Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397720180701Exploring 70 Years of the British National Health Service through Anniversary Documents574580347310.15171/ijhpm.2018.21ENMartinPowellHealth Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK0000-0002-9148-5087Journal Article20171220<span class="fontstyle0">The British National Health Service (NHS) celebrates its 70th birthday on July 5, 2018. This article examines this anniversary through the lens of previous anniversaries. It examines seven documents close to each anniversary over a period of some 60 years, drawing on interpretive content analysis, based on the narrative dimensions of context (structure and finance); success or achievements; problems; and solutions or recommendations. It finds that the anniversary documents tend to show change rather than consistency. For example, the Guillebaud Report tended to dismiss the problem of ageing populations, for it to reappear in 1979 and 1989, to fade in 2009, and reappear once more in 2017. Despite being downplayed or ignored in some years, the problems identified by most of the documents such as demography and technology are unlikely to disappear. Some solutions such as market-based reform have flowed and ebbed over the years, and the ‘solution’ of structural reorganisation in one year has become the ‘problem’ in a future year. While predicting the future is always hazardous, it can be said with some confidence that future anniversaries are likely to see discussion of similar themes.</span>https://www.ijhpm.com/article_3473_e64b9cef9547ae38494b7333f323c675.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397720180701Addressing Health Equity Through Action on the Social Determinants of Health: A Global Review of Policy Outcome Evaluation Methods581592345910.15171/ijhpm.2018.04ENJaniceLeeSchool of Regulation and Global Governance (RegNet), College of Asia and
the Pacific, Australian National University, Canberra, ACT, AustraliaAshleySchramSchool of Regulation and Global Governance (RegNet), College of Asia and
the Pacific, Australian National University, Canberra, ACT, Australia0000-0001-5231-6291EmilyRileyMenzies
Centre for Health Policy, Sydney Medical School, The University of Sydney,
Sydney, NSW, AustraliaPatrickHarrisMenzies
Centre for Health Policy, Sydney Medical School, The University of Sydney,
Sydney, NSW, Australia0000-0002-4649-4013FranBaumSouthgate Institute of Health, Society and Equity,
Flinders University, Adelaide, SA, Australia0000-0002-2294-1368MattFisherSouthgate Institute of Health, Society and Equity,
Flinders University, Adelaide, SA, Australia0000-0003-3756-1146TobyFreemanSouthgate Institute of Health, Society and Equity,
Flinders University, Adelaide, SA, Australia0000-0002-2787-8580SharonFrielSchool of Regulation and Global Governance (RegNet), College of Asia and
the Pacific, Australian National University, Canberra, ACT, Australia0000-0002-8345-5435Journal Article20170705Background<br /> Epidemiological evidence on the social determinants of health inequity is well-advanced, but considerably less attention has been given to evaluating the impact of public policies addressing those social determinants. Methodological challenges to produce evidence on policy outcomes present a significant barrier to mobilising policy actions for health equities. This review aims to examine methodological approaches to policy evaluation of health equity outcomes and identify promising approaches for future research.<br /> <br /> Methods<br /> We conducted a systematic narrative review of literature critically evaluating policy impact on health equity, synthesizing information on the methodological approaches used. We searched and screened records from five electronic databases, using pre-defined protocols resulting in a total of 50 studies included for review. We coded the studies according to (1) type of policy analysed; (2) research design; (3) analytical techniques; (4) health outcomes; and (5) equity dimensions evaluated.<br /> <br /> Results<br /> We found a growing number of a wide range of policies being evaluated for health equity outcomes using a variety of research designs. The majority of studies employed an observational research design, most of which were cross-sectional, however, other approaches included experimental designs, simulation modelling, and meta-analysis. Regression techniques dominated the analytical approaches, although a number of novel techniques were used which may offer advantages over traditional regression analysis for the study of distributional impacts of policy. Few studies made intra-national or cross-national comparisons or collected primary data. Despite longstanding challenges of attribution in policy outcome evaluation, the majority of the studies attributed change in physical or mental health outcomes to the policy being evaluated.<br /> <br /> Conclusion<br /> Our review provides an overview of methodological approaches to health equity policy outcome evaluation, demonstrating what is most commonplace and opportunities from novel approaches. We found the number of studies evaluating the impacts of public policies on health equity are on the rise, but this area of policy evaluation still requires more attention given growing inequitieshttps://www.ijhpm.com/article_3459_a0dd788951dff189523154479133fc77.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397720180701“Three Nooses on Our Head”: The Influence of District Health Reforms on Maternal Health Service Delivery in Vietnam593602343910.15171/ijhpm.2017.134ENNguyenThi Hoai ThuInstitute for Preventive Medicine and Public Health, Hanoi Medical University,
Hanoi, VietnamFionaMcDonaldAustralian Centre for Health Law Research, Faculty of Law,
Queensland University of Technology, Brisbane, QLD, AustraliaSophieWitterInstitute for
Global Health and Development, Queen Margaret University, Musselburgh,
UK0000-0002-7656-6188AndrewWilsonMenzies Centre for Health Policy, University of Sydney, Sydney, NSW,
AustraliaJournal Article20170512<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">The impact of reorganisation on health services delivery is a recurring issue in every healthcare system. In 2005 Vietnam reorganised the delivery of health services at the district level by splitting preventive, curative, and administrative roles. This qualitative study explored how these reforms impacted on the organisation of maternal health service delivery at district and commune levels.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">Forty-three semi-structured interviews were conducted with health staff and managers involved in the provision of maternal health services from the commune to the central level within five districts of two Northern provinces in Vietnam. The data were analysed thematically.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">The results showed that 10 years after the reforms created three district-level entities, participants reported difficulties in management of health services at the district and commune levels in Vietnam. The reforms were largely perceived to negatively affect the efficient and effective use of clinical and other resources. At the commune level, the reforms are said to have affected the quality of supervision of the communes and their staff and increased the workload in community health centres.<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">The findings from this study suggest that the current organisation of district health services in Vietnam may have had unintended negative consequences. It also indicates that countries which decide to reform their systems in a manner similar to Vietnam need to pay attention to coordination between a multiplicity of agencies at the district level.</span>https://www.ijhpm.com/article_3439_c676536f3d3399cd835958f46cf2b54c.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397720180701Examining the Implementation of the Free Maternity Services Policy in Kenya: A Mixed Methods Process Evaluation603613344010.15171/ijhpm.2017.135ENEricTamaHealth Economics Research Unit, KEMRI Wellcome Trust Research
Programme, Nairobi, KenyaInstitute of Healthcare Management, Strathmore
University, Nairobi, Kenya0000-0003-4840-1535SassyMolyneuxKEMRI Wellcome Trust Research Programme,
Kilifi, Kenya0000-0001 9522-416XEvelynWaweruKEMRI Wellcome Trust Research Programme,
Kilifi, KenyaBenjaminTsofaKEMRI Wellcome Trust Research Programme,
Kilifi, KenyaJaneChumaHealth Economics Research Unit, KEMRI Wellcome Trust Research
Programme, Nairobi, KenyaThe World Bank, Kenya Country Office, Nairobi, KenyaEdwineBarasaHealth Economics Research Unit, KEMRI Wellcome Trust Research
Programme, Nairobi, KenyaNuffield
Department of Medicine, University of Oxford, Oxford, UK0000-0001-5793-7177Journal Article20170502<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">Kenya introduced a free maternity policy in 2013 to address the cost barrier associated with accessing maternal health services. We carried out a mixed methods process evaluation of the policy to examine the extent to which the policy had been implemented according to design, and positive experiences and challenges encountered during implementation.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">We conducted a mixed methods study in 3 purposely selected counties in Kenya. Data were collected through in-depth interviews (IDIs) with policy-makers at the national level, health managers at the county level, and frontline staff at the health facility level (n = 60), focus group discussions (FGDs) with community representatives (n = 10), facility records, and document reviews. We analysed the data using a framework approach.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">Rapid implementation led to inadequate stakeholder engagement and confusion about the policy. While the policy was meant to cover antenatal visits, deliveries, and post-natal visits, in practice the policy only covered deliveries. While the policy led to a rapid increase in facility deliveries, this was not matched by an increase in health facility capacity and hence compromised quality of care. The policy led to an improvement in the level of revenues for facilities. However, in all three counties, reimbursements were not made on time. The policy did not have a system of verifying health facility reports on utilization of services.<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">The Kenyan Ministry of Health (MoH) should develop a formal policy on the free maternity services, and provide clear guidelines on its content and implementation arrangements, engage with and effectively communicate the policy to stakeholders, ensure timeliness of payment disbursement to healthcare facilities, and introduce a mechanism for verifying utilization reports prepared by healthcare providers. User fee removal policies such as free maternity programmes should be accompanied by supply side capacity strengthening</span>https://www.ijhpm.com/article_3440_cca2ad9a33d3c4744010470311ecee2d.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397720180701Psychosocial Workplace Factors and Healthcare Utilization: A Study of Two Employers614622344210.15171/ijhpm.2017.132ENJessica AlliaWilliamsHarvard Center for Population & Development Studies, Cambridge, MA, USAThe University of Kansas Medical Center, Department of Health Policy and
Management, Kansas City, KS, USAOrfeuBuxtonDepartment of Biobehavioral Health,
Pennsylvania State University, State College, PA, USADivision of Sleep
Medicine, Harvard Medical School, Boston, MA, USADepartment of Social
and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston,
MA, USAJesseHindeDepartment of Public Policy, University of North Carolina at Chapel
Hill, Chapel Hill, NC, USARTI International, Research Triangle Park, NC,
USAJeremyBrayDepartment of Economics, University of North Carolina Greensboro,
Greensboro, NC, USALisaBerkmanHarvard Center for Population and Development
Studies, T.H. Chan Harvard School of Public Health, Cambridge, MA, USAJournal Article20170419<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">While a large literature links psychosocial workplace factors with health and health behaviors, there is very little work connecting psychosocial workplace factors to healthcare utilization.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">Survey data were collected from two different employers using computer-assisted telephone interviewing as a part of the Work-Family Health Network (2008-2013): one in the information technology (IT) service industry and one that is responsible for a network of long-term care (LTC) facilities. Participants were surveyed four times at six month intervals. Responses in each wave were used to predict utilization in the following wave. Four utilization measures were outcomes: having at least one emergency room (ER)/Urgent care, having at least one other healthcare visit, number of ER/urgent care visits, and number of other healthcare visits. Population-averaged models using all four waves controlled for health and other factors associated with utilization.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">Having above median job demands was positively related to the odds of at least one healthcare visit, odds ratio [OR] 1.37 (</span><span class="fontstyle0">P </span><span class="fontstyle0">< .01), and the number of healthcare visits, incidence rate ratio (IRR) 1.36 (</span><span class="fontstyle0">P </span><span class="fontstyle0">< .05), in the LTC sample. Work-to-family conflict was positively associated with the odds of at least one ER/urgent care visit in the LTC sample, OR 1.15 (</span><span class="fontstyle0">P </span><span class="fontstyle0">< .05), at least one healthcare visit in the IT sample, OR 1.35 (</span><span class="fontstyle0">P </span><span class="fontstyle0">< .01), and with more visits in the IT sample, IRR 1.35 (</span><span class="fontstyle0">P </span><span class="fontstyle0">< .01). Greater schedule control was associated with reductions in the number of ER/urgent care visits, IRR 0.71 (</span><span class="fontstyle0">P </span><span class="fontstyle0">< .05), in the IT sample.<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">Controlling for other factors, some psychosocial workplace factors were associated with future healthcare utilization. Additional research is needed.</span>https://www.ijhpm.com/article_3442_686f4284104a57209b94c93964395fbb.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397720180701Validation of Instruments for Assessing Drug Safety Management During the Conduction of Clinical Trials623629344610.15171/ijhpm.2017.140ENYaimarelisSaumellGroup of Health Technology Assessment, Institute of Molecular Immunology,
Havana, CubaOlgaTorresGroup of Health Technology Assessment, Institute of Molecular Immunology,
Havana, CubaMaritzaBatistaResearch Department, Joaquin Castillo Duany’s Hospital,
Santiago de Cuba, CubaLizetSánchezGroup of Health Technology Assessment, Institute of Molecular Immunology,
Havana, CubaJournal Article20170127<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">The management of drug safety with the collection of reliable safety data during the conduction of clinical trials conduct is essential for the registry and marketing of products. The systematic evaluation of this process, based on objective measures, requires the application of quality instruments. This study was aimed to design and validate eight instruments through the components of quality (structure, process, and results), for characterizing and assessing the process of drug safety management, during the conduction of clinical trials.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">The eight instruments were designed according to the international recommendations for Good Clinical Practice (GCP) and comprise a knowledge survey for professionals at the investigational sites, a satisfaction scale of internal and external clients and a satisfaction survey for patients with the treatment of the adverse events. The instruments also include a checklist to evaluate the safety management infrastructure (human, material and organizational resources) in the sponsoring center, a checklist to evaluate the same criterion at the investigational sites and three checklists that evaluate adherence to regulatory requirements of essential documents (investigator’s brochure, protocol, and informed consent form). The content validity was evaluated by Delphi method and the reliability was determined by Cronbach α test.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">All the items were valued as very adequate after the second round of the expert panel. The instruments were deemed as appropriate and understandable in the pre-test performed. All responders agreed with the options given and the accessibility of the application. Only 10% of professionals at the research sites suggested that the knowledge survey was too long. Cronbach α values between .66 and .93 were obtained.<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">The structure, process, and outcome framework allowed for the characterization of drug safety management during clinical trials, providing a useful approach for the promoter to systematically measure and evaluate the process. The eight instruments were deemed as reliable, feasible and easy to be used for examining drug safety management while carrying out clinical trials.</span>https://www.ijhpm.com/article_3446_28af62624ae370356485b1b0c1b3ec7f.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397720180701Performance-Based Financing Empowers Health Workers Delivering Prevention of Vertical Transmission of HIV Services and Decreases Desire to Leave in Mozambique630644344810.15171/ijhpm.2017.137ENRoseanne C.SchusterProgram in International Nutrition, Division of Nutritional Sciences, Cornell
University, Ithaca, NY, USACenter for Global Health, School of Human
Evolution and Social Change, Arizona State University, Tempe, AZ, USAOctávioDe SousaCARE Mozambique, Maputo, MozambiqueAnne-KatheRemeProgram in International Nutrition, Division of Nutritional Sciences, Cornell
University, Ithaca, NY, USACARE Mozambique, Maputo, MozambiqueCarolynVopelakMailman School of Public
Health, Columbia University, New York, NY, USAInternational Medical Corps,
Washington, DC, USADavid L.PelletierProgram in International Nutrition, Division of Nutritional Sciences, Cornell
University, Ithaca, NY, USALynn M.JohnsonCornell Statistical Consulting Unit, Cornell University,
Ithaca, NY, USAMduduziMbuyaProgram in International Nutrition, Division of Nutritional Sciences, Cornell
University, Ithaca, NY, USAGlobal Alliance for Improved Nutrition (GAIN), Washington,
DC, USADelphinePinaultCARE Mozambique, Maputo, MozambiqueSera L.YoungProgram in International Nutrition, Division of Nutritional Sciences, Cornell
University, Ithaca, NY, USADepartment of Population Medicine and Diagnostic Sciences,
Cornell University, Ithaca, NY, USADepartment of Anthropology, Northwestern
University, Evanston, IL, USA.Journal Article20170131<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">Despite increased access to treatment and reduced incidence, vertical transmission of HIV continues to pose a risk to maternal and child health in sub-Saharan Africa. Performance-based financing (PBF) directed at healthcare providers has shown potential to improve quantity and quality of maternal and child health services. However, the ways in which these PBF initiatives lead to improved service delivery are still under investigation.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">Therefore, we implemented a longitudinal-controlled proof-of-concept PBF intervention at health facilities and with community-based associations focused on preventing vertical transmission of HIV (PVT) in rural Mozambique. We hypothesized that PBF would increase worker motivation and other aspects of the workplace environment in order to achieve service delivery goals. In this paper, we present two objectives from the PBF intervention with public health facilities (n = 6): first, we describe the implementation of the PBF intervention and second, we assess the impact of the PBF on health worker motivation, key factors in the workplace environment, health worker satisfaction, and thoughts of leaving. Implementation (objective 1) was evaluated through quantitative service delivery data and multiple forms of qualitative data (eg, quarterly meetings, participant observation (n = 120), exit interviews (n = 11)). The impact of PBF on intermediary constructs (objective 2) was evaluated using these qualitative data and quantitative surveys of health workers (n = 83) at intervention baseline, midline, and endline.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">We found that implementation was challenged by administrative barriers, delayed disbursement of incentives, and poor timing of evaluation relative to incentive disbursement (objective 1). Although we did not find an impact on the motivation constructs measured, PBF increased collegial support and worker empowerment, and, in a time of transitioning implementing partners, decreased against desire to leave (objective 2).<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">Areas for future research include incentivizing meaningful quality- and process-based performance indicators and evaluating how PBF affects the pathway to service delivery, including interactions between motivation and workplace environment factors.</span>https://www.ijhpm.com/article_3448_da8efb1b25bfeb792c8b113a70782a3e.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397720180701Contribution of Nepal’s Free Delivery Care Policies in Improving Utilisation of Maternal Health Services645655345210.15171/ijhpm.2018.01ENHemaBhattOxford Policy Management/NHSSP, Kathmandu, NepalSureshTiwariOxford Policy
Management, Kathmandu, NepalTimEnsorUniversity of Leeds, Leeds, UK0000-0003-0279-9576Dhruba RajGhimireOxford Policy
Management, Kathmandu, NepalTaniaGavidiaVolunteer
VSO, NepalJournal Article20161202<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">Nepal has made remarkable improvements in maternal health outcomes. The implementation of demand and supply side strategies have often been attributed with the observed increase in utilization of maternal healthcare services. In 2005, Free Delivery Care (FDC) policy was implemented under the name of Maternity Incentive Scheme (MIS), with the intention of reducing transport costs associated with giving birth in a health facility. In 2009, MIS was expanded to include free delivery services. The new expanded programme was named “Aama” programme, and further provided a cash incentive for attending four or more antenatal visits. This article analysed the influence of FDC policies, individual and community level factors in the utilisation of four antenatal care (4 ANC) visits and institutional deliveries in Nepal.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">Demographic and health survey data from 1996, 2001, 2006 and 2011 were used and a multi-level analysis was employed to determine the effect of FDC policy intervention, individual and community level factors in utilisation of 4 ANC visits and institutional delivery services.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">Multivariate analysis suggests that FDC policy had the largest effect in the utilisation of 4 ANC visits and institutional delivery compared to individual and community factors. After the implementation of MIS in 2005, women were three times (adjusted odds ratio [AOR] = 3.020, </span><span class="fontstyle0">P </span><span class="fontstyle0">< .001) more likely to attend 4 ANC visits than when there was no FDC policy. After the implementation of Aama programme in 2009, the likelihood of attending 4 ANC visits increased six-folds (AOR = 6.006, </span><span class="fontstyle0">P </span><span class="fontstyle0">< .001) compared prior to the implementation of FDC policy. Similarly, institutional deliveries increased two times after the implementation of the MIS (AOR = 2.117, </span><span class="fontstyle0">P </span><span class="fontstyle0">< .001) than when there was no FDC policy. The institutional deliveries increased five-folds (AOR = 5.116, </span><span class="fontstyle0">P </span><span class="fontstyle0">< .001) after the implementation of Aama compared to no FDC policy.<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">Results from this study suggest that MIS and Aama policies have had a strong positive influence on the utilisation of 4 ANC visits and institutional deliveries in Nepal. Nevertheless, results also show that FDC policies may not be sufficient in raising demand for maternal health services without adequately considering the individual and community level factors</span>https://www.ijhpm.com/article_3452_47b0576223eaf49c225233d77ee02958.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397720180701From Mid-Level Policy Analysis to Macro-Level Political Economy; Comment on “Developing a Framework for a Program Theory-Based Approach to Evaluating Policy Processes and Outcomes: Health in All Policies in South Australia”656658346110.15171/ijhpm.2018.12ENRonaldLabontéCanada Research Chair, Globalization and Health Equity, Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa,
Ottawa, ON, Canada0000-0002-0615-740XJournal Article20171230<span class="fontstyle0">This latest contribution by the evaluation research team at Flinders University/Southgate Institute on their multiyear study of South Australia’s Health in All Policies (HiAP) initiative is simultaneously frustrating, exemplary, and partial. It is frustrating because it does not yet reveal the extent to which the initiative achieved its stated outcomes; that awaits further papers. It is exemplary in describing an evaluation research design in which the research team has excelled over the years, and in adding to it an element of theory testing and re-testing. It is partial, in that the political and economic context considered important in examining both process and outcome of the HiAP initiative stops at the Australian state’s borders as if the macro-level national and global political economy (and its power relations) have little or no bearing on the sustainability of the policy learning that the initiative may have engendered. To ask that of an otherwise elegant study design that effectively engages policy actors in its implementation may be demanding too much; but it may now be time that more critical political economy theories join with those that elaborate well the more routine praxis of public policy-making.</span>https://www.ijhpm.com/article_3461_e9de6815a1a7fadc620ba96bbdf3a774.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397720180701It Ain’t What You Do (But the Way That You Do It): Will Safety II Transform the Way We Do Patient Safety; Comment on “False Dawns and New Horizons in Patient Safety Research and Practice”659661346910.15171/ijhpm.2018.14ENRebeccaLawtonSchool of Psychology, University of Leeds, Leeds, UKBradford Institute for Health Research, Bradford Teaching Hospitals Foundation Trust,
Bradford, UKJournal Article20171203<span class="fontstyle0">Mannion and Braithwaite outline a new paradigm for studying and improving patient safety – Safety II. In this response, I argue that Safety I should not be dismissed simply because the safety management strategies that are developed and enacted in the name of Safety I are not always true to the original philosophy of ‘systems thinking.’</span>https://www.ijhpm.com/article_3469_579b79636c738c9fffe264ea91ed43d3.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397720180701A Safety-II Perspective on Organisational Learning in Healthcare Organisations; Comment on “False Dawns and New Horizons in Patient Safety Research and Practice”662666346810.15171/ijhpm.2018.16ENMarkSujanWarwick Medical School, University of Warwick, Coventry, UK0000-0001-6895-946XJournal Article20171128<span class="fontstyle0">In their recent editorial Mannion and Braithwaite provide an insightful critique of traditional patient safety improvement efforts, and offer a powerful alternative vision based on Safety-II thinking that has the potential to radically transform the way we approach patient safety. In this commentary, I explore how the Safety-II perspective points to new directions for organisational learning in healthcare organisations. Current approaches to organisational learning adopted by healthcare organisations have had limited success in improving patient safety. I argue that these approaches learn about the wrong things, and in the wrong way. I conclude that organisational learning in healthcare organisations should provide deeper understanding of the adaptations healthcare workers make in their everyday clinical work, and that learning and improvement approaches should be more democratic by promoting participation and ownership among a broader range of stakeholders as well as patients.</span>https://www.ijhpm.com/article_3468_cbeb5eeb6f785ea56825eed2e6b487b0.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397720180701The Rise of Patient Safety-II: Should We Give Up Hope on Safety-I and Extracting Value From Patient Safety Incidents?; Comment on “False Dawns and New Horizons in Patient Safety Research and Practice”667670347510.15171/ijhpm.2018.23ENAndrewCarson-StevensDivision of Population Medicine, School of Medicine, Cardiff University, Cardiff,
UKLiamDonaldsonLondon School of Hygiene and Tropical Medicine, London, UKAzizSheikhUsher
Institute of Population Health Sciences and Informatics, The University of
Edinburgh, Edinburgh, UKJournal Article20171222<span class="fontstyle0">Who could disagree with the seemingly common-sense reasoning that: “We must learn from the things that go wrong.”? Despite major investments to improve patient safety, relatively few evaluations demonstrate convincing reductions in risk, harm, serious error or death. This disappointing trajectory of improvement from learning from errors or </span><em><span class="fontstyle0">Safety-I </span></em><span class="fontstyle0">as it is sometimes known has led some researchers to argue that there is more to be gained by learning from the majority of healthcare episodes: the things that go right. Based on this premise, socalled </span><span class="fontstyle0"><em>Safety-II</em> </span><span class="fontstyle0">has emerged as a new paradigm. In this commentary, we consider the ongoing value of </span><em><span class="fontstyle0">Safety-I </span></em><span class="fontstyle0">based approaches and explore whether now is the time to abandon learning from “the bad” and re-energise data collection and analysis by focusing on “the good.”</span>https://www.ijhpm.com/article_3475_ab1d6a9cc95f2c88910541d52e36a997.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397720180701Safety I to Safety II: A Paradigm Shift or More Work as Imagined?; Comment on “False Dawns and New Horizons in Patient Safety Research and Practice”671673347610.15171/ijhpm.2018.24ENKelly M.SmithMedStar Institute for Quality and Safety, MedStar Health, Columbia, MD, USAAnnette L.ValentaDepartment of Medical Education, College of Medicine, University of Illinois at
Chicago, Chicago, IL, USA0000-0002-9145-204XJournal Article20171130<span class="fontstyle0">In their editorial, Mannion and Braithwaite contend that the approach to solving the problem of unsafe care, </span><em><span class="fontstyle0">Safety I</span></em><span class="fontstyle0">, is flawed and requires a shift in thinking to what they are calling </span><em><span class="fontstyle0">Safety II</span></em><span class="fontstyle0">. We have reservations as to whether by itself the shift from </span><em><span class="fontstyle0">Safety I </span></em><span class="fontstyle0">to </span><span class="fontstyle0"><em>Safety II</em> </span><span class="fontstyle0">is sufficient. Perhaps our failure to improve outcomes in the field of patient safety and quality lies less in our approach – </span><em><span class="fontstyle0">Safety I </span></em><span class="fontstyle0">vs. </span><em><span class="fontstyle0">Safety II </span></em><span class="fontstyle0">– and more in the lack of an agreed upon, commonly understood set of core competencies (knowledge, skills, and attitudes) needed in its workforce. The authors explore in this commentary the need to establish core competencies as part of the pathway to professionalism for the discipline of patient safety and quality.</span>https://www.ijhpm.com/article_3476_c80897cfdabd78bb3595f2a3dae94cf2.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397720180701Tapping the Power of Soda Taxes: A Call for Multidisciplinary Research and Broad-Based Advocacy Coalitions – A Response to the Recent Commentaries674676348410.15171/ijhpm.2018.30ENSarah A.RoacheO’Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC, USALawrence O.GostinO’Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC, USA0000-0001-5286-4044Journal Article20180315https://www.ijhpm.com/article_3484_40acdf0ff659535645b3a1378b2ba63b.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397720180701Human Rights and the Tobacco Industry: An Unsuitable Alliance677677345510.15171/ijhpm.2018.03ENBrigitToebesGlobal Health Law Groningen Research Centre, Department of Transboundary Legal Studies, Faculty of Law, University of Groningen, Groningen,
The Netherlands0000-0003-0503-2004Journal Article20171210https://www.ijhpm.com/article_3455_979acde2eefdb28e358b713de7bbaa86.pdf