scholarly journals Advantages and limitations of virtual online consultations in a NHS acute trust: the VOCAL mixed-methods study

2018 ◽  
Vol 6 (21) ◽  
pp. 1-136 ◽  
Author(s):  
Sara Shaw ◽  
Joseph Wherton ◽  
Shanti Vijayaraghavan ◽  
Joanne Morris ◽  
Satya Bhattacharya ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Scale Up ◽  
Structuration Theory ◽  
Mixed Methods Study ◽  
Macro Level ◽  
Meso Level ◽  
Face To Face ◽  
Micro Level ◽  
Acute Trust ◽  
Remote Consultations

BackgroundThere is much enthusiasm from clinicians, industry and the government to utilise digital technologies and introduce alternatives to face-to-face consultations.Objective(s)To define good practice and inform digital technology implementation in relation to remote consultations via Skype™ (Microsoft Corporation, Redmond, WA, USA) and similar technologies.DesignMultilevel mixed-methods study of remote video consultations (micro level) embedded in an organisational case study (meso level), taking account of the national context and wider influences (macro level).SettingThree contrasting clinical settings (Diabetes, Antenatal Diabetes and Cancer Surgery) in a NHS acute trust.Data collection and analysisMacro level – interviews with 12 national-level stakeholders combined with document analysis. Meso level – longitudinal organisational ethnography comprising over 300 hours of observations, 24 staff interviews and analysis of 16 documents. Micro level – 30 video-recorded remote consultations; 17 matched audio-recorded face-to-face consultations. Interview and ethnographic data were analysed thematically and theorised using strong structuration theory. Consultations were transcribed verbatim and analysed using the Roter interaction analysis system (RIAS), producing descriptive statistics on different kinds of talk and interaction.ResultsPolicy-makers viewed remote video consultations as a way of delivering health care efficiently in the context of rising rates of chronic illness and growing demand for services. However, the reality of establishing such services in a busy and financially stretched NHS acute trust proved to be far more complex and expensive than anticipated. Embedding new models of care took much time and many resources, and required multiple workarounds. Considerable ongoing effort was needed to adapt and align structures, processes and people within clinics and across the organisation. For practical and safety reasons, virtual consultations were not appropriate for every patient or every consultation. By the end of this study, between 2% and 20% of all consultations were being undertaken remotely in participating clinics. Technical challenges in setting up such consultations were typically minor, but potentially prohibitive. When clinical, technical and practical preconditions were met, virtual consultations appeared to be safe and were popular with both patients and staff. Compared with face-to-face consultations, virtual consultations were very slightly shorter, patients did slightly more talking and both parties sometimes needed to make explicit things that typically remained implicit in a traditional encounter. Virtual consultations appeared to work better when the clinician and the patient knew and trusted each other. Some clinicians used Skype adaptively to support ad hoc clinician-initiated and spontaneous patient-initiated encounters. Other clinicians chose not to use the new service model at all.ConclusionsVirtual consultations appear to be safe, effective and convenient for patients who are preselected by their clinicians as ‘suitable’, but such patients represent a small fraction of clinic workloads. There are complex challenges to embedding virtual consultation services within routine practice in the NHS. Roll-out (across the organisation) and scale-up (to other organisations) are likely to require considerable support.LimitationsThe focus on a single NHS organisation raises questions about the transferability of findings, especially quantitative data on likely uptake rates.Future researchFurther studies on the micro-analysis of virtual consultations and on the spread and scale-up of virtual consulting services are planned.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Uncertainty about cellulitis and unmet patient information needs: a mixed methods study

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X697349
Author(s):  
Anna Lalonde ◽  
Emma Teasdale ◽  
Ingrid Muller ◽  
Joanne Chalmers ◽  
Peter Smart ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Information Needs ◽  
Qualitative Data ◽  
Information Provision ◽  
Mixed Methods Study ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Face To Face ◽  
Patient Information Needs ◽  
History Of

BackgroundCellulitis is a common painful infection of the skin and underlying tissues that recurs in approximately a third of cases. Patients’ ability to recover from cellulitis or prevent recurrence is likely to be influenced by their understanding of the condition.AimTo explore patients’ perceptions of cellulitis and their information needs.MethodMixed methods study comprising semi-structured, face-to-face interviews and cross-sectional survey, recruiting through primary care, secondary care and advertising. Adults aged 18 or over with a history of cellulitis (first or recurrent) were invited to complete a survey, take part in an interview or both. Qualitative data was analysed thematically.ResultsThirty interviews were conducted between August 2016 and July 2017. Qualitative data revealed low prior awareness of cellulitis, uncertainty around diagnosis, concern/surprise at the severity of cellulitis, and perceived insufficient information provision. People were surprised they had never heard of the condition and that they had not received advice or leaflets giving self-care information. Some sought information from the internet and found this bewildering. Two hundred and forty surveys were completed (response rate 17%). These showed that, while most people received information on the treatment of cellulitis (60.0%, n = 144), they reported receiving no information about causes (60.8%, n = 146) or prevention of recurrence (73.3%, n = 176).ConclusionThere is a need for provision of basic information for people with cellulitis, particularly being informed of the name of their condition, how to manage acute episodes, and how to reduce risk of recurrence.

scholarly journals Young Children’s Belonging in Finnish Educational Settings: an Intersectional Analysis

2021 ◽  
Author(s):  
Anna-Maija Puroila ◽  
Jaana Juutinen ◽  
Elina Viljamaa ◽  
Riikka Sirkko ◽  
Taina Kyrönlampi ◽  
...  
Keyword(s):  
Educational Policy ◽  
Educational Programs ◽  
Macro Level ◽  
Educational Settings ◽  
Policy Documents ◽  
Meso Level ◽  
Continuity And Change ◽  
Positional Power ◽  
Micro Level ◽  
Similarities And Differences

AbstractThe study draws on a relational and intersectional approach to young children’s belonging in Finnish educational settings. Belonging is conceptualized as a multilevel, dynamic, and relationally constructed phenomenon. The aim of the study is to explore how children’s belonging is shaped in the intersections between macro-, meso-, and micro-levels of young children’s education in Finland. The data consist of educational policy documents and ethnographic material generated in educational programs for children aged birth to 8 years. A situational mapping framework is used to analyze and interpret the data across and within systems levels (macro-level; meso-level; and micro-level). The findings show that the landscape in which children’s belonging is shaped and the intersections across and within the levels are characterized by the tensions between similarities and differences, majority and minorities, continuity and change, authority and agency. Language used, practices enacted, and positional power emerge as the (re)sources through which children’s (un)belonging is actively produced.

The prospects for pluralism in contract theory

Legal Studies ◽  
2021 ◽  
pp. 1-20
Author(s):  
Zhong Xing Tan
Keyword(s):  
Contract Theory ◽  
Practical Reasoning ◽  
Contemporary Literature ◽  
Contract Law ◽  
Macro Level ◽  
Meso Level ◽  
Specific Performance ◽  
Micro Level

Abstract This paper explores the promise of pluralism in the realm of contract law. I begin by identifying and rejecting conceptual strategies adopted by monistic and dualistic approaches. Turning towards pluralism, I evaluate three versions in contemporary literature: pluralism across contracting spheres and types, pluralism through consensus and convergence, and pluralism through localised values-balancing and practical reasoning. I suggest embracing some pluralism about contract pluralism, by using these models to construct a framework of ‘meta-pluralism’, where at the macro-level, we are concerned with plural spheres of contracting activity; at the meso-level, a variety of trans-substantive interpretive concepts that receive some measure of juristic consensus; and at the micro-level, practical reasoning through particularistic analysis of case-specific considerations. I illustrate the meta-pluralistic framework through a case study on the varieties of specific performance, and explain how the proposed pluralistic framework enriches our understanding of the nature of contract.

Scale-up and Sustainability of a Personalized End-of-Life Care Intervention: A Longitudinal Mixed-Methods Study

2020 ◽  
Author(s):  
Alyson Takaoka ◽  
Benjamin Tam ◽  
Meredith Vanstone ◽  
France J. Clarke ◽  
Neala Hoad ◽  
...  
Keyword(s):  
Mixed Methods ◽  
End Of Life ◽  
Life Support ◽  
Scale Up ◽  
Fold Increase ◽  
Mixed Methods Study ◽  
Secondary Outcome ◽  
Patient Death ◽  
Dying Patients ◽  
Clinical Program

Abstract Background: Scaling-up and sustaining healthcare interventions can be challenging. Our objective was to describe how the 3 Wishes Project (3WP), a personalized end-of-life intervention, was scaled-up and sustained in an intensive care unit (ICU).Methods: In a longitudinal mixed-methods study from January 1,2013 - December 31, 2018, dying patients and families were invited to participate if the probability of patient death was >95% or after a decision to withdraw life support. A research team member or bedside clinician learned more about each of the patients and their family, then elicited and implemented <3 personalized wishes for patients and/or family members. We used a qualitative descriptive approach to analyze interviews and focus groups conducted with 25 clinicians who cared for patients enrolled in the project. We used descriptive statistics to summarize patient, wish, and clinician characteristics, and analyzed outcome data in quarters using Statistical Process Control charts. The primary outcome was enrollment of terminally ill patients and respective families; the secondary outcome was the number of wishes per patient; tertiary outcomes included wish features and stakeholder involvement. Results: Both qualitative and quantitative analyses suggested a three-phase approach to the scale-up of this intervention during which 369 dying patients were enrolled, having 2039 terminal wishes implemented. From a research project to clinical program to an approach to practice, we documented a three-fold increase in enrolment with a five-fold increase in total wishes implemented, without a change in cost. Beginning as a study, the protocol provided structure; starting gradually enabled frontline staff to experience and recognize the value of acts of compassion for patients, families, and clinicians. The transition to a clinical program was marked by handover from the research staff to bedside staff, whereby project catalysts mentored project champions to create staff partnerships, and family engagement became more intentional. The final transition involved empowering staff to integrate the program as an approach to care, expanding it within and beyond the organization. Conclusions: The 3WP is an end-of-life intervention which was implemented as a study, scaled-up into a clinical program, and sustained by becoming integrated into practice as an approach to care.

The Meaning of Property in Things

2020 ◽  
pp. 3-21
Author(s):  
Bart J. Wilson
Keyword(s):  
Property Rights ◽  
Homo Sapiens ◽  
Physical World ◽  
Macro Level ◽  
Human Society ◽  
Ordinary People ◽  
Social Scientists ◽  
Meso Level ◽  
Micro Level ◽  
Central Claim

The central claim of the book is that property is a universal and uniquely human custom. Contra cultural relativists, every human society has property tools, utensils, and ornaments. Contra biologists, only Homo sapiens has property in things other than food, mates, and territories. Contra philosophers and legal scholars, the bedrock of property is custom, not rights. Contra social scientists and ordinary people, property is indeed a custom and not something that must be instituted by government. Property operates at the three levels. At the micro-level core of property is an organism that perceives the physical world through its body. The meso-level of property is the community within which the organism resides. At the macro-level of property are the institutions that unite strangers of different communities through the modern democratic concept of rights. Whereas the custom of property is ancient, moral, and universal to all people, property rights are modern, amoral, and majoritarian.

Value co-creation through actor embeddedness and actor engagement

2019 ◽  
Vol 37 (3) ◽  
pp. 271-283 ◽  
Author(s):  
Anees Wajid ◽  
Muhammad Mustafa Raziq ◽  
Omer Farooq Malik ◽  
Shahab Alam Malik ◽  
Nabila Khurshid
Keyword(s):  
Design Methodology ◽  
Conceptual Models ◽  
Perceived Value ◽  
Marketing Research ◽  
Macro Level ◽  
Content Type ◽  
Creation Process ◽  
Meso Level ◽  
Micro Level ◽  
Service Ecosystem

Purpose It is argued that the service-dominant (S-D) view of the value co-creation concept is mainly of a macro nature and is difficult to examine empirically. In this regard, marketing research using the micro-foundation theory proposes some conceptual models, through which relationships (involving value co-creation) at a micro/meso level may be studied. The purpose of this paper is to add to such exchanges regarding value co-creation and conceptualize the link of embeddedness of an actor (in a service-ecosystem) to their engagement in the value co-creation process. Design/methodology/approach The authors draw on the S-D logic and the value co-creation concept and make propositions with regard to two micro-foundational concepts: actor engagement and actor embeddedness. Findings The authors show that actor embeddedness can be considered as an antecedent of actor engagement, which leads to value co-creation at a macro level and perceived value in context at the micro level. Originality/value The authors fill some gaps in literature with regard to S-D logic and value co-creation by combining two micro-foundational concepts: actor engagement and actor embeddedness and propose how through these, some macro-level outcomes such as value co-creation and resource integration may be determined.

Meeting the Challenges in Evaluating Mobile Learning

2011 ◽  
pp. 178-194 ◽  
Author(s):  
Giasemi Vavoula ◽  
Mike Sharples
Keyword(s):  
Mobile Learning ◽  
Mobile Technology ◽  
Cultural Context ◽  
Learning Experience ◽  
Learning Processes ◽  
Macro Level ◽  
Learning In Context ◽  
Meso Level ◽  
Micro Level ◽  
Context Of Learning

We propose six challenges in evaluating mobile learning: capturing and analysing learning in context and across contexts, measuring mobile learning processes and outcomes, respecting learner/participant privacy, assessing mobile technology utility and usability, considering the wider organisational and socio-cultural context of learning, and assessing in/formality. A three-level framework for evaluating mobile learning is proposed, comprising a micro level concerned with usability, a meso level concerned with the learning experience, and a macro level concerned with integration within existing educational and organisational contexts. The article concludes with a discussion of how the framework meets the evaluation challenges and with suggestions for further extensions.

Structural Sexism and Health in the United States: A New Perspective on Health Inequality and the Gender System

2019 ◽  
Vol 84 (3) ◽  
pp. 486-516 ◽  
Author(s):  
Patricia Homan
Keyword(s):  
Health Outcomes ◽  
Physical Health ◽  
Gender Inequality ◽  
Health Inequality ◽  
State Level ◽  
The United States ◽  
Macro Level ◽  
Future Research ◽  
Meso Level ◽  
Micro Level

In this article, I build a new line of health inequality research that parallels the emerging structural racism literature. I develop theory and measurement for the concept of structural sexism and examine its relationship to health outcomes. Consistent with contemporary theories of gender as a multilevel social system, I conceptualize and measure structural sexism as systematic gender inequality at the macro level (U.S. state), meso level (marital dyad), and micro level (individual). I use U.S. state-level administrative data linked to geocoded data from the NLSY79, as well as measures of inter-spousal inequality and individual views on women’s roles as predictors of physical health outcomes in random-effects models for men and women. Results show that among women, exposure to more sexism at the macro and meso levels is associated with more chronic conditions, worse self-rated health, and worse physical functioning. Among men, macro-level structural sexism is also associated with worse health. However, greater meso-level structural sexism is associated with better health among men. At the micro level, internalized sexism is not related to physical health among either women or men. I close by outlining how future research on gender inequality and health can be furthered using a structural sexism perspective.

Bridging Levels of Public Administration: How Macro Shapes Meso and Micro

2019 ◽  
Vol 52 (4) ◽  
pp. 631-656 ◽  
Author(s):  
Alasdair Roberts
Keyword(s):  
Public Administration ◽  
American History ◽  
The State ◽  
Macro Level ◽  
Levels Of Analysis ◽  
Meso Level ◽  
State Institutions ◽  
Micro Level ◽  
The Relationship

Scholars in public administration now recognize three levels of analysis: macro, meso, and micro. But there is uncertainty about the relationship between levels and concern about a “schism” in research. However, linkages between levels can be demonstrated easily. At the macro-level, leaders develop an overall strategy for pursuing national priorities, which determines the broad architecture of the state. Institutions must be built, renovated, or managed to give effect to these strategies: This is the meso-level of public administration. Overall, strategies also shape the micro-level relationship between people who rule and people who are ruled. This is done by categorizing people—as subjects or citizens, for example—and by redefining categories. Macro-level strategies evolve, with consequences for the agenda at the meso- and micro-levels. Experience at lower levels also shapes strategy at the macro-level. The interaction among levels is illustrated by comparison of three eras in modern American history.

Integrative Governance

2016 ◽  
Vol 47 (1) ◽  
pp. 130-147 ◽  
Author(s):  
Margaret Stout ◽  
Jeannine M. Love
Keyword(s):  
Theoretical Analysis ◽  
Progressive Era ◽  
A Priori ◽  
Collective Responsibility ◽  
Macro Level ◽  
Community Members ◽  
Face To Face ◽  
Constructive Conflict ◽  
Alternative Approach ◽  
Micro Level

Public encounters, the micro-level relational process of face-to-face contact between public professionals and community members, are argued to have a meaningful effect on the outcomes of governance activities. In turn, the specific characteristics of these encounters are constrained by institutionalized macro-level structures, yet the variety of contexts and associated relational styles have not been carefully explored. Therefore, in this article, public encounters are considered in light of a particular governance typology to (a) clearly differentiate macro-level contexts, (b) clearly differentiate the associated styles of relating in each type of public encounter, (c) describe the ways in which these interactions hinder or foster productive processes and outcomes, and (d) identify a preferred approach for potentially more fruitful results. In this way, the article provides a theoretical platform for future analysis of empirical cases. This theoretical analysis reveals the pathological dynamics in public encounters produced by typical approaches to governance and offers an alternative approach that may produce more effective public encounters. Specifically, using the method of integration described by Progressive Era scholar Mary Follett, we argue fruitful public encounters entail a relational disposition, a cooperative style of relating, a collaborative mode of association, and a method for achieving integration that enables constructive conflict through disintegration of a priori positions; collaborative discovery of facts and values; revaluation of desires and methods through dialogue; creative and integrative determinations; collective responsibility; and experientially founded commitment.

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