Dismantling institutional racism: theory and action

Despite a strong commitment to promoting social change and liberation, there are few community psychology models for creating systems change to address oppression. Given how embedded racism is in institutions such as healthcare, a significant shift in the system's policies, practices, and procedures is required to address institutional racism and create organizational and institutional change. This paper describes a systemic intervention to address racial inequities in healthcare quality called dismantling racism. The dismantling racism approach assumes healthcare disparities are the result of the intersection of a complex system (healthcare) and a complex problem (racism). Thus, dismantling racism is a systemic and systematic intervention designed to illuminate where and how to intervene in a given healthcare system to address proximal and distal factors associated with healthcare disparities. This paper describes the theory behind dismantling racism, the elements of the intervention strategy, and the strengths and limitations of this systems change approach.     

The Financial Dimension of Integrated Behavioral/Primary Care

There are two reasons why mental health, now more appropriately termed behavioral healthcare, is declining: (a) a lack of understanding among psychotherapists of healthcare economics, particularly the intricacies of medical cost offset, and (b) our failure as a profession to see the importance of behavioral interventions as an integral part of the healthcare system inasmuch as the nation pays for healthcare, not psychosocial care. This paper will briefly describe the rapid changes in the economics of healthcare during the past 75 years, including the post World War II enthusiastic espousal of psychotherapy by the American public which was followed by a precipitous decline as our outcomes research in behavioral care remained ignorant of financial outcomes, leaving it to the government and managed care to arbitrarily curtail escalating mental health costs. At the present time psychology is on the cusp of becoming part of the healthcare system through integrated behavioral/primary care, renewing the primacy of financial considerations such as return on investment (ROI) and medical cost offset, as well as an urgency that we avoid the mistakes that are emerging in some flawed implementations of integrated care.     

We are not a Healthcare Business: Our Inadvertent Vow of Poverty

Psychology has been fractionated from mainstream healthcare delivery and this schism has resulted in huge costs to psychologists and our intended customers. Psychology has also been naïve economically. The authors suggest three revolutions: (1) for clinical psychology to be better integrated into the healthcare delivery system; (2) for psychologists to better understand healthcare economics and business; and (3) for psychologists to become more entrepreneurial, i.e., see needs in healthcare (such as those of the elderly, obesity, improved access and value through ehealth) and systematically fill these. We note high quality businesses help many individuals (customers, family members, employees) not typically recognized by anti-business psychologists.     

Predicting emotional reactions after being harmed by another

Being harmed by others is a frequent and disturbing experience in normal social life, resulting in the arousal of two emotional complexes, anger and worry. The present research developed a model to predict these two dimensions of emotional response to being harmed. It was argued that in addition to being driven by judgments of blame, anger is also enhanced by assessments that one's social face has been damaged. The victim's judgment of this face loss also contributes to feelings of worry, as one's social credibility has been compromised in the eyes of others by being harmed. Worry is further augmented by the victim's concern about the damage done to his or her relationship with the perpetrator by the harm-doing. As hypothesized, both perceived image loss and blame judgments were found to predict the emotional complex of anger, while image loss and the perceived harm to the relationship predicted the emotional complex of worry. This research supplemented the well-researched Western construct of blame in response to harm by incorporating the more salient collectivist concerns of image loss and relationship damage, pushing our models of social processes to be more comprehensive and ultimately universal in their scope.     

The use of control charts by laypeople and hospital decision-makers for guiding decision making

Graphs presenting healthcare data are increasingly available to support laypeople and hospital staff’s decision making. When making these decisions, hospital staff should consider the role of chance—that is, random variation. Given random variation, decision-makers must distinguish signals (sometimes called special-cause data) from noise (common-cause data). Unfortunately, many graphs do not facilitate the statistical reasoning necessary to make such distinctions. Control charts are a less commonly used type of graph that support statistical thinking by including reference lines that separate data more likely to be signals from those more likely to be noise. The current work demonstrates for whom (laypeople and hospital staff) and when (treatment and investigative decisions) control charts strengthen data-driven decision making. We present two experiments that compare people’s use of control and non-control charts to make decisions between hospitals (funnel charts vs. league tables) and to monitor changes across time (run charts with control lines vs. run charts without control lines). As expected, participants more accurately identified the outlying data using a control chart than using a non-control chart, but their ability to then apply that information to more complicated questions (e.g., where should I go for treatment?, and should I investigate?) was limited. The discussion highlights some common concerns about using control charts in hospital settings.     

Victim and Perpetrator Groups’ Divergent Perspectives on Collective Violence: Implications for Intergroup Relations

Groups in conflict develop strikingly different construals of the same violent events. These clashing perceptions of past violence can have detrimental consequences for intergroup relations and might provoke new hostilities. In this article, we integrate and juxtapose what we know about construals of collective violence by delineating the different dimensions along which these construals differ between victim and perpetrator groups: regarding the question of who is the victim, who is responsible for the harm doing, what the perpetrator’s intent was, how severe the violence was, and when it took place. Then, we discuss the individual‐ and group‐level factors (e.g., collective narratives, social identities) that shape these construals, as well as their implications for attitudes regarding the conflict and support for relevant policies. We distinguish two different core motives that drive construals and their outcomes among victim and perpetrator groups: Perpetrator groups try to cope with moral identity threats and preserve a positive image of the ingroup, while victim groups try to protect their ingroup from future harm doing and desire acknowledgment of their group’s experiences. Lastly, we discuss implications for strategies and interventions to address victim and perpetrator groups’ divergent perspectives of collective violence.     

Human rights,harm, and climate change mitigation

Abstract

A number of philosophers have resisted impersonal explanations of our obligation to mitigate climate change, and have developed accounts according to which these obligations are explained by human rights or harm-based considerations. In this paper I argue that several of these attempts to explain our mitigation obligations without appealing to impersonal factors fail, since they either cannot account for a plausibly robust obligation to mitigate, or have implausible implications in other cases. I conclude that despite the appeal of the motivations for rejecting the appeal to impersonal factors, such factors must play a prominent role in explaining our mitigation obligations.     

外科患者安全、医疗缺陷和并发症

在医疗工作中,由于客观存在的各种医疗缺陷、过失,甚至错误,会引起各种并发症,影响着患者安全。在以往常注意到了医疗工作中所发生的各种并发症的结果,但是没有或较少重视发生这些并发症的过程,以及在此过程存在的缺陷。在外科领域中,应注意可能发生外科并发症的环节和过程,尽量避免医疗缺陷,同时还要注意开展新技术,减少因技术能力不足带来的伤害;减少侵害性医疗干预。