Using evidence-based accreditation standards to promote continuous quality improvement: the experiences of the San Mateo County Human Services Agency

Following a difficult period of service provision, an agency determined that drastic changes were needed to improve agency-wide capacity and functioning. The agency engaged in an organizational level self-assessment aimed at identifying areas for improvement and beginning work towards determining professional standards for service. Results of this organizational self-assessment paved the way for pursuing accreditation of its services, and the agency became the first public agency in its state to be accredited by the Council on Accreditation in all eligible services. This case study describes this agency's efforts in engaging in an organizational self-assessment, the analysis and codification of their practices, and their eventual development of a systematized process for capturing, evaluating and improving practice.     

Disability beliefs and help-seeking behavior of depressed Chinese-American patients in a primary care setting

In this study the authors assessed the effects of disability beliefs, conceptualization and labeling of emotional disabilities, and perceived barriers on help-seeking behaviors among depressed Chinese Americans in a primary care setting. Forty-two Chinese Americans participated in semistructured interviews using established psychological measures and open-ended questions adapted from the Explanatory Model Interview Catalogue. The authors found that care utilization appears to be complicated by somatization of emotional problems, variations in causal attribution to depression, barriers to receiving mental health care, and the burden of comorbid physical conditions. Their findings highlight the importance of addressing these issues and educating patients about body-mind dialectic common to depression.     

Inside and outcast: multifaceted stigma and redemption in the lives of gay and lesbian Jehovah's Witnesses

Homosexuality has become a divisive issue in many religions and congregations. Like many other fundamentalist denominations, Jehovah's Witnesses condemns homosexual acts, thoughts, and feelings. Consequently, gay and lesbian Witnesses experience not just stigmatization and conflict between their sexual and religious identities in the social world, but also a nearly impossible task in their inner world. This inner task adds a new facet to our understanding of stigma (Goffman, 1963). This study explores the written narratives of a subset of gay and lesbian former Jehovah's Witnesses who were able to comprehend, negotiate, and, in most cases, resolve their multifaceted stigmas and conflicts through struggle, self-determination, and eventually connecting with networks of peers who faced or are facing similar stigmas. This research contributes to other work on the intersection of religion, family, and homosexuality; in particular, the findings have implications for the study of other strict fundamentalist religions.     

语言与联邦制:多元种族的挑战

种族、语言和宗教认同在最近 1 0年浮出水面 ,现代国家制度处理多元文化的能力面临挑战。这样 ,多语模式作为对这一挑战的回应 ,在有关联邦制的实证研究中已成热门话题。这种研究与对联邦制的古典研究形成对照———古典研究主要关注如何在制度上对国家及其各组成单元之间的权力进行划分。在这里 ,语言扮演着双重角色 :一方面是作为不同政治主体之间交往协商的宽松纽带 ,另一方面是作为深厚的意义体系而承载着历史、宗教、文化、礼仪和记忆的负荷。印度和瑞士相当成功地适应了多元语言状态 ,通过对比这两个案例 ,本文研究语言的上述两面性 ,并讨论宪政手段和政策工具让一个现代国家在面对多元种族挑战之时如何使地区的差异性和国家的统一性保持平衡     

人为因素

人为因素是对工程学、实验心理学、神经科学、计算机科学和人类工程学的一种折中组合，按照字面意思来看，即为“工作科学”。它是应用科学的方法和原理来研究、设计、维修和操作复杂的人一机器系统。人为因素不但针对个体、小组和团体，而且针对控制、显示和作业。人为因素工程的首要目标，一是通过使人适应机器来优化系统的性能，例如，通过培训使操作人员熟悉机器；二是通过使机器适应人来优化系统的性能，例如，通过应用诸如“控制一显示兼容”的设计原理使机器适用于操作人员。简而言之，人为因素是系统工程的一个关键的中心组成部分。     

Evaluating risk: global fees and episodic care

In 1999, two articles in The Physician Executive -- "Part I: Global Theory and the Nature of Risk (July-August)." and "Part II: Towards a Choice-Based Model of Managed Care (October-November)" -- outlined the flaws of orthodox managed care theory and highlighted the unique advantages of moving to a genuinely market-based model, which included the concept of direct contracting for integrated episodes of care. This follow-up focuses on comparing an episode contracting system to a traditional capitated program and outlines the features that make this approach much more attractive to physicians, payers, and most importantly patients.