Conference Agenda

RN16_05b: Health Care Organisations and Policy
Thursday, 22/Aug/2019:
11:00am - 12:30pm

Session Chair: Guido Giarelli, 'Magna Graecia' of Catanzaro
Location: UP.4.205
University of Manchester Building: University Place, Fourth Floor Oxford Road


Sociology For Transdisciplinar Innovation: Useful R&D For Improving Intensive Care Units dynamics in 2019.

María Elena Fabregat Cabrera, Diana Jareño Ruiz, Raúl Ruiz Callado

University of Alicante.

In 2010, the doctoral thesis “The Intensive Care Units (ICUs) as social systems: social construction of time and its influence on communication processes”, described the social structure of those relationships articulating the coexistence of relatives, patients and health professionals in this hospital service. The conclusions drawn a complex network of internal and external links, perceived differently by the groups of agents, which acts by conditioning the management of both information and communication processes. Being aware of the subjective perceptions of each group was revealed as a fundamental piece for promoting empathy within the system, reduce tensions and achieve more effective communication strategies.

The present paper updates those results, translating them to the 2019 reality and analysing the impact that massive introduction of mobile devices has generated in the social structures of ICUs. The characteristics of the service and the relative-patient needs have experienced significant changes and interpretative nuances in the relational system. The study details those modifications and the impact they produce on the subjective attribution of responsibilities in the communication-care process, drawing an analytical map that aims to be to be a useful tool to start planning humanization care policies from a comprehensive understanding of the social system involved. Agile Techniques of Social Research were implemented in the study, applying the User Centred Design and the Design Thinking approaches. The novelty of using this kind of methodological design, more common in business research than in the hospital and health sector, is the inauguration of a new way of doing research in the field in which the iterative approach gives real-time insight to researchers and the power to make decisions diligently.

Communication Within a Perinatal Center: Effectiveness Proposed and Barriers Experienced

Anastasiia Novkunskaya

European University at Saint-Petersburg, Russian Federation

The World Health Organization proposes the effective communication between both members of the multi-professional team and maternity care providers and women in labour as one of the key conditions for the positive childbirth experience of the latter (WHO 2018). The proposed principle puts a mother-to-be at the center of the model of care, and suggests the communication be providing the continuity of care, comfort, interest and all the information, patients require. This paper is devoted to the investigation of the way, different social actors are communicating in the context of a perinatal centre – a huge and complex maternity facility with multiple units, subdivisions, and health practitioners. In particular, it questions the possibility of effective communication and addresses the conflicts and boundaries emerging in it between different care providers and women interacting in this context.

The research employs the qualitative data, collected within the joint project ‘Medical interactions in the changing childbirth services: women’s needs and professionals’ opportunities’ (2018) headed by Professor Anna Temkina (EUSP). The research materials consist of observations in the Perinatal centre, in-depth semi-structured interviews with the centre’s workers and patients in prenatal and postpartum units, and the document analysis (official complaints, on-line reports in the Internet, orders, notes etc.). Preliminary findings of the research reflect on the mutual distrust of care providers and patients and the inability to overcome communicational boundaries in some cases.

Patient-Centeredness in European G7 Nations' Healthcare Regulation: Current Patterns and Future Directions

Humayun Ahmed1, Jovana Vukcevic1, Sohaib Ahmed1, Sophia Glisch1, Saleem Ahmed2,3,4,5

1University of Toronto, Canada; 2Sindh Medical College, Pakistan; 3College of Physicians and Surgeons of Pakistan, Pakistan; 4Aga Khan University, Pakistan; 5Jinnah Post-Graduate Medical Centre, Pakistan

Patient-centeredness has gained considerable centrality as a concern for regulatory bodies in recent years, following the acknowledgement that patients should be heavily involved in defining health care quality standards despite the importance of physician self-regulation. Organizations outwardly espouse such barrier-mitigating values and goals as transparency, informalization, physician accountability, and patient education. However, declared though these values and goals may be, our and others’ prior analyses suggest that the adherence of medical regulation to its stated quality standards is questionable throughout much of the developed and developing worlds, including G7 member states. Despite a superficial commitment to involving patients in their processes, regulatory bodies do not appear to deliver the patient engagement and patient-driven regulatory and conduct amelioration they publicly aspire towards. In order to propose policy and enforcement recommendations to improve current systems, this paper will first look at the current state of medical regulation in European G7 nations, including European Union member states. We will describe the standards publicly set by these states’ medical regulatory bodies, analyze the extent to which these standards demonstrate patient-centeredness, and evaluate the degree to which the regulatory bodies appear to comply with their own standards, with an emphasis on progression, hindrances, and trends. We will then recommend revisions to the formulation and enforcement of these standards, with the aim of mitigating the barriers and boundaries barring patient participation in health care quality standard definition, and fostering a true sense of belonging for patients within health care regulation.

Are Clinical Guidelines An Effective Means Of Achieving “Disruptive Innovation” In Healthcare? Lessons From A Recent NICE Guideline Controversy In The English NHS

Alex Rushforth, Trisha Greenhalgh, Sietse Wieringa

University of Oxford , United Kingdom

The past three decades have seen the emergence of new logics of governance in healthcare systems that attempt to move from profession-centred models of clinical practice towards more “rational” and managerial models of care. Within this context, clinical guidelines are a central instrument of standardization. Whilst guidelines are often presented as neutral conveyers of research evidence, sociological research has found that competing political, economic and scientific arguments and interests shape their production and use. Recent research has surfaced a trend for hopeful, aspirational claims and visions linked to the inclusion of technologies within clinical guidelines. The argument is that through “evidence-based” guidelines, new technologies can be more rapidly and effectively introduced, leading to improved care and better patient outcomes. In this talk, we will consider whether clinical guidelines are indeed an effective means of introducing “disruptive” technological innovations into healthcare systems, thereby reshaping clinical practice. Drawing on extensive ethnographic data from an in-depth, multi-level case study of a controversial attempt to introduce technology-supported testing and precision medicine into asthma management in primary care in the English NHS, we will show how a “trailblazing” guideline did not initially achieve its intended radical impact on clinical practice. We will contextualise our findings within a wider literature review of the promises and pitfalls of guidelines as instruments for catalysing “disruptive” innovation in healthcare and suggest ways to improve the success of such initiatives.