This unique and engaging open access title provides a compelling and ground-breaking account of the patient safety movement in the United States, told from the perspective of one of its most prominent leaders, and arguably the movement's founder, Lucian L. Leape, MD. Covering the growth of the field from the late 1980s to 2015, Dr. Leape details the developments, actors, organizations, research, and policy-making activities that marked the evolution and major advances of patient safety in this time span. In addition, and perhaps most importantly, this book not only comprehensively details how and why human and systems errors too often occur in the process of providing health care, it also promotes an in-depth understanding of the principles and practices of patient safety, including how they were influenced by today's modern safety sciences and systems theory and design. Indeed, the book emphasizes how the growing awareness of systems-design thinking and the self-education and commitment to improving patient safety, by not only Dr. Leape but a wide range of other clinicians and health executives from both the private and public sectors, all converged to drive forward the patient safety movement in the US. Making Healthcare Safe is divided into four parts: I. In the Beginning describes the research and theory that defined patient safety and the early initiatives to enhance it. II. Institutional Responses tells the stories of the efforts of the major organizations that began to apply the new concepts and make patient safety a reality. Most of these stories have not been previously told, so this account becomes their histories as well. III. Getting to Work provides in-depth analyses of four key issues that cut across disciplinary lines impacting patient safety which required special attention. IV. Creating a Culture of Safety looks to the future, marshalling the best thinking about what it will take to achieve the safe care we all deserve. Captivatingly written with an "insider's" tone and a major contribution to the clinical literature, this title will be of immense value to health care professionals, to students in a range of academic disciplines, to medical trainees, to health administrators, to policymakers and even to lay readers with an interest in patient safety and in the critical quest to create safe care.

NHS reform continues to be a topical yet contentious issue in the UK. Reforming healthcare: What's the evidence? is the first major critical overview of the research published on healthcare reform in England from 1990 onwards by a team of leading UK health policy academics. It explores work considering the Conservative internal market of the 1990s and New Labour's healthcare reorganizations, including its attempts at performance management and the reintroduction of market-based reform from 2004 to 2010. It then considers the implications of this research for current debates about healthcare reorganization in England, and internationally. As the most up-to-date summary of what research says works in English healthcare reform, this essential review is aimed at anyone interested in the wide-ranging debates about health reorganization, but especially students and academics interested in social policy, public management and health policy.

For more than a decade, the focus of information technology has been on capturing and sharing data from a patient within an all-encompassing record (a.k.a. the electronic health record, EHR), to promote improved longitudinal oversight in the care of the patient. There are both those who agree and those who disagree as to whether this goal has been met, but it is certainly evolving. A key element to improved patient care has been the automated capture of data from durable medical devices that are the source of (mostly) objective data, from imagery to time-series histories of vital signs and spot-assessments of patients. The capture and use of these data to support clinical workflows have been written about and thoroughly debated. Yet, the use of these data for clinical guidance has been the subject of various papers published in respected medical journals, but without a coherent focus on the general subject of the clinically actionable benefits of objective medical device data for clinical decision-making purposes. Hence, the uniqueness of this book is in providing a single point-of-capture for the targeted clinical benefits of medical device data--both electronic- health-record-based and real-time--for improved clinical decision-making at the point of care, and for the use of these data to address and assess specific types of clinical surveillance. Clinical Surveillance: The Actionable Benefits of Objective Medical Device Data for Crucial Decision-Making focuses on the use of objective, continuously collected medical device data for the purpose of identifying patient deterioration, with a primary focus on those data normally obtained from both the higher-acuity care settings in intensive care units and the lower-acuity settings of general care wards. It includes examples of conditions that demonstrate earlier signs of deterioration including systemic inflammatory response syndrome, opioid-induced respiratory depression, shock induced by systemic failure, and more. The book provides education on how to use these data, such as for clinical interventions, in order to identify examples of how to guide care using automated durable medical device data from higher- and lower-acuity care settings. The book also includes real-world examples of applications that are of high value to clinical end-users and health systems.

The increasing pressure on the bottom line of healthcare provider organizations requires leaders who understand and can adeptly apply the basic principles of effective financial and operations management. To be successful in today's environment leaders must simultaneously improve quality and service while reducing expense. Improving Financial and Operations Performance: A Healthcare Leader's Guide is a collection of proven effective tips, tools, and techniques accumulated from real-world challenges and lessons learned logically organized to provide a straightforward approach to planning, assessing, managing, and monitoring a business enterprise to improve profitability.This book provides a clear, step-by-step "how to" approach for both new and experienced leaders seeking a leg up in tackling the myriad of common and complex challenges they are facing including conducting a budget variance analysis, managing labor and non-labor productivity and expense, performing a comprehensive financial condition analysis, growing profitable volume and market share, developing an effective business case for improving quality, and evaluating the financial impact of a future project. Written for clinical and administrative leaders working in the trenches, it provides practical and applicable tools with relevant, real-world, and replicable case study examples. The essential value of Improving Financial and Operations Performance: A Healthcare Leader's Guide is improving decision-making effectiveness, enhancing operations efficiency know-how, and developing strong financial management acumen to overcome the challenges in today's healthcare environment. Key Features: Author experience with extensive expertise as a former investor-owned hospital CEO, integrated health system vice president, managing director for the renowned turnaround experts, the Hunter Group, and graduate business school professor in management, finance, and economics. Realistic case examples to apply the key lessons through detailed practical and relevant case studies using clear step-by-step instructions. Calls-to-action at the end of each chapter with critical leadership imperatives to help prioritize and focus efforts on what matters most. Comprehensive glossary of key terms and concepts using plain easy to understand language. Appendices and Excel templates containing easy-to-use plug-and-play financial worksheets, checklists, best practice pathways, and performance assessments. eBook access purchase includes digital access for use on most mobile devices or computers.

EMERGENCY MANAGEMENT OF THE HI-TECH PATIENT IN ACUTE AND CRITICAL CARE Emergency Management of the Hi-Tech Patient in Acute and Critical Care helps practitioners stabilize and care for pediatric and adult patients who have specialized medical devices such as prosthetic valves, cochlear transplants, insulin pumps, orthopedic hardware, and ventriculoperitoneal (VP) shunts. Using a step-by-step approach to acute presentations of patients with clinical hardware, this concise yet comprehensive guide provides specific instructions for the initial evaluation and management of numerous clinical scenarios including device malfunctions, infections, trauma, surgical complications, and more. Encompassing management of both the patient and the device, the guide enables emergency and critical care clinicians to rapidly make appropriate treatment decisions without the immediate need for extensive research, extended discussions with subspecialists, or recalling complex diagnostic and therapeutic algorithms. Clear, concise, and easy-to-follow chapters--written by a panel of highly experienced experts across specialties--include numerous algorithms, figures, tables, diagrams, and color illustrations and clinical images. An invaluable resource for improving the quality of care for the unique hi-tech patient population, this advanced practical manual: Provides algorithms for the most common clinical scenarios of device malfunction and related complications Covers management of patients who have undergone major operations such as organ transplantation or complex congenital heart disease repair Presents detailed management plans for a wide range of hardware types and medical conditions Offers expert guidance to practitioners in settings where not all specialties are readily available, such as rural and remote areas or community hospitals Features contributions from a team of experts in various areas of adult and pediatric emergency and critical care medicine Emergency Management of the Hi-Tech Patient in Acute and Critical Care is a must-have clinical reference and guide for pediatric and adult emergency medicine physicians, general pediatricians, internists, general practitioners, critical care specialists, and allied health practitioners.

Artificial intelligent systems, which offer great improvement in healthcare sector assisted by machine learning, wireless communications, data analytics, cognitive computing, and mobile computing provide more intelligent and convenient solutions and services. With the help of the advanced techniques, now a days it is possible to understand human body and to handle & process the health data anytime and anywhere. It is a smart healthcare system which includes patient, hospital management, doctors, monitoring, diagnosis, decision making modules, disease prevention to meet the challenges and problems arises in healthcare industry. Furthermore, the advanced healthcare systems need to upgrade with new capabilities to provide human with more intelligent and professional healthcare services to further improve the quality of service and user experience. To explore recent advances and disseminate state-of-the-art techniques related to intelligent healthcare services and applications. This edited book involved in designing systems that will permit the societal acceptance of ambient intelligence including signal processing, imaging, computing, instrumentation, artificial intelligence, internet of health things, data analytics, disease detection, telemedicine, and their applications. As the book includes recent trends in research issues and applications, the contents will be beneficial to Professors, researchers, and engineers. This book will provide support and aid to the researchers involved in designing latest advancements in communication and intelligent systems that will permit the societal acceptance of ambient intelligence. This book presents the latest research being conducted on diverse topics in intelligence technologies with the goal of advancing knowledge and applications healthcare sector and to present the latest snapshot of the ongoing research as well as to shed further light on future directions in this space. The aim of publishing the book is to serve for educators, researchers, and developers working in recent advances and upcoming technologies utilizing computational sciences.

Organizations are ethically, morally, and legally required to maintain safe workplaces that protects employees, visitors and anyone who frequents their establishments. But why do organizations that employee uniformed security personnel as part of their overall workplace violence prevention program still struggle to create and maintain the safest possible workplaces? To meet these obligations organizations often employ uniformed security officers to deter, observe, and report criminal behavior, and in some contexts, they physically interact with dangerous individuals to protect employees, consumers and visitors from violent behaviors. Unfortunately, many organizations don't utilize their security personnel to their fullest potential and organizational and community members continue to be victims of workplace violence. This book identifies the flawed principles, policies and personnel decisions that organizations use, and it provides practical solutions to address them. The book covers two major themes: the misapplication of law enforcement community safety principles to private, free-market businesses and the use of risk aversive philosophies to their security officer's activities. This book covers the principles, policies and personnel necessary for maximizing the effectiveness of uniformed security personnel to successfully mitigate potential workplace violence and create and maintain safe organizations. There is a strong need for this book since workplace violence prevention has taken on a new focus due to increases in workplace violence incidents and new laws requiring organizations to take a more serious approach to workplace violence prevention. The healthcare and campus markets are most affected by these laws and are under public scrutiny because of their vulnerable populations. These two markets combined employ the most non-contract, propriety private security personnel in the country. Both markets rely on uniform security officers to create and maintain safe communities and play an important role in their respective workplace violence prevention plans.

Since the time AIDS and HIV infection were first discovered, no medical cures have been developed. It became clear early on that education would be the cornerstone in the fight against AIDS, and that assessment remains true in the 1990s. This book describes how to tailor HIV education and prevention efforts to specific communities, including how to identify those most at risk, what types of interventions are most appropriate to those communities, how to engage those most at risk, and the role of participatory evaluation in determining the effectiveness of community education efforts.

This book examines the financing of China's health system, argues that present arrangements are not adequate and proposes an increased role for commercial health insurance as a way of overcoming the difficulties. Highlighting that China's present social medical insurance system can only cover basic medical services, with the results that many Chinese people with higher income are going abroad for high-quality medical services and that doctors are not bringing in the salaries and obtaining the social status they expect, the book suggests that commercial health insurance offers a possible solution, in that it can help meet the demand of higher-income groups for better healthcare services while at the same time increasing the income of more competent medical professionals. The book goes on to consider the current state of China's commercial insurance industry, outlining the various challenges that the industry needs to overcome if it is to fulfil an increased role, challenges such as greater specialization, increased capacity, structural reform, improved regulation and closer integration with China's medical reform programme.

Our current healthcare system is sick, and the cure is simple: We need to bring compassion back to healthcare. In The Cutting Edge of Compassion, board-certified orthopedic surgeon Dr. Barry Rose reflects on how physicians and patients can create the best healing outcomes by appreciating personality differences, addressing fear, being open to Eastern and Western medical philosophies, and working together to address insurance, legal, and pharmaceutical obstacles to optimal care. Rose presents a compassionate vision for healthcare where health professionals and patients work together to heal. The Cutting Edge of Compassion will open your eyes and your heart and reveal that compassionate healthcare is possible when patients and health professionals work together to achieve it. Dr. Barry Rose is a board-certified orthopedic surgeon and chief of orthopedic surgery and surgical division head for the Alameda division of the Palo Alto Foundation Medical Group, one of the largest multi-specialty groups in California. He resides in San Francisco with his wife Rose.

First edition named a 2013 PROSE Award Winner in Nursing and Allied Health Sciences. This textbook for Canadian nursing and allied health students explores the major health issues of Indigenous populations and how to improve their overall health. The second edition addresses a key development since the first edition was published: an increasing consensus among Indigenous peoples that their health is tied to environmental determinants, both physical and philosophical. This text describes what is distinctive about Indigenous approaches to health and healing and why it should be studied as a discrete field. It provides a framework for professionals to approach Indigenous clients in a way that both respects the client's worldview while retaining a professional epistemology. Grounded in the concepts of cultural sensitivity, competency, and safety - yet filled with practical information - this book integrates historical, social, and clinical approaches illuminated by concrete examples from the field and relevant case studies. New to the Second Edition: Delivers thoroughly updated content, statistics, and coverage of political developments since 2013 Includes a complete test bank of multiple choice, true/false, and short answer questions in each chapter Provides sample PowerPoint presentation lectures in each chapter Key Features: Authored by a leading researcher and educator in First Nations and Inuit health Serves as the only up-to-date text on Indigenous health in Canada Enhances learning with chapter objectives, critical thinking exercises, abundant primary source material, and references

Assisted Living Administration and Management: Effective Practices and Model Programs in Elder Care 2nd Edition provides students and healthcare professionals with the most up to date and essential knowledge on assisted living and residential care. This comprehensive text empowers current and future assisted living administrators to employ effective practices, understand model programs, and learn the necessary tools and tips to maximize the overall health, safety, and comfort of residents in their care. Organized by domains of practice, it also covers content information required to prepare for state-based Residential Care and Assisted Living (RC/AL) administrator certification or licensure exams.The textbook is structured in five parts which instruct on how to build and manage effective assisted living and residential care communities, beginning with Organizational Management and progressing through Human Resources, Business and Financial Management, Environmental Management, and Resident Care Management. The second edition includes six new chapters on evolving topics, such as interprofessional practice, home and community-based services (HCBS) as alternatives to assisted living, information and communication technology (ICT), LGBT issues, memory care units, and palliative and hospice care. Chapters feature learning objectives, case studies, effective practices, and more enabling students and healthcare professionals to evaluate, analyze, and synthetize information on how to best operate, manage, and lead assisted living communities. Useful for any long-term care and health management professional or student in the fields of gerontology, health administration, and long-term care administration, this comprehensive book covers the most crucial aspects of assisted living and residential care management the most abundant and fastest growing senior living line of service in the United States. Key Features: Describes real-life situations and challenges associated with Assisted Living Administration with pragmatic solutions which highlight the most effective practices and model programs in elder care Contains new chapters on interprofessional practice, home and community-based services (HCBS) as an alternative to assisted living, information and communication technology (ICT), LGBT issues, memory care units, palliative and hospice care Highlights useful details on business and financial management, including guidelines for marketing facilities and services, important legal issues and terms, and evolving public policy issues Incorporates chapters on environmental management, with information on accessibility, fire safety, disaster preparedness, universal design and aging in place, and much more Emphasizes the importance of holistic, resident care management by examining the biological, psychological, and social aspects of aging Prepares students to qualify and sit for the state certification or licensure examination as Assisted Living Administrators Includes access to the fully downloadable eBook and instructor resources including a test bank

This book is a reference guide for healthcare executives and technology providers involved in the ongoing digital transformation of the healthcare sector. The book focuses specifically on the challenges and opportunities for health systems in their journey toward a digital future. It draws from proprietary research and public information, along with interviews with over one hundred and fifty executives in leading health systems such as Cleveland Clinic, Partners, Mayo, Kaiser, and Intermountain as well as numerous technology and retail providers. The authors explore the important role of technology and that of EHR systems, digital health innovators, and big tech firms in the ongoing digital transformation of healthcare. Importantly, the book draws on the accelerated learnings of the healthcare sector during the COVID-19 pandemic in their digital transformation efforts to adopt telehealth and virtual care models. Features of this book: Provides an understanding of the current state of digital transformation and the factors influencing the ongoing transformation of the healthcare sector. Includes interviews with executives from leading health systems. Describes the important role of emerging technologies; EHR systems, digital health innovators, and more. Includes case studies from innovative health organizations. Provides a set of templates and frameworks for developing and implementing a digital roadmap. Based on best practices from real-life examples, the book is a guidebook that provides a set of templates and frameworks for digital transformation practitioners in healthcare.

Compiled by two leading experts in the field, this volume provides a concise, timely, and authoritative review of some of the most problematic infections of the new century. It presents issues and new ideas for preventing and controlling infectious diseases.

This provocative and timely book examines the current state of primary care practice and outlines a new vision for the delivery of primary care services, primarily in the UK but also internationally. Encouraging a social compact between citizens, governments and the providers of care, the book describes how this will necessitate a redesign of the welfare sector to ensure it is 'fit for purpose' in the digital world. It explores the respective roles of the inverse care law and the rule of halves, systems theory and learning organisations, mutuality and active citizenship, and how these can be applied to improve service delivery. Key Features Offers an alternative approach to thinking and a challenge to leaders within primary care and to those with administrative responsibility for the sector Reflects the multiple challenges facing primary care, including the rise in frail elderly patients, increasing multi-morbidities, the impact of changing demography with migration and much more Sets these challenges in a context of increasing workforce pressures, including changing attitudes to professionalism, burnout and recruitment difficulties Outlines a road map for improvement, responding to current challenges around social care as well as digital/e-health Aimed at, and written for, all those committed to improving the future of the primary care sector in the UK and internationally, this important book will be of interest to students, clinicians, managers, commissioners, policy makers and service users.

Applied Problem-Solving in Healthcare Management is a practical textbook devoted to developing and strengthening problem-solving and decision-making leadership competencies of healthcare administration students and healthcare management professionals. Built upon the University of Minnesota Master of Healthcare Administration Program's Problem-Solving Method, the text describes the "never assume" mindset and the structured method that drive evidence-based, action-oriented problem-solving. The "never assume" mindset requires healthcare leaders to understand themselves and their stakeholders, and to engage in waves of divergent and convergent thinking. This structured method guides the problem solver through the phases of defining, studying, and acting on complex interrelated organizational problems that involve multiple root causes. The book also describes how the Problem-Solving Method is complementary to quality improvement methods and can be used in healthcare organizations along with Lean, Design Thinking, and Human Centered Design. Providing step-by-step instruction including useful tips, tools, activities, and case studies, this effective resource demonstrates the utility of the method for all types of health organization settings including health systems, hospitals, clinics, population health, and long-term care. For students taking health management, capstone, and experiential learning courses, including internship and residency projects, this book allows them to test and apply their problem-solving and decision-making skills to real-world situations. Beyond the classroom, it is an indispensable resource for organizations seeking to enhance the problem-solving skills of their workforce. The authors of the text have nearly 75 years of combined experience in healthcare management, leadership, and professional consulting, and teaching and advising healthcare administration students in classrooms, on student capstone, internship and residency projects, and case competitions. Synthesizing their expertise, this text serves as a guide for those who wish to strengthen their problem-solving abilities to systematically identify, analyze, study, and solve pressing organizational challenges in healthcare settings. Key Features: Describes a mindset and a structured problem-solving method that builds leadership competencies Encourages a step-by-step problem-solving approach to define, study, and act on problems to drive action-oriented solutions Supports experiential learning and coaching for students and professionals early in their careers, applicable especially to healthcare management, capstone, and student consulting courses, internship and residency projects, case competitions, and professional development in organizations Compares the Problem-Solving Method to other complementary methods used in many healthcare organizations, including Lean, Design Thinking, and Human Centered Design Includes access to the fully downloadable eBook as well as ancillary materials such as Instructor's Manual and Sample Syllabi

This book is the first of its kind to tackle in detail the nutritional requirements of the industrialized, so-called developed world. It discusses the link between socio-economic status and food security, focusing especially on the relationship between income and food security in different age groups. The authors calculate the actual levels of essential micronutrients delivered by current dietary patterns, identifying important shortfalls in the provision of key micronutrients, and elucidate the public health consequences of nutrition insecurity. Finally, the authors discuss future approaches for ensuring nutrition security on the basis of three pillars: access, availability and nutritional value. The approaches advocated in this ground-breaking publication will allow all people, irrespective of age and social status, to have access to a safe and nutritious diet. Key stakeholders such as legislators, government, academia and industry, as well as consumers themselves, all have important roles to play in making this a reality.

The WHO's history spans a period of over six decades, with particular emphasis on the past twenty years. This has been a particularly busy period in WHO's development, given the transition from international to global health cooperation, and thus the need to adapt to important changes in its operating environment. In some cases, WHO has been a direct part of the institutional arrangements that have been created, and has shared the increased funding, provided for global health. In other cases, the organization has had to adapt its activities and programs in response to rival initiatives. This has led to many changes, not only to the name of specific parts of WHO but the nature of their activities; and this second edition attempts to capture some of this institutional complexity. The Historical Dictionary of the World Health Organization covers the history of the WHO through a chronology, an introductory essay, appendixes, and an extensive bibliography. The dictionary section has over 1000 cross-referenced entries on key bodies, programs, events and people. This book is an excellent access point for students, researchers, and anyone wanting to know more about the World Health Organization.

Baragwanath Hospital, Soweto illustrates how this rapidly growing, underfunded but surprisingly effective institution found the niche that allowed it to exist, to provide medical care to a massive patient body and at times even to flourish in the apartheid state. The book offers new ways of exploring the history of apartheid, apartheid medicine and health care. The long history of Chris Hani Baragwanath Hospital (its full current name) or Bara, as it's popularly known, has been shaped by a complex set of conditions. Established in the early 1940s, Bara stands on land purchased by the Cornish immigrant John Albert Baragwanath in the late nineteenth century. He set up a refreshment post, trading store and hotel on the site - in what is now Soweto - which was a one day journey by ox-wagon from Johannesburg. The hotel became affectionately known as 'Baragwanath Place' (the surname is Welsh, from 'bara' meaning 'bread' and 'gwenith' meaning' wheat'). The land was then bought by Corner House Mining Group and later taken over by Crown Mines Ltd. but was never mined. The British government bought the land in the early 1940s to build a military hospital but by 1947, Baragwanath ceased to operate as a military hospital and under the auspices of the Transvaal Provincial Administration a civilian hospital was opened with 480 beds. Patients were transferred from the 'non-European' wing of the Johannesburg General Hospital in the 'white' area of Johannesburg. Links were immediately forged with the University of the Witwatersrand and Bara would over time become one of its largest teaching centres. This link brought medical students and their teachers into direct contact with apartheid in the medical sphere. This book will contribute to studies of the history of apartheid that have begun to provide a more nuanced account of its workings. The history of Baragwanath and of the doctors and nurses who worked there tells us much about apartheid ideology and practice, as well as resistance to it, in the realm of health care.

Numerous important issues arise in relation to the health of, and healthcare for (and by), migrants. Much commentary on the migrant crisis and healthcare has focused on the allocation of resources, with less discussion of the needs of, and provision for, migrants. Presenting a comparative perspective on the UK and Germany, this volume increases knowledge of a broad spectrum of challenges in healthcare provision for migrants. 'Migration' is deliberately understood in its broadest sense and includes not only migrant patients but also migrant healthcare professionals. The book's content is diverse, with insights from healthcare ethics, healthcare law, along with clinical perspectives as well as perspectives from the social sciences. The collection provides normative reflections on current issues, and presents data from empirical studies. By informing researchers, politicians and healthcare practitioners about approaches to challenges arising in healthcare provision for migrants, the collection seeks to inform the development of adequate and ethically appropriate strategies.

With the growth of information and focus on Healthcare Informatics, there remains an interest in case studies. In the current field of Health Informatics there is no text that uses case studies to explain the difficulties that occur. . Edited by specialists in the field of Health Informatics, the third edition of Transforming Healthcare Through Information: Case Studies builds upon the specific examples of case studies to exemplify the various phases of introducing technological advancements into healthcare institutions. The new edition includes a section on how to implement Link2care, a system that will allow caregivers of ill patients, to seek reliable and informative online information and support. In addition the cases will be framed under new sections with discussion on new topics in the area of healthcare technology such as quality data management and knowledge management. The case studies described in the third edition will benefit not only the practicing professional but also the instructor and student studying in the field of health informatics.

Qualitative methods are increasingly used within health economics research, but there is almost no specific material to guide the use of these methods in this context; there is very little that links them to the specific questions that (health) economists ask or that provides guidance on analyzing from an 'economic' or 'resource-focused' perspective. Whilst the main themes within the book will look very similar to those in many other texts on qualitative research methods, they will: *Apply the concepts familiar from qualitative methods to health economics issues in a way that is meaningful in this specific context; *Work within an economic analytical approach where the analytic focus is on issues around scarcity and resource allocation; Incorporate examples that are relevant to health economists grappling with resource allocation problems in health care.

This book explains the politics of thirty years of 'market reform' in the English NHS, with the rest of the UK a counter-factual. Paton shows how each subsequent reform has been shaped by the confusion left by the previous reform. The long-term ideology has been anti-statist but policy-making at each stage of 'reform' has been driven by short-term politics. The outcome in England has been ever-increasing complexity in the NHS, with significantly increased management costs and no commensurate benefit.