Some issues in the assessment of clinical practice: a review of the literature

? This paper focuses on some issues in the assessment of clinical practice of particular interest to the author. ? The assessment of students of nursing in clinical practice is acknowledged as a long-standing and difficult problem. ? There is little consensus as to what is meant by the term competence when applied to clinical nursing practice, making the assessment of clinical practice a mainly subjective process. ? The English National Board (1989) has distinguished the term mentor as meaning counsellor and guide, nevertheless the roles of mentor and assessor are frequently confused. ? It is suggested that nurses are equally accountable for the accurate assessment of student nurses' clinical skills as they are for their own practice. ? The validity and reliability of tools used to assess clinical practice are difficult to establish, making objective assessment complex at best, and impossible at worst. ? The assessment of the reflective process has been suggested as one way out of the dilemma, but the ability to think and to write does not necessarily translate into competent clinical practice.     

Sexual and reproductive health and rights in changing health systems

Sexual and reproductive health and rights (SRHR) are centrally important to health. However, there have been significant shortcomings in implementing SRHR to date. In the context of health systems reform and universal health coverage/care (UHC), this paper explores the following questions. What do these changes in health systems thinking mean for SRHR and gender equity in health in the context of renewed calls for increased investments in the health of women and girls? Can SRHR be integrated usefully into the call for UHC, and if so how? Can health systems reforms address the continuing sexual and reproductive ill health and violations of sexual and reproductive rights (SRR)? Conversely, can the attention to individual human rights that is intrinsic to the SRHR agenda and its continuing concerns about equality, quality and accountability provide impetus for strengthening the health system? The paper argues that achieving equity on the UHC path will require a combination of system improvements and services that benefit all, together with special attention to those whose needs are great and who are likely to fall behind in the politics of choice and voice (i.e., progressive universalism paying particular attention to gender inequalities).     

Coaching: A Primer for the Radiologist

The practice of coaching using positive psychology is an emerging and promising approach to address the radiologist burnout epidemic, with the focus on wellness even more urgent given the coronavirus disease 2019 pandemic and other recent stressful events. Coaching uses a strengths-based approach to help radiologists identify and achieve positive emotions, create meaningful relationships, increase engagement and purpose, and develop coping skills for personal and professional stressors, including communication, improving resilience, team building, and mindfulness. Health and wellness coaching promotes healthy behavior change as a means of averting or mitigating chronic lifestyle-related diseases and is a potential treatment for burnout and stress management. Coaches help clients enhance self-motivation, identify strengths, and implement a framework for change by applying psychological resources, including mindfulness, positive mind-set, resilience, self-efficacy, and self-awareness. The framework of coaching is built upon psychological safety, mindfulness, accountability, and the coach-client relationship. Coaches use the three fundamental skills of mindful listening, open-ended inquiry, and perceptive reflections to empower clients on their journeys to achieve their best selves.     

La responsabilidad social de las facultades de Medicina. Una exigencia inaplazable para adaptarse a las necesidades de la población

Social responsibility (SR) is a philosophy which starts to permeate the medical schools and drives the need to revise their mission in society and how to better contribute to its development for equity, participation, collaboration and social welfare values. We speak of the fact that medical schools must become aware of their obligations to satisfy the needs of society, as expressed by the global consensus in SR. In some countries, especially in the Anglo-Saxon ones, USA, Australia and Canada SR where has already being implemented. In Europe its implementation is still limited, except for some very specific cases in France and Belgium due to the Francophone Network. For some authors we are facing a change in the medical education paradigm which may have similar impact as the Flexner report in 1910, when a radical change took place, both in the training of the doctor and in the professional practice, which led to specialization and detriment of general medicine.The aim of this article is to clarify the concept, background and implications of SR in health science schools, as well as to present the main models developed up to now, all of them oriented to Primary and Community Care, a weakness that the COVID-19 pandemic has highlighted.     

Accountability for the human right to health through treaty monitoring: Human rights treaty bodies and the influence of concluding observations

Employing novel coding methods to evaluate human rights monitoring, this article examines the influence of United Nations (UN) treaty bodies on national implementation of the human right to health. The advancement of the right to health in the UN human rights system has shifted over the past 20 years from the development of norms under international law to the implementation of those norms through national policy. Facilitating accountability for this rights-based policy implementation under the right to health, the UN Committee on Economic, Social and Cultural Rights (CESCR) monitors state implementation by reviewing periodic reports from state parties, engaging in formal sessions of ‘constructive dialogue’ with state representatives, and issuing concluding observations for state response. These concluding observations recognise the positive steps taken by states and highlight the principal areas of CESCR concern, providing recommendations for implementing human rights and detailing issues to be addressed in the next state report. Through analytic coding of the normative indicators of the right to health in both state reports and concluding observations, this article provides an empirical basis to understand the policy effects of the CESCR monitoring process on state implementation of the right to health.     

Holding American hospitals accountable: rhetoric and reality

Assessing the vast arena that continues to grow in pursuit of accountability in American hospitals, this paper raises the following question: Is this enterprise geared toward making hospitals better or toward making them only look better? ‘Accountability’ has become an umbrella concept to signal the need to demonstrate — to others — that performance is being measured and perfected. The author asserts that there is an imperfect fit between health‐care and the industrial model being used to measure quality of care due to four problematic issues: the nature of contemporary patient care, the overstating and overselling of accountability proposals, inflated expectations placed upon ‘rationalization’, and insufficient attention afforded accident and error. The paper concludes with a plea for reconsideration of the tilt toward a business approach to health‐care, asking if, in our zeal to hold hospitals accountable, we are measuring what is important or simply making important what we can measure.     

Using accountability to improve reproductive health care

Accountability is best understood as a referee of the dynamics in two-way relationships, often between unequal partners. The literature on accountability distinguishes between political, fiscal, administrative, legal and constitutional accountability. This paper focuses on accountability mechanisms in health care and how they mediate between service providers and communities and between different kinds of health personnel at the primary health care level. It refers to case studies of participatory processes for improving sexual and reproductive health service delivery. Information, dialogue and negotiation are important elements that enable accountability mechanisms to address problems by supporting change and engagement between participants. In order to succeed, however, efforts towards better accountability that broaden the participation of users must take into account the social contexts and the policy and service delivery systems in which they are applied, address power relations and improve the representation of marginalised groups within communities and service delivery systems.     

When you hear hoofs,think horses,not zebras: an evidence-based model of health care accountability

Health care organizations are increasingly asked to show accountability about their performance. This paper proposes that accountability can best be achieved through evaluative methods that are based on evidence regarding the relationship between processes of care and expected outcomes. Root cause analysis (RCA) is used as an illustration of how a generic method of inquiring can be transformed into an ongoing monitoring, evaluation, user education and accountability strategy. The role of performance indicators, as well as patient and community expectations, is discussed.     

Absent voices compromise the effectiveness of nursing home regulation: a critique of regulatory reform in the UK nursing home industry

Over the last decade there has been consistent pressure for the healthcare services in the UK to become more accountable to users. Now over half the healthcare beds in England are in the privatised nursing home sector, and regulation of the sector is under reform. Yet requirements for user accountability have not been reflected in these reforms. In other sectors, consumer involvement in regulatory agencies and processes is seen as important to the success of the regulatory enterprise. But in the care sector neither users nor their representatives have been given legal rights of involvement in the National Care Standards Commission or in regulatory processes. This paper argues that failure to involve users not only places the regulation enterprise at risk of capture by the industry, but will also weaken the legitimacy of the new Commission.