Leading collective action to address wicked problems

The alleviation of wicked problems requires collective action because these issues are characterized by significant uncertainty and complexity. This research extends prior work by examining how conveners' use robust action to navigate wicked problems' defining characteristics in the mobilization process. It provides a longitudinal study of a health care nonprofit attempting to engage other stakeholders in addressing the high costs and inadequate quality of health care in a region of the United States. Specifically, the convener sought to address this wicked problem by developing a health information exchange. The findings relate five robust action tactics through which the convener advanced collective action.     

养老服务的逻辑、实现方式与治理路径

养老服务是不同供给主体将不同内容、质量和价格的养老产品或项目,以不同的方式配送到不同需求老年群体的过程。不同供给主体基于责任驱动和利益驱动,为需求主体提供适应性养老服务,是养老服务的基本逻辑。养老服务的实现,是在特定地域、特定的社会关系网络中,通过优化配置养老服务资源,聚集整合养老服务资本,来保障有质量、有尊严的老年生活。鉴于养老服务供给的多元性和需求的复杂性,养老服务的治理则需要运用先进的合作治理与参与治理理念、选择科学的治理工具和现代化的治理技术,保障养老服务供给与需求的适应性匹配,进而保障养老服务实现方式的有序运行。     

Is it possible to incorporate evidence-based professional midwifery practices into public health services in Mexico?

Problem and backgroundDuring the past two decades, Mexico has launched innovative maternal health initiatives to improve maternal and neonatal outcomes, placing emphasis on the incorporation of professional midwifery practices into the healthcare system. This study explored the perceptions of healthcare providers and women using public birth care services regarding professional midwifery practices and how can the inclusion of evidence-based midwifery techniques improve the quality of service.MethodologyWe conducted a qualitative, cross-sectional study of three healthcare networks in Mexico. A content analysis was performed of data collected through 109 semi-structured interviews: 72 with healthcare providers and 37 with women.ResultsHealthcare providers and women had minimal knowledge of the competencies and skills of professional midwives. Medical personnel accepted the incorporation of some evidence-based midwifery practices. Women had experienced fear and anguish during childbirth so they considered that incorporating professional midwifery practices into maternal health services would be favourable in that it would render birth care more respectful.Discussion and conclusionsHealthcare providers are willing to consider the inclusion of some evidence-based midwifery practices in health services and regard assistance from professional midwives. They believe that structural conditions will complicate their incorporation. Although the women interviewed had experienced fear, anxiety and loneliness during childbirth, most of them admitted to feeling “safer” in a hospital (secondary-care health centre) setting where possible complications could be resolved. This perception of safety served to justify the delivery of healthcare in a manner that is inattentive to women’s needs, which go beyond biomedical issues and include emotions and the positive experience of childbirth.     

Stillbirth in Australia 5: Making respectful care after stillbirth a reality: The quest for parent-centred care

Stillbirth is a tragedy that can leave parents feeling powerless and vulnerable. Respectful and supportive bereavement care is essential to reducing adverse psychosocial impact. Initiatives of the Australian Centre of Research Excellence in Stillbirth are designed to improve care after stillbirth. At their heart are the voices of perinatally bereaved parents and support organisations and shared decision making between parents and health care providers. Priorities in future perinatal bereavement care research include ensuring appropriate care for population groups who experience higher rates of stillbirth and addressing implementation challenges to best practice in respectful and supportive bereavement care within our health systems.     

Acknowledging the primacy of continuity of care experiences in midwifery education

BackgroundContinuity of midwifery care is the best maternity care model for women at any risk level, and there is a global imperative to improve access to midwifery-led care. However, diverse perspectives about how best to prepare graduates for working in midwifery continuity of care models persist. The continuity of care experience standard in Australia was anticipated to address this.AimTo challenge the dearth of published information about the structures and processes in midwifery education programs by identifying: the educational value and pedagogical intent of the continuity of care experience; issues with the implementation, completion and assessment of learning associated with continuity of care experience; and discuss curriculum models that facilitate optimal learning outcomes associated with this experience. We discuss the primacy of continuity of care experience in midwifery education programs in Australia.DiscussionThe inclusion of continuity of care experience in midwifery programs in Australia became mandatory in 2010 requiring 20, however this number was reduced to 10 in 2014. Research has shown the beneficial outcomes of continuity of care experience to both students and women. Continuity of care experience builds mutual support and nurturing between women and students, fosters clinical confidence, resilience, and influences career goals. We require curriculum coherence with both structural and conceptual elements focusing on continuity of care experience.Implications and recommendationsEducation standards that preference continuity of care experience as the optimal clinical education model with measurable learning outcomes, and alignment to a whole of program philosophy and program learning outcomes is required.     

Reducing waiting times in the Italian NHS: The case of Emilia-Romagna

In 2015, the Emilia-Romagna Regional Government implemented a plan to reduce waiting times for elective outpatient procedures. The objective set by the regional government establishes that at least 90 per cent of specialist services are to be provided within the following maximum waiting times: 30 days for the first specialist consultation, and 60 days for diagnostic tests. The plan adopted by the Emilia-Romagna Regional Government is of particular interest because it encompasses a combined strategy. Some of the interventions envisaged in the plan aim at increasing the supply of specialist services. Others address the demand side, seeking to reduce inadequate requests and discourage no-shows by patients. And others focus on combining supply and demand and neutralizing the effects of some perverse incentives. The Emilia-Romagna plan appears to have had a successful outcome. In the first 4 years of implementation, the 90 per cent target has not only been achieved but also widely exceeded.     

The experiences of carers in using shared activities to communicate with looked‐after young people about alcohol,tobacco, and drug use

Parental conversations with their teenage children about alcohol, tobacco, and drugs are associated with lower rates of use. Looked‐after young people are at greater risk of early initiation, higher rates of use, and more problematic use. However, there is no evidence regarding whether these conversations occur in settings where the parental role is assumed by someone other than the biological parent. The aim of the study was to examine how carers communicate with looked‐after young people about alcohol, tobacco, and drug use. In‐depth interviews were conducted with 16 residential care staff and foster carers in Scotland. Data were analysed using a thematic analysis approach. Participants talked about “shared doing” as a way of building relationships and communicating about substance use. Shared doing encompassed particular activities that carers and young people would do together, such as driving in the car, cooking, watching TV, and going for a walk. Shared doing provided an opportunity to spend time together and to create an environment in which communication could be facilitated. These environments were shaped by space, time, and context. Carers should be encouraged to take advantage of the time‐limited occasions they are with young people to have conversations about substance use.     

Child care subsidy and child maltreatment

This study examined the relationship between receipt of child care subsidies and child maltreatment investigations in a sample of low‐income mothers in Illinois. We expected that receiving child care subsidies would have a protective effect on child maltreatment risk and therefore decrease the likelihood of child protective services investigations. Using structural equation modelling, we tested the direct and indirect paths of the receipt of child care subsidies to physical abuse or neglect. We found only direct effects of receiving child care subsidies on both physical abuse and neglect investigations. The findings suggest an important protective role of child care subsidies in the lives of low‐income families.