Bringing ethics into governance: the case of the UK COVID-19 contact tracing app

PurposeIn April 2020, it was announced that NHSX, a unit of the UK National Health Service (NHS) responsible for digital innovation, was developing a contact tracing app that would offer a digital solution to managing the COVID-19 pandemic. Despite the urgency with which the app was developed, a clear commitment was made to designing the technology in a way that enshrined key ethical principles, and an ethics advisory board (EAB) was established to provide timely advice, guidance and recommendations on associated ethical issues. Alongside this, there were extensive criticisms of how NHSX adhered to ethical principles in the handling of the app development-criticisms that require empirical exploration. This paper explores how ethics was incorporated into decision-making during governance processes associated with the development of app.Design/methodology/approachInterviews were conducted with those involved in the app's development/governance, those with a consulting role associated with the app, or those who sat on the EAB.FindingsThe EAB fulfilled an important role by introducing ethical considerations to app developers. Though at times, it was difficult to accommodate key ethics principles into governance processes, which sometimes suffered from little accountability.Originality/valueWhile several articles have provided overviews of ethical issues, or explored public perceptions towards contact tracing apps, to the best the authors, knowledge this is the first empirical piece analysing ethics governance issues via stakeholder interviews.

Assessing community health governance for evidence-informed decision-making: a cross-sectional study across nine districts of India

PurposeThe authors intend to assess the village health sanitation and nutrition committees (VHSNC) on six parameters, including their formation, composition, meeting frequencies, activities, supervisory mechanisms and funds receipt and expenditures across nine districts of the three states of India.Design/methodology/approachThe cross-sectional study, conducted in the states of Uttar Pradesh (five districts), Odisha (two districts) and Rajasthan (two districts), used a quantitative research design. The community health workers of 140 VHSNCs were interviewed using a semi-structured questionnaire. The details about the funds' receipt and expenditures were verified from the VHSNC records (cashbook). Additionally, the authors asked about the role of health workers in the VHSNC meetings, and the issues and challenges faced.FindingsThe average number of members in VHSNCs varied from 10 in Odisha to 15 in Rajasthan. Activities were regularly organized in Rajasthan and Odisha (one per month) compared to Uttar Pradesh (one every alternate month). Most commonly, health promotion activities, cleanliness drives, community monitoring and facilitation of service providers were done by VHSNCs. Funds were received regularly in Odisha compared to Rajasthan and Uttar Pradesh. Funds were received late and less compared to the demands or needs of VHSNCs.Research limitations/implications This comprehensive analysis of VHSNCs' functioning in the selected study areas sheds light on the gaps in many components, including the untimely and inadequate receipt of funds, poor documentation of expenditures and involvement of VHSNC heads and inadequate supportive supervision.Originality/value VHSNCs assessment has been done for improving community health governance.

Board level “Picture-Understanding-Action”: a new way of looking at quality

PurposeThe purpose of this study is to present a quality improvement approach titled “Picture-Understanding-Action” used in Ireland to enhance the role of healthcare boards in the oversight of healthcare quality and its improvement.Design/methodology/approachThe novel and practical “Picture-Understanding-Action” approach was implemented using the Model for Improvement to iteratively introduce changes across three quality improvement projects. This approach outlines the concepts and activities used at each step to support planning and implementation of processes that allow a board to effectively achieve its role in overseeing and improving quality. This approach matured over three quality improvement projects.FindingsThe “Picture” included quantitative and qualitative aspects. The quantitative “Picture” consisted of a quality dashboard/profile of board selected outcome indicators representative of the health system using statistical process control (SPC) charts to focus discussion on real signals of change. The qualitative picture was based on the experience of people who use and work in health services which “people-ised” the numbers. Probing this “Picture” with collective grounding, curiosity and expert training/facilitation developed a shared “Understanding”. This led to “Action(s)” from board members to improve the “Picture” and “Understanding” (feedback action), to ask better questions and make better decisions and recommendations to the executive (feed-forward action). The Model for Improvement, Plan-Do-Study-Act cycles and a co-design approach in design and implementation were key to success.Originality/valueTo the authors’ knowledge, this is the first time a board has undertaken a quality improvement (QI) project to enhance its own processes. It addresses a gap in research by outlining actions that boards can take to improve their oversight of quality of care.

A critical analysis of the social media policies in Ontario's healthcare system

PurposeSocial media has made a revolutionary change in the relationship between the customers and business or service providers by enabling customers to publish and share feedback and views about product or service quality. This revolutionary change has not been echoed in some healthcare systems. This study analyses the social media policies of healthcare regulatory authorities in Ontario and explores how these policies encourage or discourage healthcare professionals' use of social media for collecting patient stories and understanding patient experience.Design/methodology/approachThe study used qualitative content analysis to analyse the policy documents, focusing on the manifest themes in these documents. It used convenient sampling to select 12 organizations, including regulating and licensing bodies and health service delivery organizations in Ontario. The authors collected 24 documents from these organizations, including policies, practice standards and social media learning materials.FindingsIn Ontario's healthcare system, social media is perceived as a source of risks to the healthcare professions and professionals. Healthcare regulators emphasize that the codes of conduct and professional standards extend to social media. The study found no systematic recognition of patient stories on social media as a source of information on healthcare quality that can be useful for healthcare professionals.Originality/valueThe study identifies potential unintended consequences of social media policies in the healthcare system and calls for policy and cultural changes to enable the development of safe social media platforms that can facilitate interaction between healthcare providers and patients, when necessary, without the fear of legal consequences or privacy breaches.

Factors affecting hospital costs and revenue: integrating expert opinions and literature review

PurposeThere is not enough comprehensive evidence on factors affecting hospital costs and revenue (HCR). The main objective of the current study is to identify and classify factors affecting HCR integrating experts' opinions and literature review.Design/methodology/approachFirst, a restricted literature review is conducted to identify the factors affecting HCR. In the second step, the targeted semi-structured interviews are conducted with 15 experts to identify, validate and classify the latent factors.FindingsIn addition to the factors identified through the literature review, 22 new important factors were added by the experts as the determinants of HCR, which were not pointed out in previous studies. The final model presented for the factors affecting HCR contains seven main groups, 22 subgroups and 70 variables.Originality/valueFactors affecting HCR will provide valuable contributions for hospital budgeting, and financial and strategic planning, and they will offer an effective horizon for future research on cost-cutting strategies.

Vaccine hesitancy and implications on childhood immunisation in Malaysia

PurposeThe World Health Organization identified vaccine hesitancy as one of the ten threats to global health in 2019. The purpose of this paper is to evaluate the implications and factors affecting parental decision on childhood immunisation in Malaysia.Design/methodology/approachThis paper reviews literature on vaccine hesitancy and evaluation of factors affecting parental decision on childhood immunisation in Malaysia.FindingsVaccine hesitancy is a growing public health concern in Malaysia with factors such as influence of Internet and social media, personal choice and individual right, conspiracy theory, religious reasons and alternative medicine as among the influencing dynamics. An urban, educated demography operating within a postmodern medical paradigm compounds the diminishing value of vaccines.Originality/valueThis paper provides a comprehensive examination of vaccine hesitancy in Malaysia. Critical appraisal on personal choice over societal responsibility within an Asian/Muslim collectivist society has not been discussed in previous studies. The acceptance of homeopathy as an Islamic medicine alternative is peculiar to multi-ethnic, multi-cultural Malaysia.

What drives the healthcare sector's economic impact? Evidence from European countries

PurposeWith high public debts and suffering economies after the COVID-19 pandemic, governments will look for ways to promote recovery. Literature substantially reports on the favorable macroeconomic impact of the healthcare sector.Design/methodology/approachThe authors use data on 19 European countries. Over 30 variables are analyzed to find factors that foster or suppress the economic impact of the healthcare sector. The economic impact is thereby expressed through five types of total multipliers, acting as dependent variables. The authors estimate multiple econometric models.FindingsThe results indicate factors that intensify or reduce the economic impact of the healthcare sector as they cause the value of one or more economic multipliers to augment or to diminish. Positive effects are expected from the growth of public funds' share in total healthcare expenditure leading to a higher output, income and value-added multipliers. The import multiplier diminishes when expenditure on healthcare as percent of GDP rises. On the other hand, rising expenditure on pharmaceuticals in the share of healthcare expenditure lowers the output multiplier. Rising GDP per capita and higher healthcare systems' technical efficiency cause the employment multiplier to lower.Originality/valuePolicymakers can strengthen the economic impact of the healthcare sector on the national economy. This could be achieved by stimulating factors, being identified in our study. Strengthening the economic impact of the healthcare sector is especially welcomed when fostering economic recovery is needed.

Rapid evidence review to understand effective frailty care pathways and their components in primary and community care

PurposeDifferent pathways of frailty care to prevent or delay progression of frailty and enable people to live well with frailty are emerging in primary and community care in the UK. The purpose of the study is to understand effective frailty care pathways and their components to inform future service development and pathway evaluation in primary- and community-care services.Design/methodology/approachA rapid evidence review was conducted: 11 research publications met the inclusion criteria and were analysed using narrative thematic synthesis.FindingsThere is strong evidence that resistance-based exercise, self-management support, community geriatric services and hospital at home (HAH) improve patient health and function. In general, evaluation and comparison of frailty care pathways, components and pathway operations is challenging due to weaknesses, inconsistencies and differences in evaluation, but it is essential to include consideration of process, determinant and implementation of pathways in evaluations.Originality/valueTo achieve meaningful evaluations and facilitate comparisons of frailty pathways, a standardised evaluation toolkit that incorporates evaluation of how pathways are operated is required for evaluating the impact of frailty pathways of care.

Strategies and lessons learnt from user involvement in researching quality and safety in nursing homes and homecare

PurposeThe purpose is to share strategies, rationales and lessons learnt from user involvement in a quality and safety improvement research project from the practice field in nursing homes and homecare services.Design/methodology/approachThis is a viewpoint paper summarizing how researchers and co-researchers from the practice field of nursing homes and homecare services (nurse counsellors from different municipalities, patient ombudsman and next-of-kin representatives/and elderly care organization representant) experienced user involvement through all phases of the research project. The project included implementation of a leadership intervention.FindingsMultiple strategies of user involvement were applied during the project including partnership in the consortium, employment of user representatives (co-researchers) and user-led research activities. The rationale was to ensure sound context adaptation of the intervention and development of tailor-made activities and tools based on equality and mutual trust in the collaboration. Both university-based researchers and Co-researchers experienced it as useful and necessary to involve or being involved in all phases of the research project, including the designing, planning, intervention implementation, evaluation and dissemination of results.Originality/valueUser involvement in research is a growing field. There is limited focus on this aspect in quality and safety interventions in nursing homes and homecare settings and in projects focussing on the leadership' role in improving quality and safety.