Buying Access One Trip at a Time Lower-Income Households and Ride-Hail

Problem, research strategy, and findings New transportation options like ride-hail can expand accessibility without the costs of car ownership. Ride-hail's potential is particularly salient for lower-income and zero-car households. We used interviews and a national (U.S.) survey to examine how and why lower-income travelers in the United States use ride-hail. Survey and interview responses provided a temporal snapshot and thus reflect, in part, travel challenges specific to COVID-19. Findings suggest that lower-income travelers, particularly those without personal cars, use ride-hail in ways distinct from those typically reported in broader travel surveys. Individuals without cars are more likely to use ride-hail, and use it more often, compared with people with cars, particularly to fill spatial and temporal gaps in public transit service and to access medical care and groceries. Costs and price unpredictability remain significant barriers limiting travelers' use of ride-hail services. Takeaway for practice This research demonstrates a latent need for car access among lower-income travelers. Substantial gaps in alternative modes pose challenges for travelers seeking reliable and timely transportation. Planners should invest in transit, biking, and walking to provide robust alternatives to car ownership. Such investments, however, take time. In the meantime, cities and agencies should consider subsidizing ride-hail trips to bridge existing gaps in the transportation network.

Improving the departmental induction programme and trainee morale using quality improvement framework

Objective By using a recognised model for quality improvement we set out to improve morale and support offered to doctors by improving the departmental induction for doctors. Design Quality improvement framework was implemented: the problem was identified, a plan was made, changes implemented and effects studied. The new improved induction programme was embedded into the annual calendar of the department as were regular planning and debriefing meetings to ensure that a high quality of induction was maintained. Methods A core team (one ST7, one clinical fellow and two ST4s) was created, to re-develop an induction programme following anonymous feedback that trainee doctors had not felt adequately equipped to provide excellent care from the beginning of the rotation. They reported that the clinical aspects of the induction needed improving. Using examples of good induction programmes from the literature, the programme was designed to include: a tour of the unit, 'how the rota works', 'what to expect and what is expected', intimate examinations and speculums, common emergencies, training in IT systems and an introduction to the Trust laparoscopic simulation suite. The core team met two weeks after the induction programme to discuss feedback and issues. Improvements were made and embedded into the planning for the next programme. The programme was made sustainable by handing over when the core team rotated;continuity was provided by the RCOG college tutor and departmental administrator. Results Online, anonymous, qualitative feedback was requested two weeks after the induction so that doctors could assess how well the induction had prepared them for their first clinics, theatres and on-calls. The online, anonymous feedback was positive and the education department noted a significant improvement in both the quality and quantity of feedback. 'Best departmental induction I've had.' 'Very useful teaching sessions'. 'Felt very welcomed'. As 2020 progressed the new challenge was moving the induction online. It was much harder for trainees to feel orientated and some felt that they missed out on meeting key members of the department. Conclusion Using a recognised framework, creating a core team and devising a programme in line with national guidance has led to significantly improved feedback from new doctors of all grades starting in the department. Morale amongst junior doctors has improved, empowering them to provide excellent care. The COVID pandemic has meant online, but the quality and content of the induction programme has been improved with the wide range of available online resources.