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Despite widespread institutional and professional support, the recommendations of the Bristol Royal Infirmary Inquiry may be insufficient to reduce patient risk from impaired senior medical practitioners. Using the First Inquiry into Neurosurgical Services at the Canberra Hospital as a case study, this article argues that the Bristol-type recommendations--which emphasise reformulation of clinical governance structures, including early reporting of "sentinel events" and compulsory clinical audits--will be ineffective without a reformed institutional ethos that encourages open transparency and respect for those committed to such processes. Such reformulation may need to commence in medical education and involve new strategies including the use of portable digital technology to facilitate self-assessment of performance and immediate reporting of adverse incidents. 相似文献
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Consistent with previous research, almost half of a sample of 41 pet-owning battered women reported that their partners had threatened or actually harmed their pets, and over a fourth reported that concern for their pets had affected their decisions about leaving or staying with the batterer. Differences between rural and urban women were not significant, although higher proportions of rural than urban women reported that their partners had threatened or harmed their pets and that concern for their pets had affected their decisions. For the sample as a whole, logistic regression analyses showed that women whose pets had been threatened or harmed were significantly more likely to report that concern for their pets had affected their decisions about leaving or staying. The findings suggest that service providers should inquire about battered women's concern for their pets and should include arrangements for animals in safety planning. 相似文献
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Political mechanisms of accountability were marginalized by Conservative government reforms during the 1980s and 1990s which sought a more market-oriented approach within the public sector in order to enhance ‘consumerism’. In education, parents were given more choice between schools and were provided with more information on school performance. The promotion of market accountability has involved a reduction in the powers of local education authorities (LEAs) which had been central to the operation of political accountability. However, whilst market-based forms of accountability were firmly enhanced in principle by the legislation, to what extent have the forms of accountability operating within LEAs changed in practice? Interviews with Chief Officers and the Chair of the Education Committee are used to identify changing perceptions and practices of accountability in LEAs in Wales. The findings indicate that although local politicians and officials have been forced to operate within the legislative framework of market accountability, they have sought to impede its successful implementation. The policy community in Wales facilitated the LEAs’ capacity to respond in this way. The market-based reforms conflicted with fundamental values held in Wales, which remain those of professional accountability. 相似文献
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This article explores Timor Leste's experience of reportingunder the reformed international human rights treaties reportingsystem during the period 2004–2007. Whilst consciousnesshas grown of the difficulties faced by states by the duplicationof treaty reporting processes and the resource burden representedby reporting, the reforms instituted to date have been comparativelyminor. Timor's experience with the new Common Core Document(CCD)/treaty-specificdocument format affirms that reporting serves useful purposes,particularly in stimulating human rights education initiatives,government/NGO collaboration and awareness of human rights gapsin practice. The reformed process highlights cross-cutting humanrights matters. Yet, significant challenges remain, particularlyfor developing, post-conflict states, before reporting willattain its desired potential of support for improved human rightspromotion and protection at the national level. The CCD itselfraises complex conceptual difficulties needing resolution. Thereremains a paucity of appropriate methodological tools to supportthe reporting process and facilitate the integration of humanrights and development goals. Further work is thus needed toshape a sustainable process for reporting. 相似文献
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Decentralized decision making has created restructuring from larger to smaller administrative units, but in many places, strays little from existing arrangements. Moves toward decentralization from central government to city‐regions, and in some areas, below city‐region scale to neighborhoods, reflect a mandate for reform. What is the nature and extent of desired reforms? Using an institutionalist lens, homogeneity and heterogeneity in local narratives about possible future reform can be surfaced. This article emphasizes the importance of understanding the role of local actors' narratives in shaping decentralized institutions. This article uses the findings from a Q‐methodology study to identify and interrogate distinctive local viewpoints on attempts to decentralize decision making in England. In a systematic empirical analysis, local actors' narratives were largely in favor of relatively minor modifications to the status quo. The findings question a conflation of decentralization with participation in decision making. 相似文献
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Alexander Pope Alison K. Cohen Catherine d.P. Duarte 《Journal of Public Affairs (14723891)》2019,19(1)
This paper explores the connections between education for youth civic engagement and theories and strategies from public health (specifically, epidemiology). We illustrate this with four applications of epidemiologic theory to youth civic engagement: social determinants and fundamental causes, vulnerable populations and cumulative disadvantage, positive spillover, and herd immunity and critical mass. Formalizing concepts of current civics, in schools and the public, as a civic epidemic, we present a case for individual‐ and group‐level interventions based around targeted, school‐based, effective civic education initiatives. Grounded in epidemiological theory, such approaches call attention to the simultaneous need to improve broad civics education and ensure that particular populations receive necessary attentions. 相似文献
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