Health outcomes are about choices and values: an economic perspective on the health outcomes movement

Development of a Remote Psychological First Aid Protocol for Healthcare Workers Following the COVID-19 Pandemic in a University Teaching Hospital, Malaysia

The purpose of this article is to discuss the importance of addressing the psychological impact of coronavirus disease 2019 (COVID-19) on healthcare workers (HCWs) who are frontliners directly involved in mitigating the spread of the disease. This paper focuses on the utilization of a clinical practice protocol for identifying HCWs who are COVID-19-positive or under investigation and surveillance for suspected infection, in a tertiary, university teaching hospital of Malaysia. The protocol for Psychological First Aid (PFA), which is applied remotely via a mobile application and phone calls, outlines the work process in stages, with expected immediate, intermediate, and long-term goals within a "Specific, Measurable, Attainable, Relevant, and Realistic Timeframe" (SMART). This protocol is developed to provide a guideline for psychological crisis interventions that promote safety, calm, and hope in HCWs, allowing them to return to psychological functioning without being stigmatized. The unprecedented remote PFA protocol may serve as a platform for further research on the application of a goal-directed approach in a healthcare organization.

General concepts of goals and goal-setting in healthcare: A narrative review

Goal-setting is fundamental to organisational management, yet not every manager knows how to do it well. A narrative literature review was done to explore current knowledge of definitions and classifications of goals, and principles of goal-setting in the healthcare sector. Online databases generated 65 relevant articles. Additional literature sources were snowballed from referenced articles, and textbooks. Most academic authors define ‘goal’ synonymously as ‘aim’ or ‘objective’, but there is evidence of hermeneutical confusion in general literature. Goal classifications are diverse, differing according to their contextual, structural, functional, and temporal characteristics. Many authors agree that goal-setting is problem-based, change-oriented, and can effectively motivate attainment if the goal statement is formulated with a specific and challenging or SMART framework. However, recent authors report varying definitions for SMART, and evidence of past studies that empirically examined the nature and efficacy of frameworks currently used for formulating goal statements for health programmes are lacking.

Priority setting in health: origins, description and application of the Australian Assessing Cost-Effectiveness initiative

This article reports on the 'Assessing Cost-Effectiveness' (ACE) initiative in priority setting from Australia. It commences with why priority setting is topical and notes that a wide variety of approaches are available. In assessing these various approaches, it is argued that a useful first step is to consider what constitutes an 'ideal' approach to priority setting. A checklist to guide priority setting is presented based on guidance from economic theory, ethics and social justice, lessons from empirical experience and the needs of decision-makers. The checklist is seen as an important contribution because it is the first time that criteria from such a broad range of considerations have been brought together to develop a framework for priority setting that endeavors to be both realistic and theoretically sound. The checklist will then be applied to a selection of existing approaches in order to illustrate their deficiencies and to provide the platform for explaining the unique features of the ACE approach. A case study (ACE-Cancer) will then be presented and assessed against the checklist, including reaction from stakeholders in the cancer field. The article concludes with an overview of the full body of ACE research completed to date, together with some reflections on the ACE experience.

Public health: disconnections between policy, practice and research

BACKGROUND

Public health includes policy, practice and research but to sufficiently connect academic research, practice and public health policy appears to be difficult. Collaboration between policy, practice and research is imperative to obtaining more solid evidence in public health. However, the three domains do not easily work together because they emanate from three more or less independent 'niches'.Work cycles of each niche have the same successive steps: problem recognition, approach formulation, implementation, and evaluation, but are differently worked out. So far, the research has focused on agenda-setting which belongs to the first step, as expressed by Kingdon, and on the use of academic knowledge in policy makers' decision-making processes which belongs to the fourth step, as elaborated by Weiss. In addition, there are more steps in the policy-making process where exchange is needed.

METHOD

A qualitative descriptive research was conducted by literature search. We analyzed the four steps of the policy, practice and research work cycles. Next, we interpreted the main conflicting aspects as disconnections for each step.

RESULTS

There are some conspicuous differences that strengthen the niche character of each domain and hamper integration and collaboration. Disconnections ranged from formulating priorities in problem statements to power roles, appraisal of evidence, work attitudes, work pace, transparency of goals, evaluation and continuation strategies and public accountability. Creating awareness of these disconnections may result in more compatibility between researchers, policy makers and practitioners.

CONCLUSION

We provide an analysis that can be used by public health services-related researchers, practitioners and policy makers to be aware of the risk for disconnections. A synthesis of the social, practical and scientific relevance of public health problems should be the starting point for a dialogue that seeks to establish a joint approach. To overcome the above mentioned disconnections, face-to-face encounters consistently emerge as the most efficient way to transfer knowledge, achieve higher quality and acknowledge mutual dependence. We recommend practice and policy based research networks to establish strong links between researchers, policy makers and practitioners to improve public health.

A fair range of choice: justifying maximum patient choice in the British National Health Service

In this paper I put forward an ethical argument for the provision of extensive patient choice by the British National Health Service. I base this argument on traditional liberal rights to freedom of choice, on a welfare right to health care, and on a view of health as values-based. I argue that choice, to be ethically sustainable on this basis, must be values-based and rational. I also consider whether the British taxpayer may be persuadable with regard to the moral acceptability of patient choice, making use of Rawls' theory of political liberalism in this context. I identify issues that present problems in terms of public acceptance of choice, and also identify a boundary issue with regard to public health choices as against individual choices.

Opportunity Cost

Low-income rural southern African American women experience a high prevalence of morbidity and mortality from coronary heart disease (CHD) as well as other related cardiovascular (CV) diseases. Few models have taken into account the full impact of the contextual influences encountered on a daily basis by these women, and the effect of these influences on their CV health status. There are clearly demarcated examples of existing health disparities that occur in various ethnic/racial, underserved, and vulnerable populations. Yet, to date, there is no conceptual model that offers a plausible explanation as to why health disparities exist. Consequently, there is a lack of guidance as to where interventions should be focused for effective CV risk reduction. Because African American women continue to die at a disproportionately higher rate, and at earlier ages than do Caucasian women, it is imperative that new theoretical models capable of driving empirically based interventions be developed, tested, and implemented. One possible choice is the conceptual model proposed in this article. The model is based on the interrelationships between contextual risk factors, rational choice theory (RCT), and opportunity cost. Conceivably, this model may serve as a foundation to ground conceptual thought and drive theory-based interventions to reduce the health disparities in the CV health of low-income rural southern African American women. A model is presented in an attempt to provide guidance for advanced practice nurses who must struggle with addressing the critical need to reduce ethnic and race-associated CV health disparities.

Towards an integrated needs and outcome framework

The British National Health Service alongside many other western countries is faced with competing pressures for limited health care resources which reflect, along with an increased accountability of both purchasers and providers of health care, the need for a clear function of explicit prioritisation from those who purchase health care. To enable limited health resources to be thus allocated, purchasers of health care must, therefore, be able to quantify not only the needs of their populations, but to predict and measure the outcomes from a health care intervention. This paper is concerned with the value framework underlying the twin dimension of needs and outcome assessment and seeks to address this framework from the sociological, philosophical and economic perspective and to determine the implications for the underlying distributive ethic.

Beyond health outcomes: the benefits of health care

Most of the debate surrounding standards in medical care, issues of medical audit and what constitutes benefit from health care assumes that what is obtained from health care is health and only that. This is an assumption which most health economists at least implicitly appear to endorse. This paper questions that assumption. There are various outcomes beyond health and there are various processes involved in health care about which patients are not indifferent. This paper calls for a fuller investigation as to what it is that patients want from their health services and the adoption of a more pluralistic conception of health care benefits. It is further argued that the objectives of health care systems are those in which citizens qua citizens also have interests and which may be different from those of patients. It is yet less likely that citizens' interests in health care will be restricted to health.

Demonstrating the value of the advanced practice nurse: an evaluation model

Advanced practice nurses are challenged to assess comprehensively the value of their role and the impact of their practice. Value is defined as quality divided by cost. The correlations among the structure, strategies of care (process), and their objectives (outcome) are key to the assessment of the quality of care and the impact of the advanced practice nurse's role. Advanced practice nurses are challenged to provide high quality care for a competitive or decreased cost. For the profession of nursing, outcomes are the result of interventions based on the nurse's clinical judgment and theoretical, practical, or scientific knowledge. An evaluation model is presented that comprehensively measures the impact of advanced practice nurses on patients and families, and an example is presented. Using the model will give credibility and validity to the APNs' positive impact on the quality and financial outcomes of care for each patient and for entire patient populations.