The Ethical Imperative to Move to a Seven-Day Care Model.

Whilst the nature of human illness is not determined by time of day or day of week, we currently structure health service delivery around a five-day delivery model. At least one country is endeavouring to develop a systems-based approach to planning a transition from five- to seven-day healthcare delivery models, and some services are independently instituting program reorganization to achieve these ends as research, amongst other things, highlights increased mortality and morbidity for weekend and after-hours admissions to hospitals. In this article, we argue that this issue does not merely raise instrumental concerns but also opens up a normative ethical dimension, recognizing that clinical ethical dilemmas are impacted on and created by systems of care. Using health policy ethics, we critically examine whether our health services, as currently structured, are at odds with ethical obligations for patient care and broader collective goals associated with the provision of publicly funded health services. We conclude by arguing that a critical health policy ethics perspective applying relevant ethical values and principles needs to be included when considering whether and how to transition from five-day to seven-day models for health delivery.

Línea fría en el Hospital Centro Alexis Vautrin (CAV) de Nancy, Francia / The cold line in the Hospital Centro Alexis Vautrin (CAV) of Nancy, France

El presente artículo nos presenta un ejemplo de gestión del servicio de alimentación y restauración de un hospital más allá de nuestras fronteras. En este caso, el Centro Alexis de Nancy (Francia), propone un sistema de organización basado en la división línea caliente-línea fría: la primera para las comidas de pacientes y comedor de personal; la segunda para las cenas de pacientes y personal (AU)

This article presents us with an example of the management of the food and catering services of a hospital outside our borders. In this case, the Alexis Vautrin Centre of Nancy (France) proposes an organization system based on the hot line-cold line division: the former for the lunches of patients and the staff canteen; and the latter for the suppers of patients and staff (AU)

Distal nursing.

This paper considers the spatial dynamics of nurse-patient relationships within hospitals, primarily in the USA, under conditions of organizational restructuring, and situates them within social theoretical perspectives on space. As a human practice to which relationship is considered essential, nursing depends upon sustaining an often taken-for-granted proximity to patients. But hospital nursing, I argue in this paper, is increasingly constrained by spatial-structural practices that disrupt relationship and reduce or eliminate such proximity. Three kinds of proximity are threatened: physical, narrative, and moral. Examining these proximities through a place-space lens suggests that nursing is increasingly "distal" to patient care. There are potentially dangerous implications in this loss of proximity.

Provider responsibility and system redesign: two sides of the same coin.

Patient safety is a serious problem that health care professionals and hospitals must confront. The health care delivery system must be redesigned. Health care professionals have a moral and ethical responsibility to actively participate in the development and operation of well-designed care processes. Efforts to redesign the delivery system will be most effective if accompanied by changes in the environment that shapes care delivery. Health care leadership must also focus attention on identifying the types of environmental changes needed at different levels, and on the part of specific stakeholders, to allow model twenty-first-century community health systems to develop.