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Root Causes

Stephen Castles and Nicholas Van Hear

in Global Migration Governance

This chapter examines the global governance of issue-areas affecting the underlying causes of movement notably in areas such as peace and security and global economic governance. It argues that an ... More

This chapter examines the global governance of issue-areas affecting the underlying causes of movement notably in areas such as peace and security and global economic governance. It argues that an understanding of the international institutions that regulate the areas that underlie human mobility is crucial for understanding global migration governance. The chapter takes an international political economy approach, suggesting that the existing governance structures need to be seen in the context of North–South relations and that many of the inequalities that exist in forums such as the WTO and the Bretton Woods institutions themselves underpin the causes of human mobility.Less

Root-Cause Analysis

Greg Fisher, John E. Wisneski, and Rene M. Bakker

in Strategy in 3D: Essential Tools to Diagnose, Decide, and Deliver

A root-cause analysis is used to identify the initiating, or root, of a causal chain that leads to an observed undesirable outcome. It is useful in helping managers to focus their problem-solving ... More

A root-cause analysis is used to identify the initiating, or root, of a causal chain that leads to an observed undesirable outcome. It is useful in helping managers to focus their problem-solving efforts on providing remedies to issues that actually prevent the undesirable outcome from recurring. Failure to identify the root cause of a problem often leads to time spent on removing causal factors, which can alleviate the symptoms of a problem yet may not prevent recurrence with full certainty. This chapter discusses the underlying theory, core idea, depiction, process, insight or value created, and risks and limitations of root-cause analysis. The chapter also discusses the illustration of the DISH Network and applies the steps of root-cause analysis to this case.Less

The 1980s: A Political Turn

Anne Hammerstad

in The Rise and Decline of a Global Security Actor: UNHCR, Refugee Protection and Security

This chapter conducts a discourse analysis of the evolution of UNHCR’s official discourse in the 1980s. Not until the latter half of the 1980s can there be said to have been a clear change in UNHCR’s ... More

This chapter conducts a discourse analysis of the evolution of UNHCR’s official discourse in the 1980s. Not until the latter half of the 1980s can there be said to have been a clear change in UNHCR’s self-representation, away from a formulaic reiteration of the claim that it is ‘entirely non-political’ and non-operational. In this period, the language of human rights becomes more central and new concepts, such as ‘root causes’ and ‘prevention’, appear. These new additions are linked to the increased frequency in the use of the concept of security from 1987 onwards. This chapter analyses UNHCR’s discursive move into the realm of politics and human rights, which gradually leads on to the emergence of a security discourse towards the end of the 1980s.Less

Impacts of the tools onconflict transformation practice

Buchanan Sandra

in Transforming conflict through social and economic development: Practice and policy lessons from Northern Ireland and the Border Counties

This chapter critically examines the impacts the three funding programmes have had on the region's conflict transformation process. Some have been positive, having supported thousands of projects. ... More

This chapter critically examines the impacts the three funding programmes have had on the region's conflict transformation process. Some have been positive, having supported thousands of projects. However, a weak aspect has been the limited attention and funding for social development, preferring instead that which is easier to account for – concrete visuals or fixed funding amounts for formal projects over set periods, underpinning a top-down, funder-focused approach to evaluation. It assesses the extent of their effectiveness in transforming the conflict firstly through general observations provided largely in terms of strengths and weaknesses and secondly by assessing the impact of each programme against the five hypotheses developed in Chapter 2: an attempt has been made to address the root causes of the conflict thus bringing about substantial changes in the social and economic structures of society; vertical and horizontal capacity has been developed and integrated through the involvement of all levels of society in the transformation process thus enabling the empowerment of the society's citizens; a long-term view has been taken of the transformation process; the tools used were tailored to suit the particular situation thus facilitating peacebuilding rather than imposing or dictating terms; the tools have not done any harm.Less

The Illusion of Clinical Success

Michael D. Stein and Sandro Galea

in Pained: Uncomfortable Conversations about the Public's Health

This chapter discusses how clinicians struggle to identify and treat illnesses whose sources often lie outside the medical system. That is what makes root causes so powerful: they escape ready ... More

This chapter discusses how clinicians struggle to identify and treat illnesses whose sources often lie outside the medical system. That is what makes root causes so powerful: they escape ready treatment and underlie a multiplicity of medical presentations. The same root cause can be responsible for a gastrointestinal or a respiratory problem, for an injury or a hepatic problem. This is why, when one thinks of the causes of medical problems strictly from an organ-based perspective, it is never enough. Because medical problems often do not arise in their end organs; they are bodily manifestations of underlying issues. These issues—such as inadequate housing, limited access to addiction treatment, poverty, and terrible neighborhoods—are medical challenges. As such, aside from being responsible for solving the immediate problem—the disease in front of them—clinicians must also grapple with the underlying causes. They can choose to become advocates, voices for public health outside of the hospital or clinic, or they can work within their day-to-day system, encouraging their hospital or clinic to embrace improving the underlying conditions that shape the health of patients.Less

Strategy

George E. Mitchell, Hans Peter Schmitz, and Tosca Bruno-van Vijfeijken

in Between Power and Irrelevance: The Future of Transnational NGOs

Chapter 3 describes major shifts in the strategic orientations of TNGOs that represent a concerted movement from their historical roots as charitable conduits to social and political change agents ... More

Chapter 3 describes major shifts in the strategic orientations of TNGOs that represent a concerted movement from their historical roots as charitable conduits to social and political change agents seeking sustainable impact and long-term transformations. Three illustrative strategic shifts—from direct service delivery to championing rights and supporting entrepreneurship; from reactive advocacy to proactive global campaigning; and from capacity-building to systems thinking—underscore the growing mismatch between the inherited institutional and normative features of the architecture and the sector’s contemporary ambitions and strategies. The evolution in TNGO strategies over the past several decades suggests new future roles for TNGOs, but future-oriented change is complicated by the need to overcome architectural challenges and confront past legacies.Less

Recipes for Reform: Supporting Evidence-Based Food Safety Governance and Improving Private Oversight

Timothy D. Lytton

in Outbreak: Foodborne Illness and the Struggle for Food Safety

The food safety system faces two persistent challenges. First, despite steady advances in understanding the pathogens that cause foodborne illness, a great deal of uncertainty remains about the root ... More

The food safety system faces two persistent challenges. First, despite steady advances in understanding the pathogens that cause foodborne illness, a great deal of uncertainty remains about the root causes of contamination. Second, the proliferation of increasingly sophisticated approaches to food safety has not always been accompanied by reliable oversight to ensure uniformly rigorous implementation. This chapter endorses a division of labor between government and industry to address these challenges. On the one hand, it advocates focusing government investment in food safety primarily on improving the infrastructure of outbreak investigations rather than on hiring more agency inspectors to oversee farms and processing facilities. Government resources are limited, and government is uniquely equipped to conduct outbreak investigations, which are essential to expanding knowledge about the root causes of contamination. On the other hand, the chapter advocates relying primarily on industry rather than government to fund oversight of food safety program implementation in farming and processing operations. This can take the form of making companies pay for government inspections or private food safety audits. The chapter examines two different models for industry funding of government inspections, and it surveys a number of efforts to improve the reliability of private food safety audits.Less

Recovering the Performative Role of Innovations in the Global Travel of Healthcare Practices: Is there a Ghost in the Machine?

Davide Nicolini, Jeanne Mengis, David Meacheam, Justin Waring, and Jacky Swan

in Mobilizing Knowledge in Healthcare: Challenges for Management and Organization

This chapter discusses the global travel of a specific approach to incident investigation (Root Cause Analysis or RCA for short). We assess how knowledge of the technique was mobilized, from the ... More

This chapter discusses the global travel of a specific approach to incident investigation (Root Cause Analysis or RCA for short). We assess how knowledge of the technique was mobilized, from the United States to Australia, the United Kingdom and beyond. We argue that the mobilization and world spanning circulation of this set of practices was sustained and facilitated by the construction of an “anxiety-reassurance” package. This package raised public and professional anxiety about patient safety and created reassurance by proposing a new management solution to solve this problem. Playing together these two seemingly opposite discourses, the innovation generated a wave of interest and urgency that it then rode and that allowed rapid globalization. We suggest that a focus on the innovation as a well-oiled piece of discursive machinery helps us to understand the active role of innovations in fueling their own translation without reverting to the old idea that innovations are “diffused.”Less

Introduction: Why a Public Health Guide to Ending the Opioid Crisis?

Michael R. Fraser and Jay C. Butler

in A Public Health Guide to Ending the Opioid Epidemic

A public health guide to ending the opioid crisis is needed to help frame efforts to go “upstream” and address the root causes of substance use disorder and addiction. In this introduction, the ... More

A public health guide to ending the opioid crisis is needed to help frame efforts to go “upstream” and address the root causes of substance use disorder and addiction. In this introduction, the editors provide an overview of the book’s three parts (Fundamentals and Frameworks; Connecting Clinical Perspectives and Public Health Practice; Moving Upstream—Prevention, Partnership, and Public Health). While a great deal of prior work has focused on the clinical aspects of the opioid epidemic, more is needed to address the community-level aspects, including addressing the root causes of addiction, and where public health professionals can intervene at the primary, secondary, and tertiary levels of prevention. The case is made for increasing effort in the areas of primary prevention and policy change to support effective opioid stewardship at the local, state, and federal levels. The editors conclude by stating that communities will not “arrest” or “treat” their way out of this crisis. Instead, we have to redouble efforts to prevent addiction and address the clinical and community aspects of what drives an individual to become addicted in the first place.Less

Identify Potential Root Causes

Arnaud Chevallier

in Strategic Thinking in Complex Problem Solving

The third chapter, “Identify potential root causes,” explains how to leverage an issue map—a graphical breakdown of the key question—to identify all the possible root causes for the problem and test ... More

The third chapter, “Identify potential root causes,” explains how to leverage an issue map—a graphical breakdown of the key question—to identify all the possible root causes for the problem and test them. The chapter introduces four rules to build effective issue maps: consistently answering the key question, going from the diagnosis question to the conclusions, breaking the problem space into a mutually exclusive and collectively exhaustive (MECE) structure, and being insightful. The chapter provides guidelines to follow each of the four rules. These include differentiating the structure from the answers, deferring criticism while generating ideas, and balancing satisficing and optimizing. It discusses how to consider alternative ways to dissect a key question and ways to assess the respective insightfulness of each. Finally, the reader will find ideas to build maps, such as using analogies to approach unfamiliar problems or considering existing frameworks.Less

When bad things happen

Diana C Strange Khursandi

in Handbook of Communication in Anaesthesia & Critical Care: A Practical Guide to Exploring the Art

When bad things happen, good communication skills and honesty are of supreme importance. Breaking bad news to patients, relatives or staff is never easy. Anaesthetists are most familiar with ... More

When bad things happen, good communication skills and honesty are of supreme importance. Breaking bad news to patients, relatives or staff is never easy. Anaesthetists are most familiar with imparting bad news when they are working in a critical care unit, where the possibility of bad news is implicit. The necessity to do so in anaesthetic practice arises relatively infrequently. When patients are acutely unwell, elderly or frail prior to surgery, the patient and his or her family may be met with beforehand to signal a possible or probable unfavourable outcome related to natural disease processes. If the worst does happen, the patients and relatives will be somewhat prepared. Adverse incidents following anaesthesia require anaesthetists to be skilled in communicating honestly to the patient and relatives. These incidents can range from an unanticipated but treatable complication—for example, dural puncture—to an unexpected major mishap in theatre resulting in a serious adverse outcome (disability or death). Effective communication is as important when the issue is a more minor adverse outcome or side effect as it is when an adverse event has had disastrous consequences. Major mishaps in anaesthesia create stressful and difficult situations, since anaesthetists are required to communicate the bad news. Why is one anaesthetist’s day in court another anaesthetist’s invitation to dinner at a patient’s home? The good news is that breaking bad news is a skill that can be learned and taught. The initial ‘breaking bad news’ communication to the patient and/or relatives about the series of events in a serious adverse outcome will be more thoroughly followed up in the subsequent disclosure process. An investigation into the contributing factors in such events (root cause analysis) may need to occur, and staff members involved in the incident must be supported (critical incident support). Each department or group of anaesthetists should consider designating one of their number to respond to major adverse events. The ‘duty anaesthetist’ may be caught up with other clinical duties, and additional senior support will be required. One anaesthetist will be needed to manage ongoing clinical work, while another will be required to manage the aftermath. Less

Preventative and paediatric dentistry

Nicholas Longridge, Pete Clarke, Raheel Aftab, and Tariq Ali

Katharine Boursicot and David Sales (eds)

in Oxford Assess and Progress: Clinical Dentistry

The child patient can be a challenging and daunting proposition for the junior dentist and dental student. Whilst children can be anxious, unco­operative, and unpredictable, they also present an ... More

The child patient can be a challenging and daunting proposition for the junior dentist and dental student. Whilst children can be anxious, unco­operative, and unpredictable, they also present an extremely rewarding opportunity, which, if managed correctly, may go on to influence their healthcare experiences for the rest of their lives. Excellent behavioural management of the child patient (and their parents!) is fundamental to a successful clinical and patient- reported outcome. Aside from possible behavioural issues, paediatric patients may pre­sent with a series of unique clinical presentations that require additional skills and knowledge above and beyond those required for adult pa­tients. Differences in the micro- and macro- structures of primary and permanent teeth, coupled with variations in eruption dates, lead to an evolving mixed dentition that can lead to some difficult diagnostic and treatment planning scenarios. Furthermore, dental anxiety and the pre­ponderance for dento- alveolar trauma in children and young adults may exacerbate the patient management of an already complex situation. Prevention is central to paediatric dentistry. However, whilst signifi­cant progression has occurred in some areas, poor dietary habits and suboptimal oral hygiene regimes remain significant concerns for the pro­fession, with large numbers of dental extractions still performed under general anaesthesia each year. Key topics include: ● Tooth anatomy and eruption patterns ● Abnormalities of structure and form ● Prevention and management of dental caries, including pulp therapy ● Dental trauma ● Dental extractions and space management ● Behavioural management ● Safeguarding ● Pharmacological management. Less

Tools in Infection Prevention and Control

Stephanie J. Smith and Martina N. Cummins

in Tutorial Topics in Infection for the Combined Infection Training Programme

The Health Act (2008) Code of Practice on the Prevention and Control of Infections and Related Guidance provides a legal statutory requirement to which all hospital trusts in England should abide ... More

The Health Act (2008) Code of Practice on the Prevention and Control of Infections and Related Guidance provides a legal statutory requirement to which all hospital trusts in England should abide to ensure the safety of patients and healthcare workers. There are similar laws in both Scotland and Wales. Prevention and control of healthcare- associated infections (HCAI) remains integral to provide safe, quality patient care and requires an effective management team to implement the Act. In July 2015, a revised Code of Practice was introduced for the prevention and control of HCAI. The Code of Practice is also referred to as the ‘Hygiene Code’ and is regulated by the Care Quality Commission (CQC). A requirement of this Act is that the board of directors receive an annual report from the Director of Infection Prevention & Control (DIPC), with acknowledgement of the report and approval of a proposed programme of delivery prior to public release and implementation. All trusts must register with the CQC, whose role is to regulate and inspect care services in the public, private, and voluntary sectors in England. Part of the CQC assessment against the Act includes Outcome 8: Cleanliness and Infection Control. Under this outcome the trust is required to demonstrate compliance. The DIPC within an organization will assume responsibility to provide assurances that criteria are met by ensuring regular committee meetings to discuss compliance with standards, monitoring of trends, and provide strategies to reduce HCAI. The trust has to be made accountable for any infection control issues for their staff and patients and have evidence of a clear framework to provide assurances that safety has been met. The IPC Team will implement a plan across their trust that requires quarterly and annual reports to ensure implementation and remedial actions listed and acted on as appropriate. A care bundle is a set of evidence-based interventions that are grouped together to ensure that patients receive optimal management consistently. Ideally, each part of the bundle should be based on evidence from at least one systematic review composed of multiple randomized control trials. Care bundles have been implemented in England since June 2005. Less

A Cross-Case Analysis of NHRAPs of Fifty-Three Countries

Azadeh Chalabi

in National Human Rights Action Planning

Part III, ‘Empirical Perspectives’, contains only one chapter, Chapter 5, which presents the results of a cross-case analysis of national human rights action plans of fifty-three countries. Adopting ... More

Part III, ‘Empirical Perspectives’, contains only one chapter, Chapter 5, which presents the results of a cross-case analysis of national human rights action plans of fifty-three countries. Adopting a purposive sampling technique, these countries are selected on the basis of four main criteria, namely human rights record, geographical diversity, political regimes, and cultural diversity. This comprehensive cross-case study follows two objectives. The first objective of this chapter is to unearth significant problems in the ‘pre-phase’ and the four phases of planning, namely ‘preparatory phase’, ‘development phase’, ‘implementing phase’, and ‘assessment phase’. These problems are significantly detrimental to the effective implementation of human rights and their identification will substantially help generate response strategies. These are best addressed by attempting to mitigate their root causes as opposed to only correcting the immediately obvious symptoms. This brings us to the chapter’s second objective, which is to explore the underlying causes of these problems.Less

The Anatomy of Uncertainty

Paul K.J. Han

in Uncertainty in Medicine: A Framework for Tolerance

Chapter 3 describes the anatomy of medical uncertainty, identifying key attributes that give it a three-dimensional conceptual shape, form, and structure. It characterizes uncertainty in terms of its ... More

Chapter 3 describes the anatomy of medical uncertainty, identifying key attributes that give it a three-dimensional conceptual shape, form, and structure. It characterizes uncertainty in terms of its (1) fundamental sources (root causes), (2) issues (substantive problems), and (3) loci (persons in whose minds uncertainty resides) and presents a conceptual framework that allows the variety of uncertainties in medicine to be classified and better understood. The chapter makes the case that in all of these ways, a three-dimensional conceptual framework can facilitate a more intentional, targeted, and rational approach to evaluating medical uncertainty. By providing a way of visualizing, ordering, and objectifying an otherwise invisible, disordered, subjective reality, the framework can ultimately enable clinicians and patients to better manage medical uncertainty.Less