scholarly journals A critical juncture in universal healthcare: insights from South Korea’s COVID-19 experience for the United Kingdom to consider

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Kyungmoo Heo ◽  
Keonyeong Jeong ◽  
Daejoong Lee ◽  
Yongseok Seo
Keyword(s):  
Decision Making ◽  
Stress Test ◽  
Healthcare Providers ◽  
Healthcare Systems ◽  
Critical Juncture ◽  
Precise Control ◽  
National Crisis ◽  
Universal Healthcare ◽  
Internal Competition ◽  
The Uk

AbstractUniversal healthcare systems have undergone a severe stress test in the form of the ongoing COVID-19 pandemic. With respect to the system-embedded allocation of decision-making powers and responsibilities among actors, different modalities have been revealed in the COVID-19 responses of South Korea and the UK, respectively. This article compares and analyzes how these two countries’ healthcare systems have reacted to COVID-19. Although both have implemented similar responsive measures, the UK has recorded a higher number of confirmed cases per thousand people and a higher death rate. Based on the analysis on which this paper is built, the key differences between the two systems are the UK system’s lack of: (1) appropriate medical equipment and technologies along with the human resources; and (2) flexible policy options to incentivize healthcare providers and induce cooperation from the public in a time of national crisis. The UK’s healthcare system is now approaching a critical juncture. The expansion of internal competition, which was introduced to the system in 1991, can serve as means of initiating a resolution to the above-mentioned issues and further reform its system. Under the UK government’s close supervision and precise control, allowing non-reimbursable special medical treatment in the system and widening public choice of medical services would be a suitable policy approach promoting internal competition while at the same time maintaining the UK’s devotion to universal healthcare. The underlying implication of internal competition though is the sharing of decision-making powers and responsibilities with societal and private sectors by inducing and facilitating participation at all levels. Fighting against COVID-19 however is widely considered ‘all-out-war.’ Under the UK government’s supervision and control, it is time for society to step up and fight the pandemic together.

Caesarean section as an informed choice in the UK: a systematic review

2021 ◽  
Vol 29 (10) ◽  
pp. 579-588
Author(s):  
Clementine Djatmika ◽  
Joanne Lusher ◽  
Jane Meyrick ◽  
James Byron-Daniel
Keyword(s):  
Decision Making ◽  
Caesarean Section ◽  
Psychological Impact ◽  
Healthcare Providers ◽  
Informed Choice ◽  
Steady Increase ◽  
Thematic Synthesis ◽  
Critical Appraisal Skills ◽  
Online Library ◽  
The Uk

Background Despite the steady increase in the number of women giving birth via caesarean section in the UK, little is understood about how shared decision making is implemented in obstetrics or what this means for women that have given birth via caesarean. The aim of this review is to assess narratives of women's experiences of caesarean birth as an informed choice and their involvement in this process. Methods A number of databases were searched, including MEDLINE via EBSCO, EMBASE via OVID, MIDIRS via OVID, Scopus, Wiley Online Library, Google Scholar and Ethos, as well as the reference sections of the included studies. Primary studies published between 1990–2020 were included and quality was assessed using the critical appraisal skills programme tool. Findings were analysed using a thematic synthesis framework to elicit higher order interpretations. Results A total of 11 studies were included in the final review. Quality assessment indicated the studies were generally of good quality, with the main limitations being in methodology quality indicators. Thematic synthesis identified eight subthemes within three main themes: ‘patient-doctor relationships’, ‘decision making as an emotional journey’ and ‘caesarean not really an informed “choice”’. The role of healthcare providers in promoting women's agency via patient-centred care was a prominent theme in women's narratives. Conclusions Women's decision making in consent to undergo caesarean births is a complex, emotionally driven process that can have a significant long-term psychological impact.

Evidence of increasing public participation in advance care planning: a comparison of polls in Alberta between 2007 and 2013

2016 ◽  
Vol 9 (2) ◽  
pp. 189-196 ◽  
Author(s):  
J E Simon ◽  
S Ghosh ◽  
D Heyland ◽  
T Cooke ◽  
S Davison ◽  
...  
Keyword(s):  
Decision Making ◽  
Advance Care Planning ◽  
Healthcare Providers ◽  
Healthcare Systems ◽  
Medical Decision ◽  
Care Planning ◽  
Future Health ◽  
Advance Care ◽  
Definition Of ◽  
Over Time

BackgroundAdvance care planning (ACP) encompasses both verbal and written communications expressing preferences for future health and personal care and helps prepare people for healthcare decision-making in times of medical crisis. Healthcare systems are increasingly promoting ACP as a way to inform medical decision-making, but it is not clear how public engagement in ACP activities is changing over time.MethodsRaw data from 3 independently conducted public polls on ACP engagement, in the same Canadian province, were analysed to assess whether participation in ACP activities changed over 6 years.ResultsStatistically significant increases were observed between 2007 and 2013 in: recognising the definition of ACP (54.8% to 80.3%, OR 3.37 (95% CI 2.68 to 4.24)), discussions about healthcare preferences with family (48.4% to 59.8%, OR 1.41 (95% CI 1.17 to 1.69)) and with healthcare providers (9.1% to 17.4%, OR 1.98 (95% CI 1.51 to 2.59)), written ACP plans (21% to 34.6%, OR 1.77 (95% CI 1.45 to 2.17)) and legal documentation (23.4% to 42.7%, OR 2.13 (95% CI 1.75 to 2.59)). These remained significant after adjusting for age, education and self-rated health status.ConclusionsACP engagement increased over time, although the overall frequency remains low in certain elements such as discussing ACP with healthcare providers. We discuss factors that may be responsible for the increase and provide suggestions for healthcare systems or other public bodies seeking to stimulate engagement in ACP.

‘I’m an expert in me and I know what I can cope with’: Patient expertise in rheumatoid arthritis

2014 ◽  
Vol 10 (3) ◽  
pp. 249-261 ◽  
Author(s):  
Tessa Sanderson ◽  
Jo Angouri
Keyword(s):  
Rheumatoid Arthritis ◽  
Meta Analysis ◽  
Healthcare Systems ◽  
Specific Knowledge ◽  
Active Involvement ◽  
Domain Specific ◽  
Access To Health ◽  
Patient Expertise ◽  
Domain Specific Knowledge ◽  
The Uk

The active involvement of patients in decision-making and the focus on patient expertise in managing chronic illness constitutes a priority in many healthcare systems including the NHS in the UK. With easier access to health information, patients are almost expected to be (or present self) as an ‘expert patient’ (Ziebland 2004). This paper draws on the meta-analysis of interview data collected for identifying treatment outcomes important to patients with rheumatoid arthritis (RA). Taking a discourse approach to identity, the discussion focuses on the resources used in the negotiation and co-construction of expert identities, including domain-specific knowledge, access to institutional resources, and ability to self-manage. The analysis shows that expertise is both projected (institutionally sanctioned) and claimed by the patient (self-defined). We close the paper by highlighting the limitations of our pilot study and suggest avenues for further research.

How multidisciplinary are multidisciplinary case reviews in cancer care? Feasibility analysis of a theory-driven team decision-making fidelity framework

2019 ◽  
Author(s):  
Tayana Soukup ◽  
Ged Murtagh ◽  
Ben W Lamb ◽  
James Green ◽  
Nick Sevdalis
Keyword(s):  
Decision Making ◽  
Cancer Care ◽  
Recent Decade ◽  
Individual Case ◽  
Multidisciplinary Teams ◽  
Final Decision ◽  
Political Climate ◽  
Implementation Framework ◽  
Feasibility Evaluation ◽  
The Uk

Background Multidisciplinary teams (MDTs) are a standard cancer care policy in many countries worldwide. Despite an increase in research in a recent decade on MDTs and their care planning meetings, the implementation of MDT-driven decision-making (fidelity) remains unstudied. We report a feasibility evaluation of a novel method for assessing cancer MDT decision-making fidelity. We used an observational protocol to assess (1) the degree to which MDTs adhere to the stages of group decision-making as per the ‘Orientation-Discussion-Decision-Implementation’ framework, and (2) the degree of multidisciplinarity underpinning individual case reviews in the meetings. MethodsThis is a prospective observational study. Breast, colorectal and gynaecological cancer MDTs in the Greater London and Derbyshire (United Kingdom) areas were video recorded over 12-weekly meetings encompassing 822 case reviews. Data were coded and analysed using frequency counts.Results Eight interaction formats during case reviews were identified. case reviews were not always multi-disciplinary: only 8% of overall reviews involved all five clinical disciplines present, and 38% included four of five. The majority of case reviews (i.e. 54%) took place between two (25%) or three (29%) disciplines only. Surgeons (83%) and oncologists (8%) most consistently engaged in all stages of decision-making. While all patients put forward for MDT review were actually reviewed, a small percentage of them (4%) either bypassed the orientation (case presentation) and went straight into discussing the patient, or they did not articulate the final decision to the entire team (8%). Conclusions Assessing fidelity of MDT decision-making at the point of their weekly meetings is feasible. We found that despite being a set policy, case reviews are not entirely MDT-driven. We discuss implications in relation to the current eco-political climate, and the quality and safety of care. Our findings are in line with the current national initiatives in the UK on streamlining MDT meetings, and could help decide how to re-organise them to be most efficient.

Benchmarking Risk Analysis Practice in the International Water Sector

2006 ◽  
Vol 1 (2) ◽  
Author(s):  
B.H. MacGillivray ◽  
P.D. Hamilton ◽  
S.E. Hrudey ◽  
L. Reekie ◽  
S.J.T Pollard
Keyword(s):  
Decision Making ◽  
Risk Analysis ◽  
Water Utilities ◽  
Water Sector ◽  
Water Utility ◽  
Analysis Techniques ◽  
The Usa ◽  
International Water ◽  
Practical Guidance ◽  
The Uk

Risk analysis in the water utility sector is fast becoming explicit. Here, we describe application of a capability model to benchmark the risk analysis maturity of a sub-sample of eight water utilities from the USA, the UK and Australia. Our analysis codifies risk analysis practice and offers practical guidance as to how utilities may more effectively employ their portfolio of risk analysis techniques for optimal, credible, and defensible decision making.

The Law & Politics of Brexit: Volume II

2020 ◽  
Keyword(s):  
Decision Making ◽  
European Union ◽  
Legal Framework ◽  
Comprehensive Analysis ◽  
The European Union ◽  
Trade Relations ◽  
The United Kingdom ◽  
The Uk ◽  
Financial Settlement ◽  
The Eu

This book provides the first comprehensive analysis of the withdrawal agreement concluded between the United Kingdom and the European Union to create the legal framework for Brexit. Building on a prior volume, it overviews the process of Brexit negotiations that took place between the UK and the EU from 2017 to 2019. It also examines the key provisions of the Brexit deal, including the protection of citizens’ rights, the Irish border, and the financial settlement. Moreover, the book assesses the governance provisions on transition, decision-making and adjudication, and the prospects for future EU–UK trade relations. Finally, it reflects on the longer-term challenges that the implementation of the 2016 Brexit referendum poses for the UK territorial system, for British–Irish relations, as well as for the future of the EU beyond Brexit.

scholarly journals Emergency cricothyrotomy during the COVID-19 pandemic: how to suppress aerosolization

2020 ◽  
Vol 5 (1) ◽  
pp. e000542
Author(s):  
Nabil Issa ◽  
Whitney E Liddy ◽  
Sandeep Samant ◽  
David B Conley ◽  
Robert C Kern ◽  
...  
Keyword(s):  
Potential Risk ◽  
Healthcare Providers ◽  
Healthcare Setting ◽  
Healthcare Systems ◽  
Financial Resources ◽  
Risk Of Infection ◽  
X Ray ◽  
General Surgeons ◽  
Fluorescein Dye ◽  
Nose And Throat

BackgroundCricothyrotomy is associated with significant aerosolization that increases the potential risk of infection among healthcare providers. It is important to identify simple yet effective methods to suppress aerosolization and improve the safety of healthcare providers.Methods5 ear, nose and throat and general surgeons used a locally developed hybrid cricothyrotomy simulator with a porcine trachea to test three draping methods to suppress aerosolization during the procedure: an X-ray cassette drape, dry operating room (OR) towels and wet OR towels. The three methods were judged based on three categories: effectiveness of suppression, availability in all healthcare systems and ease of handling.ResultsAll five surgeons performed the procedure independently using each of the three suppression methods. The wet OR towel drape was found to be an effective method to suppress aerosolization, and it did not hinder the surgeons from performing the procedure accurately. This finding was confirmed by using an atomized fluorescein dye injection into the porcine trachea, representing aerosolized material while performing the procedure.ConclusionsWe present a novel intervention using wet towels to suppress aerosolization during cricothyrotomy. Wet towels are cheap and readily available within any healthcare setting regardless of the financial resources available.

scholarly journals Experiences and impact of international medical volunteering: a multi-country mixed methods study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e041599 ◽  
Author(s):  
Mary McCauley ◽  
Joanna Raven ◽  
Nynke van den Broek
Keyword(s):  
Low Income ◽  
Online Survey ◽  
Positive Impact ◽  
Healthcare Providers ◽  
International Medical ◽  
Middle Income ◽  
Use Of Resources ◽  
The Uk ◽  
Medical Volunteers ◽  
The Impact

ObjectiveTo assess the experience and impact of medical volunteers who facilitated training workshops for healthcare providers in maternal and newborn emergency care in 13 countries.SettingsBangladesh, Ghana, India, Kenya, Malawi, Namibia, Nigeria, Pakistan, Sierra Leone, South Africa, Tanzania, UK and Zimbabwe.ParticipantsMedical volunteers from the UK (n=162) and from low-income and middle-income countries (LMIC) (n=138).Outcome measuresExpectations, experience, views, personal and professional impact of the experience of volunteering on medical volunteers based in the UK and in LMIC.ResultsUK-based medical volunteers (n=38) were interviewed using focus group discussions (n=12) and key informant interviews (n=26). 262 volunteers (UK-based n=124 (47.3%), and LMIC-based n=138 (52.7%)) responded to the online survey (62% response rate), covering 506 volunteering episodes. UK-based medical volunteers were motivated by altruism, and perceived volunteering as a valuable opportunity to develop their skills in leadership, teaching and communication, skills reported to be transferable to their home workplace. Medical volunteers based in the UK and in LMIC (n=244) reported increased confidence (98%, n=239); improved teamwork (95%, n=232); strengthened leadership skills (90%, n=220); and reported that volunteering had a positive impact for the host country (96%, n=234) and healthcare providers trained (99%, n=241); formed sustainable partnerships (97%, n=237); promoted multidisciplinary team working (98%, n=239); and was a good use of resources (98%, n=239). Medical volunteers based in LMIC reported higher satisfaction scores than those from the UK with regards to impact on personal and professional development.ConclusionHealthcare providers from the UK and LMIC are highly motivated to volunteer to increase local healthcare providers’ knowledge and skills in low-resource settings. Further research is necessary to understand the experiences of local partners and communities regarding how the impact of international medical volunteering can be mutually beneficial and sustainable with measurable outcomes.

scholarly journals ‘Not just a piece of skin in front of you’—a qualitative exploration of the experiences of adolescents with eczema and psoriasis with healthcare professionals

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e041108
Author(s):  
Isabella Joy de Vere Hunt ◽  
Abigail McNiven ◽  
Amanda Roberts ◽  
Himesh Parmar ◽  
Tess McPherson
Keyword(s):  
Young People ◽  
Skin Disease ◽  
Healthcare Professionals ◽  
Healthcare Delivery ◽  
Healthcare Providers ◽  
Secondary Analysis ◽  
Emotional Impact ◽  
Skin Conditions ◽  
The Uk ◽  
Qualitative Exploration

BackgroundThere is little qualitative research in the UK focussing on adolescents’ experience of their healthcare providers, and inflammatory skin conditions are a common heath problem in adolescence.AimTo explore the experiences of adolescents with eczema and psoriasis with healthcare professionals, and to distil the participants’ key messages for their healthcare providers.DesignThis is a secondary thematic analysis of interviews with adolescents with eczema or psoriasis.ParticipantsThere were a total of 41 text transcripts of interviews with young people with eczema or psoriasis who had given permission for secondary analysis; 23 of the participants had eczema, and 18 psoriasis. Participants were living in the UK at time of interview, and aged 15–24 years old.ResultsWe have distilled the following key messages from young people with eczema and psoriasis for healthcare providers: (1) address the emotional impact; (2) give more information, with the subtheme and (3) appreciate patient research. We identified the following eczema-specific themes: (ECZ-4) ‘It’s not taken seriously’; (ECZ-5) offer choice in treatment and (ECZ-6) lack of structure/conflicting advice. Two psoriasis-specific themes were identified: (PSO-4) feeling dehumanised/treat me as a person; and (PSO-5) think about how treatments will affect daily life.ConclusionThis qualitative data analysis highlights the need for greater recognition of the emotional impact of skin disease in adolescence, and for more comprehensive provision of information about the conditions. We call for greater sensitivity and flexibility in our approach to adolescents with skin disease, with important implications for healthcare delivery to this group.

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