The Effect of Integrated Scheduling and Capacity Policies on Clinical Efficiency

In outpatient healthcare clinics, capacity, patient flow, and scheduling are rarely managed in an integrated fashion, so a question of interest is whether clinic performance can be improved if the policies that guide these decisions are set jointly. Despite the potential importance of this issue, we find surprisingly few studies that look at how the allocation of capacity, paired with various appointment scheduling policies and different patient flow configurations, affects patient flow and clinical efficiency. In this paper, we develop an empirically based discrete‐event simulation to examine the interactions between patient appointment policies and capacity allocation policies (i.e., the number of available examination rooms) and how they jointly affect various performance measures, such as resource utilization and patient waiting time. Findings suggest that scheduling lower‐variance, shorter appointments earlier in the clinic (and, conversely, higher‐variance, longer appointments later) results in less overall patient waiting without reducing physician utilization or increasing clinic duration. Additionally, exam rooms exhibited classic bottleneck behavior: there was no effect on physician utilization by adding exam rooms beyond a certain threshold, but too few exam rooms were devastating to clinic throughput. Some significant interactions between these variables were observed, but were not influential to the level of managerial concern. Clinicians' intuition about managing capacity in healthcare settings may differ substantially from best policies.     

“I Felt Guilty for Being So Happy”: Narrative Expressions and Management of Postdivorce Ambivalence

Scholars have highlighted ambivalence as a central feature of experiences of divorce and its aftermath and discussed ambivalence as an important issue for divorcees in adjusting to their new status. While most of this scholarship assesses postdivorce ambivalence as a psychological phenomenon to be addressed therapeutically, this study analyzes postdivorce ambivalence as an interpretive problem to be addressed sociologically. Following Merton’s (1976) insight that ambivalence be viewed as rooted in culture and social structure as well as individual psyche, we use a narrative analytic perspective to examine how divorcees both discursively express and interpretively manage their ambivalence. We then consider some of the more general cultural discourses—such as images of marriage and divorce—that shape or condition these narratives. Ultimately, we argue that conflicting stances toward marriage in the wider U.S. culture are at once important sources of postdivorce ambivalence and significant interpretive resources for its discursive management.     

Lessons in Democracy: America's Tenuous History with Immigrants

Taking an uncompromising stance on immigration enforcement, the Trump administration has been sharply criticized for its policies and racially coded rhetoric of immigrants as criminals or undesirables. Despite this criticism, the administration's policies fall in line with historically widespread, exclusionary, nativist and xenophobic attitudes towards immigrants. Much of the American immigrant story has been a tortuous struggle for equality, integration and civil rights. This essay takes a critical look at the complicated history of immigration policy during the last century, focusing on the social, economic and political forces that helped shape legislation.     

Identity,selfhood and dementia: messages for social work

Dementia has been identified as a policy priority area for the European Union (EU). Given projected figures on the global increase in dementia over the next few decades, working with people with dementia is likely to become an even more prominent area of activity for social workers in older people's services. Recent research has begun to engage with the subjective experiences of people with dementia and there is considerable focus within nursing literature on their active efforts to maintain identity and selfhood. However, these issues have received little attention within the domain of social work. This paper reviews recent research on the subjective experiences of people with dementia and discusses the implications for social work in relation to: early intervention; communication and assessment, and support arrangements. Based on experience in England, it is argued that the current policy and practice context constrains social work's ability to respond to these issues and that a supportive organisational context, as well as high levels of skill, time and commitment, are required if concepts of personhood and citizenship are to have meaning in practice.     

Navigating the First Year of College: Siblings,Parents, and First-Generation Students’ Experiences

Although college education is a key to upward mobility, students from socioeconomically disadvantaged backgrounds are less likely to enter and complete college than their more advantaged peers. Prior literature has illuminated how cultural capital contributes to these disparities. An alternative conceptualization of cultural capital, however, suggests that it can also play a role in social mobility. In this study, we build on and extend the literature on cultural mobility by proposing that exposure to education can benefit not only individuals but also families. We examine the influence of older siblings who attended college on the experiences of younger college-going siblings in families where neither parent has completed college (i.e., first-generation families). We find that students rarely rely on their older siblings as sources of information and advice, except in a few instances where older siblings attended the same institution. However, both the topics and nature of conversations between parents and students differ between families with and without older college-educated siblings. The primary benefit of having college-educated siblings is thus related to students’ engagement with and support received from parents. These findings have important implications for cultural capital research and understanding experiences of first-generation college students.     

Participatory research meets validated outcome measures: Tensions in the co‐production of social care evaluation

Funding for care service research is increasingly subject to the satisfaction of two requirements: public involvement and adoption of validated outcome tools. This study identifies competing paradigms within these requirements and reveals significant challenges faced by researchers who seek to satisfy them. The focus here is on a study co‐produced between academic researchers and people with experience of adult social care services. It examines to what extent research studies can conduct high‐quality public involvement and genuine co‐production of knowledge, whilst attempting to produce quantifiable outcome scores. Findings add to debate around how to incorporate diverse perspectives in research, which may draw on incommensurate accounts of validity and reliability. Findings also highlight constructive attempts by academic and co‐researchers to make the combination of approaches work in the field. These small scale acts of researcher agency indicate some scope to combine the two approaches in future research studies. However, conclusions foreground the importance of broader awareness of how tensions and power imbalances related to this combination of approaches play out in social policy research practice.     

Nonprofit and Social Marketing

Marketing Social Change: Changing Behavior to Promote Health, Social Development, and the Environment, by Alan R. Andreasen. San Francisco: Jossey-Bass, 1995. 367 pp., $30.95 cloth. Marketing Strategies for Nonprofit Organizations, by Siri Espy. Chicago, Ill.: Lyceum Books, 1993. 165 pp., $19.95 paper. Marketing Nonprofit Programs and Services: Proven and Practical Strategies to Get More Customers, Members, and Donors, by Douglas B. Herron. San Francisco: Jossey-Bass, 1997. 282 pp., $32.95 cloth.     

The impact of job loss on family dissolution

The impact of involuntary job displacements on the probability of divorce is analysed using discrete duration models. The analysis uses the sample of couples from the British Household Panel Survey and distinguishes between types of displacements. Results show that couples in which the husband experiences a job loss are more likely to divorce. Redundancies have small, positive, often insignificant and short-lived effects while dismissals and temporary job endings have larger positive impacts. This is consistent with the interpretation of redundancies as capturing negative income shocks while other types of job loss also convey new information about potential future earnings and match quality.