIFICATES OF DIVESTITURE Contents of Public Reports § 2634.310 Trusts, estates, and investment funds. (a) In general. (1) Except as otherwise...

  3. 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…

  4. 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.…

  5. 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…

  6. Social Trust, Social Partner Time and Television Time

    ERIC Educational Resources Information Center

    Patulny, Roger

    2011-01-01

    Social trust is an important phenomenon, but the influence of important time-based measures upon trust has not been examined. Such measures include social contact and anti-social activity, such as television watching, which allows for the co-presence of other people. This paper reports on associations between trust and weighted means of co-present…

  7. 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),…

  8. 5 CFR 2634.310 - Trusts, estates, and investment funds.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Trusts, estates, and investment funds... EXECUTIVE BRANCH FINANCIAL DISCLOSURE, QUALIFIED TRUSTS, AND CERTIFICATES OF DIVESTITURE Contents of Public Reports § 2634.310 Trusts, estates, and investment funds. (a) In general. (1) Except as otherwise...

  9. The Effects of Individual Communicator Styles on Perceived Faculty Trust

    ERIC Educational Resources Information Center

    Brimhall, Jack C.

    2010-01-01

    The research problem addressed in this study was the lack of trust between faculty-principal, faculty-client, and faculty-colleague in U.S. secondary schools. The purpose of the study was to determine the relationship between communicator styles and perceptions of trust. Organizational trust theory served as the theoretical foundation. A…

  10. 24 CFR 92.500 - The HOME Investment Trust Fund.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 24 Housing and Urban Development 1 2012-04-01 2012-04-01 false The HOME Investment Trust Fund. 92... Urban Development HOME INVESTMENT PARTNERSHIPS PROGRAM Program Administration § 92.500 The HOME Investment Trust Fund. (a) General. A HOME Investment Trust Fund consists of the accounts described in...

  11. 24 CFR 92.500 - The HOME Investment Trust Fund.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 24 Housing and Urban Development 1 2013-04-01 2013-04-01 false The HOME Investment Trust Fund. 92... Urban Development HOME INVESTMENT PARTNERSHIPS PROGRAM Program Administration § 92.500 The HOME Investment Trust Fund. (a) General. A HOME Investment Trust Fund consists of the accounts described in...

  12. 24 CFR 92.500 - The HOME Investment Trust Fund.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 24 Housing and Urban Development 1 2014-04-01 2014-04-01 false The HOME Investment Trust Fund. 92... Urban Development HOME INVESTMENT PARTNERSHIPS PROGRAM Program Administration § 92.500 The HOME Investment Trust Fund. (a) General. A HOME Investment Trust Fund consists of the accounts described in...

  13. 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…

  14. Patients' Race, Ethnicity, Language, and Trust in a Physician

    ERIC Educational Resources Information Center

    Stepanikova, Irena; Mollborn, Stefanie; Cook, Karen S.; Thom, David H.; Kramer, Roderick M.

    2006-01-01

    We examine whether racial/ethnic/language-based variation in measured levels of patients' trust in a physician depends on the survey items used to measure that trust. Survey items include: (1) a direct measure of patients' trust that the doctor will put the patient's medical needs above all other considerations, and (2) three indirect measures of…

  15. 78 FR 30324 - Secretarial Commission on Indian Trust Administration and Reform

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-22

    ... speakers and attendees about the trust relationship, other trust models, and trust reform; review... nation-to-nation relationships. The Commission will complete a comprehensive evaluation of the... speakers and attendees about the trust relationship, other trust models, and trust reform Review...

  16. Effects of Cognitive Load on Trusting Behavior – An Experiment Using the Trust Game

    PubMed Central

    2015-01-01

    Last decades have witnessed a progressing decline of social trust, which has been predominantly linked to worsening economic conditions and increasing social inequality. In the present research we propose a different type of explanation for the observed decline – cognitive load related to technological development and the accelerating pace of modern life. In an experimental study participants played the trust game while performing one of two different secondary tasks – listening to a disturbing noise or memorizing a sequence of characters – or with no additional task in the control condition. Results show that in both cognitive load conditions participants expressed significantly less trust in the trust game than in case of no cognitive load. Additionally, when cognitive resources were limited, participants’ behavior was more impulsive than when their resources were fully available. PMID:26010489

  17. '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'. PMID:19696135

  18. 14 CFR 47.8 - Voting trusts.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRCRAFT REGISTRATION General § 47.8 Voting trusts. Link to an amendment published at 75 FR 41979, July 20, 2010. Link... domestic corporation as a U.S. citizen, the corporate applicant must submit to the Registry— (1) A...

  19. 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…

  20. [Patient-physician relations, consent and trust].

    PubMed

    Lafarge, Marie-Paule

    2013-10-01

    The therapeutic relationship between the doctor and the patient is asymmetric. Through the trust which the patient places in him or her, the doctor is invited to see the illness, in other words the narcissistic flaw which he or she alone is authorised to examine "objectively". PMID:24245035

  1. 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…

  2. Analysing Trust Building in Educational Activities

    ERIC Educational Resources Information Center

    Farini, Federico

    2012-01-01

    This article aims to offer both a theoretical contribution and examples of practices of trust building in peace education; the article presents an empirical analysis of videotaped interactions in the context of peace education activities in international groups of adolescents. The analysis aims to understand if and in which ways peace education is…

  3. 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…

  4. 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 other…

  5. 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…

  6. 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…

  7. Developmental Writing: Trust, Challenge, and Critical Thinking.

    ERIC Educational Resources Information Center

    Miller, David

    2002-01-01

    Explores the idea that basic writing students, when positioned in a classroom setting where safety and trust are paramount, will be willing to take risks. Notes that successful risks will lead students into a more positive relationship with their own writing abilities. Concludes that success in writing leads to a more open-minded approach which…

  8. 40 CFR 280.102 - Trust fund.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 28 2012-07-01 2012-07-01 false Trust fund. 280.102 Section 280.102 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) TECHNICAL STANDARDS AND CORRECTIVE ACTION REQUIREMENTS FOR OWNERS AND OPERATORS OF UNDERGROUND STORAGE TANKS...

  9. 40 CFR 280.102 - Trust fund.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 27 2011-07-01 2011-07-01 false Trust fund. 280.102 Section 280.102 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) TECHNICAL STANDARDS AND CORRECTIVE ACTION REQUIREMENTS FOR OWNERS AND OPERATORS OF UNDERGROUND STORAGE TANKS...

  10. 40 CFR 280.102 - Trust fund.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 27 2014-07-01 2014-07-01 false Trust fund. 280.102 Section 280.102 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) TECHNICAL STANDARDS AND CORRECTIVE ACTION REQUIREMENTS FOR OWNERS AND OPERATORS OF UNDERGROUND STORAGE TANKS...

  11. 40 CFR 280.102 - Trust fund.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 28 2013-07-01 2013-07-01 false Trust fund. 280.102 Section 280.102 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) TECHNICAL STANDARDS AND CORRECTIVE ACTION REQUIREMENTS FOR OWNERS AND OPERATORS OF UNDERGROUND STORAGE TANKS...

  12. 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 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) TECHNICAL STANDARDS AND CORRECTIVE ACTION REQUIREMENTS FOR OWNERS AND OPERATORS OF UNDERGROUND STORAGE TANKS...

  13. Sudden trust collapse in networked societies

    NASA Astrophysics Data System (ADS)

    da Gama Batista, João; Bouchaud, Jean-Philippe; Challet, Damien

    2015-03-01

    Trust is a collective, self-fulfilling phenomenon that suggests analogies with phase transitions. We introduce a stylized model for the build-up and collapse of trust in networks, which generically displays a first order transition. The basic assumption of our model is that whereas trustworthiness begets trustworthiness, panic also begets panic, in the sense that a small decrease in trustworthiness may be amplified and ultimately lead to a sudden and catastrophic drop of collective trust. We show, using both numerical simulations and mean-field analytic arguments, that there are extended regions of the parameter space where two equilibrium states coexist: a well-connected network where global confidence is high, and a poorly connected network where global confidence is low. In these coexistence regions, spontaneous jumps from the well-connected state to the poorly connected state can occur, corresponding to a sudden collapse of trust that is not caused by any major external catastrophe. In large systems, spontaneous crises are replaced by history dependence: whether the system is found in one state or in the other essentially depends on initial conditions. Finally, we document a new phase, in which agents are well connected yet distrustful.

  14. Continuing Trust Education in the 1980's.

    ERIC Educational Resources Information Center

    Blech, Scott A.

    1980-01-01

    The need for continuing professional education in the trust industry is noted and emphasis is placed on need for new or additional training in management, taxation, employee benefits, marketing, and investments. The pros and cons of residential schools are outlined, and the use of regional and state seminars is discussed. Available from 6285…

  15. Building Student Trust in Online Learning Environments

    ERIC Educational Resources Information Center

    Wang, Ye Diana

    2014-01-01

    As online learning continues to gain widespread attention and thrive as a legitimate alternative to classroom instruction, educational institutions and online instructors face the challenge of building and sustaining student trust in online learning environments. The present study represents an attempt to address the challenge by identifying the…

  16. Sex Restricted Scholarships and the Charitable Trust

    ERIC Educational Resources Information Center

    Iowa Law Review, 1974

    1974-01-01

    Examines three areas of vulnerability of charitable trusts which provide scholarships restricting applicants to one sex. The first area is based on constitutional grounds; the second, under the 1972 amendment to the Education Act; and the third, the entitlement of tax exempt status. (Author/PG)

  17. Cultivating Trust among Urban Youth at Risk

    ERIC Educational Resources Information Center

    Owens, Michael A.; Johnson, Bob L., Jr.

    2008-01-01

    By examining data from interviews with students in the Upward Bound program (a federally sponsored program that provides academic support to students at risk who are preparing for college entrance), this study seeks to strengthen an understanding of the role of trust among urban youth at risk in the educational organizations that serve them. This…

  18. 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…

  19. 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

  20. Partnership as a Product of Trust: Parent-Teacher Relational Trust in a Low-Income Urban School

    ERIC Educational Resources Information Center

    Chang, Heather Lynn

    2013-01-01

    Trust is an important factor affecting parent-teacher relationships. In urban schools, the lack of trust between parents and teachers is exacerbated by racial and social class differences (Bryk and Schneider, 2002). This paper examines how relational trust was both fostered and inhibited between low-income parents and their children's…

  1. "Do You Trust Him?" Children's Trust Beliefs and Developmental Trajectories of Aggressive Behavior in an Ethnically Diverse Sample

    ERIC Educational Resources Information Center

    Malti, Tina; Averdijk, Margit; Ribeaud, Denis; Rotenberg, Ken J.; Eisner, Manuel P.

    2013-01-01

    This study investigated the role of trust beliefs (i.e., trustworthiness, trustfulness) on aggression trajectories in a four-wave longitudinal study using an ethnically diverse sample of 8- to 11-year-old children (N = 1,028), as well as the risk profiles of low trust beliefs and low socioeconomic status on aggression trajectories. At Time 1 to…

  2. 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. PMID:27532071

  3. Marrying Heterogeneous Circles of Trust: No Silver Bullet Yet

    NASA Astrophysics Data System (ADS)

    Ates, Mikaël; Gravier, Christophe; Fayolle, Jacques; Sauviac, Bruno

    2008-11-01

    Numerous business and state-owned entities assert the need of secured information exchanges on digital identities based on trusted third parties. Entities trusting each other create a federation. At first, it is necessary for them to formalize this alliance with legal documents. In a second time, an architecture of identity federation will allow them to establish technical trust links, creating a circle of trust, most often with a public key infrastructure. The real challenge for the identity federation domain is the interoperability of information systems thanks to normalized and standardized protocols, that is to say, realize interconnection of circles of trust.

  4. 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

  5. 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

  6. 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

    2013-01-01

    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 to aid development. This

  7. Linking NHS data for pediatric pharmacovigilance: Results of a Delphi survey

    PubMed Central

    Hopf, Y.M.; Francis, J.; Helms, P.J.; Haughney, J.; Bond, C.

    2016-01-01

    Background Adverse drug events are a major cause of patient safety incidents. Current systems of pharmacovigilance under-report adverse drug reactions (ADRs), especially in children, leading to delays in their identification. This is of particular concern, as children especially have an increased vulnerability to ADRs. Objectives The objective was to seek consensus among healthcare professionals (HCPs) about barriers and facilitators to the linkage of routinely collected health data for pediatric pharmacovigilance in Scotland. Methods A Delphi survey was conducted with a random sample of HCPs including nurses, pharmacists and doctors, working in primary or secondary care, in Scotland. Participants were identified from sampling frames of the target professionals such as an NHS workforce list for general practitioners and recruited by postal invitation. A total of 819 HCPs were invited to take part. Those agreeing to participate were given the option of completing the questionnaires online or as hard copy. Reminders were sent twice at a fortnightly interval. Questions content included description of professional role as well as testing for the willingness to support the proposed project and was informed by the Theoretical Domains Framework of Behavior Change (TDF) and earlier qualitative work. Three Delphi rounds were administered, including a first round for item generation. Results 121 of those invited agreed to take part (15%). The first round of the Delphi study included 21 open questions and generated over a 1000 individual statements from 61 participants that returned the questionnaires (50.4%). These were rationalized to 149 items for the second round in which participants rated their views on the importance (or not) of each item on a 9-point Likert scale (strongly disagree – strongly agree). After the third round, there was consensus on items that focused on professional standards, and practical requirements, overall there was support for data linkage and a

  8. A Robust Trust Establishment Scheme for Wireless Sensor Networks

    PubMed Central

    Ishmanov, Farruh; Kim, Sung Won; Nam, Seung Yeob

    2015-01-01

    Security techniques like cryptography and authentication can fail to protect a network once a node is compromised. Hence, trust establishment continuously monitors and evaluates node behavior to detect malicious and compromised nodes. However, just like other security schemes, trust establishment is also vulnerable to attack. Moreover, malicious nodes might misbehave intelligently to trick trust establishment schemes. Unfortunately, attack-resistance and robustness issues with trust establishment schemes have not received much attention from the research community. Considering the vulnerability of trust establishment to different attacks and the unique features of sensor nodes in wireless sensor networks, we propose a lightweight and robust trust establishment scheme. The proposed trust scheme is lightweight thanks to a simple trust estimation method. The comprehensiveness and flexibility of the proposed trust estimation scheme make it robust against different types of attack and misbehavior. Performance evaluation under different types of misbehavior and on-off attacks shows that the detection rate of the proposed trust mechanism is higher and more stable compared to other trust mechanisms. PMID:25806875

  9. A robust trust establishment scheme for wireless sensor networks.

    PubMed

    Ishmanov, Farruh; Kim, Sung Won; Nam, Seung Yeob

    2015-01-01

    Security techniques like cryptography and authentication can fail to protect a network once a node is compromised. Hence, trust establishment continuously monitors and evaluates node behavior to detect malicious and compromised nodes. However, just like other security schemes, trust establishment is also vulnerable to attack. Moreover, malicious nodes might misbehave intelligently to trick trust establishment schemes. Unfortunately, attack-resistance and robustness issues with trust establishment schemes have not received much attention from the research community. Considering the vulnerability of trust establishment to different attacks and the unique features of sensor nodes in wireless sensor networks, we propose a lightweight and robust trust establishment scheme. The proposed trust scheme is lightweight thanks to a simple trust estimation method. The comprehensiveness and flexibility of the proposed trust estimation scheme make it robust against different types of attack and misbehavior. Performance evaluation under different types of misbehavior and on-off attacks shows that the detection rate of the proposed trust mechanism is higher and more stable compared to other trust mechanisms. PMID:25806875

  10. Damage to the insula is associated with abnormal interpersonal trust

    PubMed Central

    Belfi, Amy M.; Koscik, Timothy R.; Tranel, Daniel

    2015-01-01

    Reciprocal trust is a crucial component of cooperative, mutually beneficial social relationships. Previous research using tasks that require judging and developing interpersonal trust has suggested that the insula may be an important brain region underlying these processes (King-Casas et al., 2008). Here, using a neuropsychological approach, we investigated the role of the insula in reciprocal trust during the Trust Game (TG), an interpersonal economic exchange. Consistent with previous research, we found that neurologically normal adults reciprocate trust in kind, i.e., they increase trust in response to increases from their partners, and decrease trust in response to decreases. In contrast, individuals with damage to the insula displayed abnormal expressions of trust. Specifically, these individuals behaved benevolently (expressing misplaced trust) when playing the role of investor, and malevolently (violating their partner’s trust) when playing the role of the trustee. Our findings lend further support to the idea that the insula is important for expressing normal interpersonal trust, perhaps because the insula helps to recognize risk during decision-making and to identify social norm violations. PMID:25846668

  11. 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

  12. Epidemiology and Pathogenesis of C. difficile and MRSA in the Light of Current NHS Control Policies: A Policy review

    PubMed Central

    Agha, Maliha

    2012-01-01

    Healthcare associated infections (HCAIs) cause significant morbidity and mortality, and are estimated to cost the United Kingdom National Health Service £1 billion annually. The current health care infection rates suggest that the level of performance to avoid HCAIs is not maintained consistently. Increasing screening, improving local accountability and performance management, careful use of antibiotics in the management of emergency patients, health economy wide approaches, and improved hand washing will be effective in lowering the rate of HCAIs. This paper reviews current NHS Control Policies in place for Methicillin Resistant Staphylococcus Aureus (MRSA) and C. difficile. PMID:26257907

  13. Promoting Trust in the Registered Nurse-Patient Relationship.

    PubMed

    Leslie, Jamie Lynn; Lonneman, William

    2016-01-01

    The establishment of trust in the registered nurse (RN)-patient relationship promotes patient engagement and improves the likelihood that the patient will be an active member of the patient care team. The purpose of this article is to examine nursing literature to identify the antecedents, attributes, and outcomes of trusting relationships between RNs and patients in home healthcare. Antecedents of trust for the RN-patient relationship included 1) meeting a need, 2) respect, 3) attention to time, 4) continuity of care, and 5) the initial visit. Attributes of trust between RN and patient in the home healthcare setting were identified as communication, connection, and reciprocity. For the RN and patient who established mutual trust, patients demonstrated better adaptation and collaboration for improvement of health, expressed a sense of security, and indicated a willingness to engage in additional trusting relationships. Barriers to a trusting relationship included a lack of respect and incompetent and/or unethical care. PMID:26645843

  14. Trusting others: the polarization effect of need for closure.

    PubMed

    Acar-Burkay, Sinem; Fennis, Bob M; Warlop, Luk

    2014-10-01

    Because trust-related issues inherently involve uncertainty, we expected individuals' social-cognitive motivation to manage uncertainty--which is captured by their need for closure--to influence their level of trust in others. Through the results of 6 studies, we showed that higher need for closure was related to more polarized trust judgments (i.e., low trust in distant others and high trust in close others) in the case of both chronic and situational need for closure. Moreover, participants with high need for closure did not revise their level of trust when they received feedback about the trustees' actual trustworthiness, whereas participants with low need for closure did. Overall, our findings indicate that polarized (either high or low, as opposed to moderate) and persistent levels of trust may serve people's seizing and freezing needs for achieving cognitive closure. PMID:25111303

  15. Acute Bronchitis

    MedlinePlus

    Bronchitis is an inflammation of the bronchial tubes, the airways that carry air to your lungs. It ... chest tightness. There are two main types of bronchitis: acute and chronic. Most cases of acute bronchitis ...

  16. Trust and Public Participation in Risk Policy Issues

    SciTech Connect

    Bradbury, Judith A. ); Branch, Kristi M. ); Focht, Will; Ragnar E. Lofstedt and George Cvetkovich

    1999-12-01

    Recent social science literature has paid increasing attention to the concept of trust, albeit with differing definitions and constituents and also with differing emphases on societal origins, functions, and implications. Recently, discussion has shifted to the role of trust in hazard management and, more broadly, to the fundamental role of trust in modern society. In this paper, we provide answers to the following questions, in an attempt to refocus the discussion and identify a more productive research approach to the relationship of trust and public participation in risk policy issues: -What is trust? What are the differing conceptions and dimensions of trust that have been identified in the literature? -What are the social functions of trust? -What is the relationship between trust and public participation in risk policy issues? Why is trust particularly important for agencies such as the Department of Energy (DOE) that are responsible for development and implementation of policies involving technological risk? -How should we define the research problem in examining the relationship between trust and public participation in risk policy issues? What are the key research questions to be addressed? Federal agencies have introduced public participation as a means of addressing public distrust and enhancing their ability to make decisions that can be implemented. In some cases, such as the Secretary of Energy's Advisory Board, public participation was explicitly identified as an organizational response that was needed to re-establish public trust and confidence in the Department of Energy (DOE). However, our review of the literature on both trust and public participation and our experience in developing criteria for evaluating public participation initiatives have resulted in our questioning the wisdom of establishing trust as a goal of public participation and caused us to examine the relationship between trust and public participation.

  17. Managing Trust in Online Social Networks

    NASA Astrophysics Data System (ADS)

    Bhuiyan, Touhid; Josang, Audun; Xu, Yue

    In recent years, there is a dramatic growth in number and popularity of online social networks. There are many networks available with more than 100 million registered users such as Facebook, MySpace, QZone, Windows Live Spaces etc. People may connect, discover and share by using these online social networks. The exponential growth of online communities in the area of social networks attracts the attention of the researchers about the importance of managing trust in online environment. Users of the online social networks may share their experiences and opinions within the networks about an item which may be a product or service. The user faces the problem of evaluating trust in a service or service provider before making a choice. Recommendations may be received through a chain of friends network, so the problem for the user is to be able to evaluate various types of trust opinions and recommendations. This opinion or recommendation has a great influence to choose to use or enjoy the item by the other user of the community. Collaborative filtering system is the most popular method in recommender system. The task in collaborative filtering is to predict the utility of items to a particular user based on a database of user rates from a sample or population of other users. Because of the different taste of different people, they rate differently according to their subjective taste. If two people rate a set of items similarly, they share similar tastes. In the recommender system, this information is used to recommend items that one participant likes, to other persons in the same cluster. But the collaborative filtering system performs poor when there is insufficient previous common rating available between users; commonly known as cost start problem. To overcome the cold start problem and with the dramatic growth of online social networks, trust based approach to recommendation has emerged. This approach assumes a trust network among users and makes recommendations

  18. Trust Management - Building Trust for International Cross Disciplinary Collaboration on Climate Change

    NASA Astrophysics Data System (ADS)

    Oakley, K. V.; Gurney, R. J.

    2014-12-01

    Successful communication and collaboration entails mutual understanding, and transfer, of information. The risk of misunderstanding and/or miscommunication between collaborating groups is tackled in different ways around the globe; some are well documented whereas others may be unknown outside particular groups, whether defined geographically or by specialism. For example; in some countries legally binding contracts define the terms of collaboration. Some regions place greater emphasis on developing trust relationships, and sometimes an official agreement is implied, such as many electronic data transfers on the web. International collaboration on climate change increasingly involves electronic data exchange (e.g. open access publications, shared documents, data repositories etc.) and with this increased reliance on electronic data a need has arisen for scientists to collaborate both internationally and cross-disciplinarily particularly with information technology and data management specialists. Trust of data and metadata on the internet (e.g. privacy, legitimacy etc.) varies, possibly due to a lack of internationally agreed standards for data governance and management, leaving many national, regional and institutional practices tailored to the needs of that group only. It is proposed that building trust relationships between cross-disciplinary and international groups could help facilitate further communication, understanding and benefits from the relationship, while still maintaining independence as separate groups. Complex international cross-disciplinary group relationship dynamics are not easily mapped and producing a set of trust building rules that can be applied to any current and future collaboration with equal validity may be unfeasible. An alternative to such a set of rules may be found in a Trust Manager, whose role is to improve mutually beneficial knowledge exchange between groups, build trust and increase future collaborative potential. This

  19. Contracting for Trust in Family Practice Obstetrics

    PubMed Central

    Klein, Michael

    1983-01-01

    A case is presented, illustrating a problem faced by family physicians who practice obstetrics; women who present with lists of inflexible requirements for labor and delivery may be attempting to control a situation in which they feel a great deal of fear, and little trust for the physician. The physician who tries to deal with every item on the list, rather than to explore the meaning of the total presentation, risks establishing a contract that cannot be met—and attracting more demanding patients. It is better to offer to discuss the patient's fear and distrust; this is described as `contracting for trust', and is a way to promote patient and doctor flexibility. PMID:21283484

  20. Trusted Measurement Model Based on Multitenant Behaviors

    PubMed Central

    Ning, Zhen-Hu; Shen, Chang-Xiang; Zhao, Yong; Liang, Peng

    2014-01-01

    With a fast growing pervasive computing, especially cloud computing, the behaviour measurement is at the core and plays a vital role. A new behaviour measurement tailored for Multitenants in cloud computing is needed urgently to fundamentally establish trust relationship. Based on our previous research, we propose an improved trust relationship scheme which captures the world of cloud computing where multitenants share the same physical computing platform. Here, we first present the related work on multitenant behaviour; secondly, we give the scheme of behaviour measurement where decoupling of multitenants is taken into account; thirdly, we explicitly explain our decoupling algorithm for multitenants; fourthly, we introduce a new way of similarity calculation for deviation control, which fits the coupled multitenants under study well; lastly, we design the experiments to test our scheme. PMID:24987731