A Multi-disciplinary Identification of Issues Associated with ‘Contracting’ in Market-oriented Health Service Reforms

Multi-disciplinary perspectives from operational research, management information systems, purposeful activity systems, accounting and finance, transaction-cost economics and organization learning are discussed in relation to `contracting' in the NHS following the recent reforms, applied within the general framework of soft-systems methodology. These are then used to frame questions for collecting information about contracting practices and issues. The data so collected suggest that the issues and activities associated with contracting can be grouped into five interacting categories of: strategy formation, making enabling arrangements, operational management of contracted activities, identifying and relating to stakeholders, and carrying forward organizational learning from experience. Each of the disciplinary perspectives attributes significance to specific forms in these five activities. The possibility of some multi-disciplinary linking of theoretical perspectives is demonstrated. Information and purposeful systems are central to this, being on the one hand created by social processes which define relevant information and corporate alignments of purpose, and on the other hand patterns of activity that can be evaluated in terms of contribution to these purposes, with properties of greater or lesser inhibition of innovation to improve purpose achievement. As a case study of an attempt at inter-disciplinary research, it demonstrates that interdisciplinary linkage can be made, though certain epistemological issues are skated over in the process. On the basis of the case study, some of the richness and insight of the different perspectives is lost in the process. The critical debate about the neutrality of soft-systems methodology is commented on in the light of the study.     

Nostalgia and the Narrativization of Identity: A Turkish Case Study

This paper offers an interpretation of the collective identity‐narrative of a Turkish faculty of vocational education. Particular attention is focused on the importance of nostalgia in acts of collective self‐authorship. Nostalgia, it is argued, is key to the understanding of the dynamics of individual and organizational identity‐construction in several ways: it can be a means of maintaining a collective sense of socio‐historic continuity, a source of resistance to hegemonic influence and a defence against anxiety. The research contribution of this paper is threefold. First, it illustrates how groups assemble shared storylines that subjectively constitute their collective identity. Second, it analyses the different ways in which acts of collective nostalgia can inform the stories by which individuals and groups understand their present circumstances, preserve self‐esteem, and react to perceived threats. Third, it theorises nostalgia as giving access to a shared heritage of apparently authentic and identity‐relevant values and beliefs, as an emotional support during periods of organizational change, and as a form of uniqueness claim central to processes of individual‐organization identification.     

An ounce of prevention?

While preventive health care is intuitively attractive, both from a disease morbidity and cost of care aspect, it is most effective when the natural history of a disease can be precisely predicted and when there is effective therapy to modify the risk factor. In contrast, if the natural history is uncertain, perhaps due to its multifactorial nature and treatment not entirely effective, there will inevitably be inefficiency in preventive treatment. In this complicated balancing act, the inefficiencies of preventive therapy may be buried beneath the surface, due in part to the method of reporting and perhaps to the enthusiasm for preventive medicine in general. Until we are able to identify more predictive risk factors, there will always be inefficiencies in preventive medicine, and many must be treated for one to benefit. However, the absolute risk reduction and the number needed to treat are useful measures to highlight what can actually be achieved with preventive therapy.     

ABMT and breast cancer: what have we learned?

The debate regarding the efficacy of and insurance coverage for ABMT for breast cancer has been raging since the widespread dissemination of ABMT in the early 1990s. Underlying the debate was the expectation that the results of randomized clinical trials would finally provide scientific data to resolve the frequently emotional controversy. Unfortunately, the results of these eagerly awaited trials failed to show a significant impact in patients with either metastatic breast cancer or those at high risk for metastatic disease. ABMT, as it is now offered, will not provide the breakthrough that was anticipated or a substantial benefit to the majority of patients. Research on ABMT may have evolved from the initial expectation that the trials would confirm a positive to more modest expectations that trials will disprove a negative. The promising results of early trials still require confirmation through randomized controlled trials, and participation in such clinical trials is vitally important.     

Distribution-Free Methods in Regression1

A modification to the least-squares estimating equations in simple linear regression, leading to exact distribution-free inference about slope, is outlined. The modification involves a general residual-transformation iψ and the cases of ψ— sign, rank, and the identity are discussed in some detail. It is also shown how exact inference about individual parameters in regressions with more than one design variable can be carried out by a restricted permutation argument coupled with a suitable design.     

GROUPING PROBLEMS IN DISTRIBUTION-FREE REGRESSION1

In regression models having symmetric errors, exact distribution-free inference about individual parameters may be carried out by grouping observations, eliminating unwanted parameters within groups, and applying distribution free techniques for the symmetric location parameter problem. Models whose errors have identical but not symmetric distributions may obtain symmetry by taking differences between pairs of observations. Both grouping and differencing involve potential efficiency loss. The choice of an optimal scheme to minimize efficiency loss is expressible as a multi–assignment type of problem, whose solutions, exact and approximate, are discussed.     

The legal status of collective bargaining by public school teachers

This paper examines the characteristics of area populations that predict the content of bargaining legislation for public school teachers. The authors provide evidence suggesting that 1) pro-bargaining legislation is correlated with the representation of union members and related workers who benefit from collective bargaining, and 2) the legislation appears to be demanded by career workers as a means of transferring resources away from teachers with relatively short career horizons. An N-chotomous probit model is used to estimate the form of legislation that ranges from bargaining prohibition to prescribed bargaining. Data for the study were obtained from 95 SMSAs in 35 states. We are indebted to Paul H. Rubin and Elchanon Cohn for their substantial contributions to this project. We also received helpful suggestions from Chris Paul and R. Carter Hill.     

Critical race theory speaks to the sociology of mental health: mental health problems produced by racial stratification

The sociology of mental health focuses on the epidemiology, etiology, correlates, and consequences of mental health (i.e., psychiatric disorder and symptoms, psychological distress, and subjective well-being) in an attempt to describe and explain how social structure influences an individual's psychological health. Critical race theory describes and explains iterative ways in which race is socially constructed across micro- and macro-levels, and how it determines life chances implicating the mundane and extraordinary in the continuance of racial stratification (i.e., racism). This paper invoked critical race theory to inform the sociology of mental health's approach to studying race and mental health by conceptualizing five hypothetical mental health problems that could exist because of racial stratification. These problems were: (1) nihilistic tendencies, (2) anti-self issues, (3) suppressed anger expression, (4) delusional denial tendencies, and (5) extreme racial paranoia. Mental health problems such as these and undocumented others can only be recognized given awareness of the social and personal implications of racial stratification.