The decline of intensive intergenerational care of older people in Great Britain, 1985-1995

There are increasing concerns about the future availability of informal care for older people, particularly care by their children. This article explores past trends in the provision of informal care by children/children-in-law to their older parents/parents-in-law between 1985 and 1995 in Great Britain, using successive General Household Survey data. The article suggests that, during this period, there was a decline in co-resident intergenerational care and that this was associated with a decline in highly intensive intergenerational care. The article explores possible factors underlying these trends, in particular, demographic changes and changes in patterns of formal care for older people.     

Priority Setting in Health Care with Disease and Treatment Risks

This paper deals with the issue of priority setting in health care under uncertainties about the severity of the illness and the effectiveness of medical treatment. We examine the effect of a disease uncertainty(a treatment uncertainty) on the allocation of health care resources in the presence of a treatment risk(a disease risk) and identify preference conditions under which the social planner allocates more resources to higher risk population. We allow for the simultaneous presence of two risks and investigate the joint effect of two-source uncertainties on health care allocation when the two risks are either small or positively quadrant dependent. The effect of inequality aversion on health care allocation is also analyzed by introducing an equity weighting function. Our work extends the previous model of health care priority to two-risk framework and provides new insights into the problem of health care decision making under uncertainty.     

HEALTH CONSUMER DIVERSITY AND ITS IMPLICATIONS

1. Introduction The health care scene in the Western world is shifting rapidly. Health care consumers have abandoned their traditionally respectful attitudes and behaviours. In the past the roles of the health consumers and providers were quite clear. The patients consumed and the health care providers provided (Edgren 1998). Today theJOURNAL OF SYSTEMS SCIENCE AND SYSTEMS ENGINEERING 35 picture is more complex. Many health care consumers no longer want to be passive receiv…     

Measuring unmet need for social care amongst older people

Recent spending cuts in the area of adult social care raise policy concerns about the proportion of older people whose need for social care is not being met. Such concerns are emphasised in the context of population ageing and other demographic changes. For example, the increasing proportion of the population aged 75 and over places greater pressure on formal and informal systems of care and support provision, while changes in the living arrangements of older people may affect the supply of informal care within the household. This article explores the concept of 'unmet need' for support in relation to specific Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs), using data on the receipt of support (informal, formal state or formal paid) from the General Household Survey, the English Longitudinal Study of Ageing and the British Household Panel Survey. The results show that different kinds of need tend to be supported by particular sources of care, and that there is a significant level of 'unmet need' for certain activities.     

Organization Change in a University Hospital: A Six Year Evaluation Report of the HORIZONS Project

Many health care organizations are currently engaged in changing the design of their health care services delivery system. The issues of cost containment, quality, and access are prominent. This paper reports on the impact of the implementation of a new organization design at one university hospital. The organization change effort (named HORIZONS) was a five year project funded in part by the Robert Wood Johnson Foundation and the Pew Charitable Trusts. In a changing health care environment, the project was undertaken with three goals in mind: (1) to maintain and enhance quality of patient care; (2) to improve the quality of working life; and (3) to accomplish this in a budget neutral manner. Initiated as a program to strengthen hospital nursing, the project became a patient-focused redesign effort encompassing both clinical and administrative affairs. The core ideas of the project approach included systems thinking, interactive planning and idealized design. This evaluation reports on the project's progress after six years.     

Simultaneous care for parents and care for children among mid-life British women and men

This article investigates care provided to parents and parents-in-law by mid-life adults with dependent children at home. Data from the General Household Survey are used first to estimate the prevalence of this 'two-way' care over the past decade, and second to develop forecasts of two-way care for a generation of women who have just finished their childbearing years. Having a higher education qualification is associated with later ages both of caring for parents and of having children at home. Increasingly late first childbearing, however, points towards a potentially greater caring 'squeeze' for higher-qualified women, with a little over 1 in 10 at age 45 projected to be caring for a parent while still having a child under 18 in the household.     

The demographic characteristics and economic activity patterns of carers over 50: evidence from the English Longitudinal Study of Ageing

Studies on informal care provision have often focused on the provision of care for persons with a long term physical or mental ill-health or disability, or problems related to old age. However, the provision of care and support more broadly, for example in the form of childcare for grandchildren, can also impact on various aspects of a carer's life, such as their employment (if under the state retirement age), lifetime earnings and, by extension, pension income in later life. This article uses data from Wave 3 of the English Longitudinal Study of Ageing (ELSA) to explore the demographic characteristics, caring patterns, health status and economic activity patterns of carers aged over 50 in England. The results suggest that the nature of care provision differs across age groups, and that caring can be quite a different experience for older men and women. This article also sheds light on the characteristics of 'round-the-clock' carers, a relatively under-researched group which makes up just over one fifth of all carers aged 50 and over.     

Application of Scenario-based Approaches in Leadership Research: An Action Research Intervention as Three Sets of Interlinked Practices

This article illustrates how scenario planning (SP) and scenario analysis as can be conceptualised as practices contributing to an action research (AR) investigation of leadership development. The project described in this article was intended to strengthen leadership capacity in Australia’s rapidly changing aged care and community care sector. A research team comprising academics from three universities and managers from two faith-based not-for-profit organisations providing aged and community care participated in this study. As part of the research, two sets of scenario-based workshops were held: the first, to identify possible futures using SP; and the second, to deal with plausible scenarios these organisations are likely to face with the changes happening in the aged care environment in Australia by using scenario analysis. Although the researchers did not consider a link between practice theory and AR during the SP phase, practice theory became useful during the scenario analysis phase. The article includes a brief literature review followed by a discussion on the relationship between AR and practice theory. The processes used in the two sets of scenario workshops are then described in detail along with the data collected and analysed. The article concludes with some reflections on the use of scenarios in practice as well as an acknowledgment that practice theory would be useful in investigating leadership capability development.     

Coproduction in Practice: Participatory Action Research to Develop a Model of Community Aged Care

Coproduction has become synonymous with innovative approaches to public service delivery in European Union countries as well as in Australia. Coproduction has the potential to bring together individuals, communities, and organisations in a process to collaboratively develop new models and services which improve public services. Yet, Australian policy makers and practitioners who would like to deploy coproduction within the context of older adult social care can only draw on a handful of papers and reports that could guide implementation. This paper fills this gap by reporting on the implementation of a multi-stakeholder coproduction approach to the development of a consumer directed care model for older people with complex health issues. The paper describes and critically highlights methodological challenges encountered during the 12 month-long participatory action research phase of a larger project involving older people with complex care needs, their carers, and government and non-government stakeholders. The paper outlines key considerations regarding (1) the involvement of older people with complex needs, (2) collaboration with industry partners, (3) engagement of government representatives, and (4) reflects on implementing participatory research projects within a context of outsourcing and interlinked supply chains. While not all challenges encountered could be resolved, the coproduction approach was successful in bringing together a wide range of stakeholders with competing agendas in an iterative process geared to resolve a plethora of concerns raised by older people, carers and services providers. This paper provides an example for others seeking to use coproduction and participatory methods to provide person-centred care services for older people.     

Change in living arrangements following death of a partner in England and Wales, 1971 to 2001

Understanding trends and changes in the circumstances of couples separated by death is important for policy initiatives to reduce vulnerabilities associated with end of life care and for those who live on. This article uses widow(er)hood statistics and census data from the Office for National Statistics Longitudinal Study. It examines changes in couples' living arrangements and households at four successive censuses from 1971 to 2001 and shows how these differ by age and gender on the death of a spouse or partner. Findings draw attention to the effects of ageing and mortality improvements as well as wider social and economic trends in family and household formation, residential independence in older age, and policy developments on long-term care provision for older people.     

Who cares? Geographic variation in unpaid caregiving in England and Wales: evidence from the 2001 census

This article investigates the prevalence of unpaid caregiving by local authority district in England and Wales, using data from a new question on caregiving in the 2001 Census. We also examine geographic variation in the characteristics of unpaid care providers including health status, socio-economic status and ethnicity. Results show clear geographic variations in caregiving. The proportion of adults providing more than 20 hours of care per week ranged from less than 2 per cent to nearly 8 per cent. The highest proportions of caregivers were found in areas with higher than average levels of deprivation and long-term illness. Carers in such areas were themselves more likely to be in poor health. There are also clear variations in caregiving propensity by ethnic group.     

Intermediate health care in a British inner city: An exercise in multiprofessional systems design

Health care in England is divided into the acute- and primary-care sectors. In the inner city the primary-care sector suffers from a number of ills that would be relieved by the introduction of a form of health care intermediate to it and the acute sector. This paper illustrates how members of the Department of General Practice at the University of Liverpool set about exploring the problems of the inner city and its health-care provision, as a means of arriving at a preliminary design for an intermediate-care service provision. The design was to form the basis for negotiations with other interested parties over the introduction of intermediate care in the inner city. The approach adopted was based on the soft systems methodology of P. B. Checkland. However, a number of variations on the traditional soft systems methodology were introduced, not the least of which was the introduction of new systemic metaphor into the root definition and conceptual modeling stages.     

Electronic Medical Records (EMR) and Nurses in Turkish Hospitals

Electronic medical records (EMR) are generally used by nurses in hospitals. However, studies investigating views on and evaluations of EMR by nurses are limited in Turkey and in other countries around the world. In this study, nurses’ views on EMR systems were investigated in terms of “Nursing care management”, “Order entry”, “Information Management”, “Information quality”, “Service quality”, “Impact of EMR system on clinical care”. The purpose of this study was to investigate the views/perceptions on EMR used by nurses working at hospital clinics in Turkey. The research questions were: (a) What are nurses’ perceptions on EMR? (b) Were there relationships among nurses’ perceptions on EMR? (c) Were there differences among nurses’ perceptions on EMR according to hospitals in Turkey. This study is composed of field research conducted using questionnaires. To prepare the data-measuring instrument, the literature on EMR was reviewed. A Likert scale type was used in this questionnaire. The study was planned and conducted on nurses working at inpatient care units at four Turkish hospitals. At the end of this study, the questionnaire had been conducted on 517 nurses. Total response rate is 66.70 %. We found that the Information quality of EMR, impact of EMR system on clinical care and service quality were high level. Information quality has the highest mean score. EMR system is an important system for nurses’ hospital has the highest mean score in this study. Nurses feel about impact of EMR system on clinical care that generally ‘EMR system’s usefulness’, ‘improving quality of information due to EMR system’, ‘improving quality of nurses’ work’, ‘improving quality of information due to EMR system’. All of the six subscales of EMR were positively correlated with each other. This study revealed that there are significant differences among the mean scores for six subscales according to the ownership of hospitals. EMR systems were not well integrated into their workflow. In addition, half of all respondents had not been trained in using EMR systems. This study will added to evaluation views and assessments of nurses about EMR literature. The results will assist in determining “Information quality”, “Service quality”, of EMR, and “Impact of EMR system on clinical for nurses in Turkish health system”. This survey suggests that nurses favor the use of an EMR and suggests opportunities for EMR enhancement.     

多阶段医疗系统下病人滞留分析与应用

连续治疗(continuity of care)逐渐成为评价医疗系统质量的一个重要指标,而现实中由于下一阶段无可用资源导致已完成当前阶段服务的病人滞留现象频繁发生.现有文献通常假定病人在滞留期间处于等待状态,实地研究却表明病人滞留期间会继续接受下一阶段治疗服务,且上下阶段的服务时长存在相关性.基于此,建立考虑病人连续治疗的排队模型,设计滞留可能性估计算法.与仿真结果及其它相关算法比较,新建算法具有更高准确性与稳定性.此外,对新建算法的扩展应用证明其在评价医疗系统性能与优化医疗资源配置上效果显著.     

Stage division and pattern discovery of complex patient care processes

This paper studies the design of a clinical pathway that defines medical service activities within each stage of a patient care process. Much prior research has developed clinical process models that consider the trajectory of services occurring in a care process, by using data mining techniques on process execution logs. A novel approach that provides a more efficient way of clinical pathway design is introduced in this paper. Based on the strategy of TEI@I methodology, the proposed approach integrates statistical methods, optimization techniques and data mining. With the preprocessed data, a complex care process is subsequently divided into several medical stages, and then the patterns of each stage are identified, and thus a clinical pathway is developed. Finally, the proposed method is applied to the real world, using archival data derived from a hospital in Beijing, about three diseases that involve various departments, with an average of 300 samples for each disease. The results of realworld applications demonstrate that the proposed method can automatically and efficiently facilitate clinical pathways design. The main contributions to the field in this paper include (a) a new application of TEI@I methodology in healthcare domain, (b) a novel method for complex processes analysis, (c) tangible evidence of automatic clinical pathways design in the real world.     

The Vanguard Method as Applied to the Design and Management of English and Welsh Children’s Services Departments

This paper follows several case studies where the children’s services departments of English and Welsh local authorities have fundamentally redesigned the way they worked following the application of the Vanguard Method (Seddon, Systems thinking in the public sector, 2008), a particular form of systems thinking. After first studying the way the children’s social care service worked as a system, the social workers in these authorities were able to demonstrate the way that government-prescribed IT and performance measures were restricting the way they could do what was shown to matter to the children in their care. The paper will document how, after being granted ministerial permission to suspend the use of their old performance measures and IT, a new set of operating principles was developed and employed. The redesigned system has shown encouraging early results. Evidence from these case studies (following Yin 2009) is presented in the form of recorded operational improvements and statements from participants. The paper will be of topical relevance to all involved in social care in the light of the government-commissioned Munro Review (Munro, The Munro Review of child protection: final report, 2011). The issues discussed will also be germane to the many other public sector partner agencies involved in the delivery of social care services (e.g. police, health, housing associations).     

考虑渠道公平的双渠道供应链均衡策略

以双渠道供应链为背景,分析了渠道公平对生产商和零售商均衡策略的影响.研究发现,当零售商市场份额较小时,生产商不会关注零售渠道是否取得了渠道公平;当零售商市场份额较大时,为了避免受到零售商设置较高零售价格的惩罚,生产商将关注渠道公平.另外,渠道公平可以有效改善"双向边际"效应.     

The Children's Planning Initiative: Researching Decision-Making for Children

This paper recounts the story of how a number of workers involved in the care of children decided that they needed to do more than improve their skills and began instead to question some of the assumptions on which child care planning processes are built. The paper records a growing consciousness about the value of action research in developing alternative models of decision-making. It leads us from early questioning, through model creation, and on into testing the model in a new and complex organizational setting. While other voices are quoted, the paper recounts the story from the viewpoint of two actors, practitioner/manager and consultant.     

Implementing Cost Control in Health Care: Strategies Driven by an Organizational Systems Approach

In this paper, we offer a systems approach to assist health care organizations in their cost-containment efforts. A general model of the organization which specifies the various components of this approach is offered. Each system—technology, structure, psychosocial, managerial, and cultural—is linked to illustrative selected actions designed to improve cost performance. In our view, the key to successful interventions to contain costs lies in careful consideration of both the direct and interactive impacts on all systems of the health care organization. A case example of an Academic Medical Center's effort to curtail costs illustrates both the model and the sample actions.     

The dynamics of living arrangements in later life: evidence from the British Household Panel Survey

Living arrangements are a key dimension of quality of life and well-being in old age. Availability of family care, as well as social and economic support, is in part a function of whom you live with. In order to be able to forecast future changes in household composition, particularly in relation to planning and targeting particular community care services, information is needed on the probability of a person experiencing a change in their living arrangements, and the life course events that may act as triggers for such changes. This article uses data from the British Household Panel Survey (1991-99) to analyse the dynamics of living arrangements in later life.