Ticking Boxes and Changing the Social World: Data Collection and the New UK General Practice Contract

The new General Medical Services contract was introduced into general practice in the UK in 2004, and it links pay to performance far more than in the past. As a result, accurate data collection about patients and the care that they receive is now not only important for good patient care but also to prove that targets are being met. The use of electronic records and information technology has thus become much more sophisticated. This article reports the results from an ethnographic study of the early stages of the new contract in two general practices. As expected, electronic data collection had increased in importance in both practices, with consequences both for clinician–patient interactions and for the structures and processes in the practices, as uniform data collection instruments are put in place that privilege ‘hard’ biomedical data that can be easily coded above ‘softer’, more patient-centred information. Roles and responsibilities had been changed to reflect the needs of the new systems, and new software applications allowed increased surveillance of both doctors’ and nurses’ performance; both of these had an impact on patterns of authority in our study practices. Furthermore, the structural changes that were found acted to embed the new ways of working, ensuring their reproduction in the future. In spite of these effects, we found little opposition to or critical reflection on the changes, and the doctors in our study continued to view their improved computer systems as neutral recording devices. The implication of these findings is discussed.     

Predicting the quality of life in the United States

A principal components analysis performed by David M. Smith on 47 U.S. state level indicators of social well-being yielded several components. The first two of these are socio-economic well-being and social pathology. Structural hypotheses are offered to explain state differences in these components. The structural variables condensed by a principal components analysis of state political, economic and social structure measures are differentiation, flexibility-rigidity, and progressive industrialization. These, along with several population measures, determine a substantial part of the variance in the two measures of social well-being.     

An alternative model for curriculum building in clinical social work education: The California Institute for Clinical Social Work

Summary The growth and development of the California Institute for Clinical Social Work has been parallelled by the enhanced professional contributions of its alumni. Of the 59 graduates of the Institute, ten hold academic positions in top-ranking institutions of higher learning while three more are the chief administrators of social agencies. The remainder devote their time to direct clinical practice.In a recent survey of alumni, all graduates commented in one form or another upon the fact that because of the program, their work was more rewarding personally and was more responsive to clients' needs because of the knowledge and skill that they had gained. The evolution begun in 1974 still continues. This novel program has been elaborated to meet changing needs. Study of its efficacy and flexibility will be pursued as its development proceeds.     

The subpoena and a day in court: guidelines for nurses

Psychiatric nurses or therapists may be subpoenaed to appear as direct or expert witnesses. The response must be carefully prepared, and nurses must be aware that testifying in court can be an anxiety-provoking experience. Testifying often involves being an advocate for a client. Clients who have a mental illness, are developmentally disabled, or have a history of abuse or recent violence deserve a conscientious response. The legal process is the avenue for providing safety or empowerment, for assuring that needs are met, and rights are obtained, and being part of that process is an important role. Being prepared for the role is essential.     

Examination of variable errors of measurement in a survey-based social indicator

The sample survey, involving the use of specially developed questionnaires and instruments, is an important source of data regarding individual experiences and social-psychological characteristics for use in social indicator research. Variable errors of measurement are often given only cursory attention in presentations of survey sampling and social indicator theory and in the analysis of such data. These errors may, however, result in reduced precision of estimates and may affect statistical inferences drawn from the data. Some procedures for assessing the extent of variable measurement error are described and examples of their use in evaluating a survey instrument and data collected are discussed.     

Examining the link between program implementation and behavior outcomes in the lifestyle education for activity program (LEAP)

Lifestyle Education for Activity Program (LEAP) was a comprehensive, school-based intervention designed to promote physical activity in high school girls. The intervention focused on changes in instructional practices and the school environment to affect personal, social, and environmental factors related to physical activity. Multiple process evaluation tools and an organizational assessment tool were developed to monitor program implementation from a framework called the LEAP essential elements, which characterized complete and acceptable intervention delivery; secular trends were also monitored. Using process data, LEAP intervention schools were categorized into low- and high-implementing groups and compared with control schools on nine essential elements assessed at the organizational level. The Wilcoxon scores test revealed that low- and high-implementing intervention, and control schools differed significantly on two of nine administrator-reported organizational-level components: having a physical activity team and having a faculty-staff health promotion program. A mixed-model analysis of covariance indicated that, compared to control schools, a greater percentage of girls in high-implementing schools reported engaging in vigorous physical activity. Process evaluation can be used to understand the relationship between level of implementation and successful program outcome.