Doctors under the microscope: the birth of medical audit

In 1989 a UK government White Paper introduced medical audit as a comprehensive and statutory system of assessment and improvement in quality of care in hospitals. A considerable body of research has described the evolution of medical audit in terms of a struggle between doctors and National Health Service managers over control of quality assurance. In this paper we examine the emergence of medical audit from 1910 to the early 1950s, with a particular focus on the pioneering work of the American surgeons Codman, MacEachern and Ponton. It is contended that medical professionals initially created medical audit in order to articulate a suitable methodology for assessing individual and organisational performance. Rather than a means of protecting the medical profession from public scrutiny, medical auditing was conceived and operationalised as a managerial tool for fostering the active engagement of senior hospital managers and discharging public accountability. These early debates reveal how accounting was implicated in the development of a system for monitoring and improving the work of medical professionals, advancing the quality of hospital care, and was advocated in ways, which included rather than excluded managers

The simulation of urban-scale evacuation scenarios with application to the Swinley forest fire

Forest fires are an annual occurrence in many parts of the world forcing large-scale evacuation. The frequent and growing occurrence of these events makes it necessary to develop appropriate evacuation plans for areas that are susceptible to forest fires. The buildingEXODUS evacuation model has been extended to model large-scale urban evacuations by including the road network and open spaces (e.g. parks, green spaces and town squares) along with buildings. The evacuation simulation results have been coupled with the results of a forest fire spread model and applied to the Swinley forest fire which occurred in Berkshire, UK in May 2011. Four evacuation procedures differing in the routes taken by the pedestrians were evaluated providing key evacuation statistics such as time to reach the assembly location, the distance travelled, congestion experienced by the agents and the safety margins associated with using each evacuation route. A key finding of this work is the importance of formulating evacuation procedures that identifies the threatened population, provides timely evacuation notice, identifies appropriate routes that maintains a safe distance from the hazard front thereby maximising safety margins even at the cost of taking longer evacuation routes. Evacuation simulation offers a means of achieving these goals