Objectives To conduct an independent evaluation of the first phase of the Health Foundation’s Safer Patients Initiative (SPI), and to identify the net additional effect of SPI and any differences in changes in participating and non-participating NHS hospitals. Design Mixed method evaluation involving five substudies, before and after design. Setting NHS hospitals in the United Kingdom. Participants Four hospitals (one in each country in the UK) participating in the first phase of the SPI (SPI1); 18 control hospitals. Intervention The SPI1 (...) was a compound (multi-component) organisational intervention delivered over 18 months that focused on improving the reliability of specific frontline care processes in designated clinical specialties and promoting organisational and cultural change. Results Senior staff members were knowledgeable and enthusiastic about SPI1. There was a small (0.08 points on a 5 point scale) but significant (P<0.01) effect in favour of the SPI1 hospitals in one of 11 dimensions of the staff questionnaire (organisational climate). Qualitative evidence showed only modest penetration of SPI1 at medical ward level. Although SPI1 was designed to engage staff from the bottom up, it did not usually feel like this to those working on the wards, and questions about legitimacy of some aspects of SPI1 were raised. Of the five components to identify patients at risk of deterioration—monitoring of vital signs (14 items); routine tests (three items); evidence based standards specific to certain diseases (three items); prescribing errors (multiple items from the British National Formulary); and medical history taking (11 items)—there was little net difference between control and SPI1 hospitals, except in relation to quality of monitoring of acute medical patients, which improved on average over time across all hospitals. Recording of respiratory rate increased to a greater degree in SPI1 than in control hospitals; in the second six hours after admission recording increased from 40% (93) to 69% (165) in control hospitals and from 37% (141) to 78% (296) in SPI1 hospitals (odds ratio for “difference in difference” 2.1, 99% confidence interval 1.0 to 4.3; P=0.008). Use of a formal scoring system for patients with pneumonia also increased over time (from 2% (102) to 23% (111) in control hospitals and from 2% (170) to 9% (189) in SPI1 hospitals), which favoured controls and was not significant (0.3, 0.02 to 3.4; P=0.173). There were no improvements in the proportion of prescription errors and no effects that could be attributed to SPI1 in non-targeted generic areas (such as enhanced safety culture). On some measures, the lack of effect could be because compliance was already high at baseline (such as use of steroids in over 85% of cases where indicated), but even when there was more room for improvement (such as in quality of medical history taking), there was no significant additional net effect of SPI1. There were no changes over time or between control and SPI1 hospitals in errors or rates of adverse events in patients in medical wards. Mortality increased from 11% (27) to 16% (39) among controls and decreased from 17% (63) to 13% (49) among SPI1 hospitals, but the risk adjusted difference was not significant (0.5, 0.2 to 1.4; P=0.085). Poor care was a contributing factor in four of the 178 deaths identified by review of case notes. The survey of patients showed no significant differences apart from an increase in perception of cleanliness in favour of SPI1 hospitals. Conclusions The introduction of SPI1 was associated with improvements in one of the types of clinical process studied (monitoring of vital signs) and one measure of staff perceptions of organisational climate. There was no additional effect of SPI1 on other targeted issues nor on other measures of generic organisational strengthening. (shrink)

At the start of the 21st century, Corporate Social Responsibility (CSR) seems to have great potential for innovating business practices with a positive impact on People, Planet and Profit. In this article the differences between the management systems approach of the nineties, and Corporate Social Responsibility are analysed.An analysis is structured around three business principles that are relevant for CSR and management systems: (1) doing things right the first time, (2) doing the right things, and (3) continuous improvement and innovation. (...) Basically CSR is focussing on the second principle, and management systems focus on the first. However, CSR is very likely to build on the management systems as well.From a CSR point of view, the existing generation of management systems with their focus on rational control (= doing things right) can only be of limited use in the development of CSR. However, the preventive rationalities of management systems are important. Values and the principle doing the right things is extremely relevant for CSR. This goes far beyond the present generation of ISO type management systems; opportunities stem from building on TQM approaches like the EFQM Business Excellence model. Continuous improvement and innovation is a permanent challenge underlying the two other business principles, and requires both individual and organisational learning processes. In the present generation of management systems, continuous improvement mainly addresses rational prevention, barely the value aspects of business.For the further development and implementation of CSR, each of the three business management principles are vital. There is a need for a new generation of management systems that addresses the values at stake in strategic decision-making, both at company level and in the behaviour of individuals, while the rationalities of prevention and anticipation are still relevant. In both directions more emphasis for continuous learning and innovation will be needed.CSR is likely to trigger the development of management systems in the directions mentioned. This will support companies to be credible and transparent in improving the performance with respect to people, planet and profit. (shrink)

Annotation. Against the background of Aristotle's Nicomachean Ethics. Bradley provides a detailed differentiation between Aristotle's and Aquinas's view on moral principles and the end of man.

Society in the Self: A Theory of Identity in Democracy shows how society is working in the deeper regions of self and identity. This book is an exploration of the democratic potentials of self and identity in a globalizing and localizing society.

The first to focus exclusively on implicit memory research, this book documents the proceedings of a meeting held in Perth, Australia where leading researchers ...

Overzicht van de rationalistische traditie in de filosofie van de kunst sinds Kant door een hoogleraar aan de Leuvense universiteit.

This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. This work was reproduced from the original artifact, and remains as true to the original work as possible. Therefore, you will see the original copyright references, library stamps (as most of these works have been housed in our most important libraries around the world), and other notations in the work. This work is in the public domain (...) in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work. As a reproduction of a historical artifact, this work may contain missing or blurred pages, poor pictures, errant marks, etc. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and made generally available to the public. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

O ponto de partida do presente ensaio é o entendimento de que a arte constitui um dos motivos catalisadores, se não mesmo um dos temas maiores da reflexão de Maurice Merleau-Ponty. Na interpretação do autor, o filósofo da percepção, aquele que, de todos os pensadores contemporâneos, conferiu ao corpo po um estatuto que a reflexão do século XX ainda não lhe concedera, chegou à arte por necessidade intrínseca do seu próprio caminho especulativo, vindo a reflexão sobre a expressão artística a (...) dar um contributo essencial para a constituição do seu próprio pensamento, contributo esse que se vai adensando, desde a Fenomenologia da Percepção até O Visível e o Invisível e O Olho e o Espírito, a ponto de poder dizer-se que na arte, particularmente na arte moderna, encontrou Merleau-Ponty uma filosofia à l'oeuvre, apesar da ausência do conceito, a que é, de facto, alheia a expressão artística. José Bettencourt da Câmara é professor no Departamento de Artes da Universidade de Évora.. In Editorial. (shrink)

It is often argued that clinical research should not violate the Kantian principle that people must not be used merely as a means for the purposes of others. At first sight, the practice of clinical research itself, however, seems to violate precisely this principle: clinical research is often beneficial to future people rather than to participants; even if participants benefit, all things considered, they are exposed to discomforts which are absent both in regular care for their diseases and in other (...) areas of daily life. Therefore, in this paper we will consider whether people are used merely as a means by being enrolled in clinical research. On the basis of recent studies of Kantian scholars we will argue that clinical research is compatible with the Kantian principle if the conditions of possible consent and end-sharing have been met. Participants are not used merely as a means if they have sufficient reasons to consent to being enrolled in clinical research and can share the ends of the researchers who use them. Moreover, we will claim that even if people are used merely as a means by participating in clinical research, it may not always be morally wrong to use them in this way. (shrink)

A bold and visionary book that reveals the false and catastrophically damaging images at the root of the oppression of women and the rape of Earth's resources, ...

In this book, I give a topic-based, modular introduction to philosophy. The book has 16 chapters: 7 in theoretical philosophy and 9 in practical philosophy. Each topic is introduced by means of a concrete question; the main positions on this question are then developed and criticized in turn. I try to avoid taking sides; instead, I emphasize that students must think through the issues for themselves.