Suchergebnisse

Determining the best use of case managers' time is difficult both because of the great variability in the factors and the lack of outcome studies. In place of the outcome studies, the responses to focus group questions of 89 experienced case managers from across Canada were used to indicate a value for case management functions in the areas of direct care, indirect care management, and program management. The case managers identified greater value for direct care with clients and families who are new to home care or who have complex problems in comparison to clients in more stable or manageable situations. Case managers were frustrated by the lack of agency and community policies and resources to allow case managers to properly support people in their homes. The case managers valued addressing problems on a program or community basis rather than the usual case-by-case. Although preliminary, the approach could be useful in assessing the efficient and effective use of a scarce resource, case managers' time.

This study re-analysed 14 semi-structured interviews with policy officials from the UK Department for Environment, Food and Rural Affairs (Defra) to explore the use of a variety of regulatory instruments and different levels of risk across 14 policy domains and 18 separately named risks. Interviews took place within a policy environment of a better regulation agenda and of broader regulatory reform. Of 619 (n) coded references to 5 categories of regulatory instrument, 'command and control' regulation (n = 257) and support mechanisms (n = 118) dominated the discussions, with a preference for 'command and control' cited in 8 of the policy domains. A framing analysis revealed officials' views on instrument effectiveness, including for sub-categories of the 5 key instruments. Views were mixed, though notably positive for economic instruments including taxation, fiscal instruments and information provision. An overlap analysis explored officials' mapping of public environmental risks to instrument types suited to their management. While officials frequently cite risk concepts generally within discussions, the extent of overlap for risks of specific significance was low across all risks. Only 'command and control' was mapped to risks of moderate significance in likelihood and impact severity. These results show that policy makers still prefer 'command and control' approaches when a certainty of outcome is sought and that alternative means are sought for lower risk situations. The detailed reasons for selection, including the mapping of certain instruments to specific risk characteristics, is still developing.

This article applies and builds upon the network leadership models introduced by Provan and Kenis to the case of the British Columbia Network for Aging Research (BCNAR). We specify a particular type of shared leadership model and term this a Targeted Shared Leadership (TSL) model based on the governance structure of BCNAR. Key features include six coleaders who are selected on the basis of representation of five major universities (typically in its gerontology center) situated in the five provincial health authorities in British Columbia. Several network characteristics are introduced and then applied to BCNAR to assess effectiveness of the leadership structure. Innovations in research grant capacity support, communication, mentorship and training of new gerontologists, and knowledge translation are used to specify the effectiveness of the leadership structural dynamics of BCNAR. Potential applications of this shared leadership model for other networks are discussed.