Explaining health system responses to public reporting of cardiac surgery mortality in England and the USA.

Public reporting of clinical performance is increasingly used in many countries to improve quality and enhance accountability of the health system. The assumption is that greater transparency will stimulate improvements by clinicians in response to peer pressure, patient choice or competition. The international diffusion of public reporting might suggest greater similarity between health systems. Alternatively, national and local contexts (including health system imperatives, professional power and organisational culture) might continue to shape its form and impact, implying continued divergence. The paper considers public reporting in the USA and England through the lens of Scott's 'pillars' institutional framework. The USA was arguably the first country to adopt public reporting systematically in the late 1980s. England is a more recent adopter; it is now being widely adopted through the National Health Service (NHS). Drawing on qualitative data from California and England, this paper compares the behavioural and policy responses to public reporting by health system stakeholders at micro, meso and macro levels and through the intersection of ideas, interests, institutions and individuals through. The interplay between the regulative, normative and cultural-cognitive pillars helps explain the observed patterns of on-going divergence.

Emplacement and everyday use of medications in domestic dwellings.

To extend knowledge of relationships between people and domestic settings in the context of medication use, we conducted fieldwork in twenty households in New Zealand. These households contained a range of 'medicative' forms, including prescription drugs, traditional remedies, dietary supplements and enhanced foods. The location and use of these substances within domestic dwellings speaks to processes of emplacement and identity in the creation of spaces for care. Our analysis contributes to current understandings of the ways in which objects from 'outside' the home come to be woven into relationships, identities and meanings 'inside' the home. We demonstrate that, as well as being pharmacological objects, medications are complex, socially embedded objects with histories and memories that are ingrained within contemporary relationships of care and home-making practices.