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Article
Publication date: 1 April 2006

Robert McMurray

Seeks to review policy and practice in the English National Health Service (NHS) to show the extent to which medically framed notions of cure act in opposition to attempts…

Abstract

Purpose

Seeks to review policy and practice in the English National Health Service (NHS) to show the extent to which medically framed notions of cure act in opposition to attempts to enforce a duty of partnership in the delivery of health and social care.

Design/methodology/approach

A review of national policy and the relevant academic literature, spanning two decades, was used to examine the development of inter‐organisational relations at the boundaries of health and social care in England.

Findings

The paper finds that, despite an espoused willingness on the part of national and local stakeholders to remove long‐established disciplinary and organisational partitions between sectors, the failure to secure a shift from medically to socially constructed notions of health continues to impede more integrated care. Furthermore, policies emphasising patient through‐put, speed of treatment, episodic intervention and the primacy of hospitals are shown to encourage and empower health professionals to withdraw from cross‐boundary working in line with the isolating tendencies of bio‐medically framed notions of cure.

Originality/value

The paper draws together evidence from policy, research and theoretical literature to identify the underlying causes of collaborative failure, highlighting the manner in which associated processes of public service reform can serve to reinforce long‐established institutional barriers to inter‐organisational working, both now and in the future.

Details

International Journal of Public Sector Management, vol. 19 no. 3
Type: Research Article
ISSN: 0951-3558

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Article
Publication date: 11 September 2007

Rachael Addicott and Ewan Ferlie

The purpose of this paper is to show that networks are emerging as a new, innovative organisational form in the UK public sector. The emergence of more network‐based modes…

Abstract

Purpose

The purpose of this paper is to show that networks are emerging as a new, innovative organisational form in the UK public sector. The emergence of more network‐based modes of organisation is apparent across many public services in the UK but has been particularly evident in the health sector or NHS. Cancer services represent an important and early example, where managed clinical networks (MCNs) for cancer have been established by the UK National Health Service (NHS) as a means of streamlining patient pathways and fostering the flow of knowledge and good practice between the many different professions and organisations involved in care. There is very little understanding of the role of power in public sector networks, and in particular MCNs. This paper aims to explore and theorise the nature of power relations within a network model of governance.

Design/methodology/approach

The paper discusses evidence from five case studies of MCNs for cancer in London.

Findings

The findings in this paper demonstrate that a model of bounded pluralism can be used to understand power relations within London MCNs. However, power over the development of policy and strategic direction is instead exerted in a top‐down manner by the government (e.g. Department of Health) and its associated national bodies.

Practical implications

The paper supports the argument that the introduction of rhetoric of a more collaborative approach to the management of public services has not been enough to destabilise the embedded managerialist framework.

Originality/value

This paper uses empirical data from five case studies of managed clinical networks to theorise the nature of power relations in the development and implementation of network reform in cancer services. Also, there is limited understanding of the nature of power relations in network relationships, particularly in relation to the public sector.

Details

Journal of Health Organization and Management, vol. 21 no. 4/5
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 4 November 2014

Mark Chandley, Maxine Cromar-Hayes, Dave Mercer, Bridget Clancy, Iain Wilkie and Gary Thorpe

The purpose of this paper is to derive from an on-going, innovative, project to explore the concept, and application, of “recovery” in the care and clinical management of…

Abstract

Purpose

The purpose of this paper is to derive from an on-going, innovative, project to explore the concept, and application, of “recovery” in the care and clinical management of patients detained in one UK high-security hospital.

Design/methodology/approach

Utilising a qualitative, action research, methodology the aim was to involve forensic mental health nurses in a collaborative, client-centred approach to identification and resolution of dilemmas in the process of planning care for offender-patients.

Findings

In this context the authors identify constraints and contradictions involved in employing recovery principles in institutions critics refer to as part of the disciplinary apparatus of psychiatric and social control; where the taken for granted lives, and relations, of an incarcerated population are measured by the calendar, not the clock.

Research limitations/implications

Protective practices remain highly relevant in high-secure practice. Safety, an important value for all can by and large be achieved through recovery approaches. The humanistic elements of recovery can offer up safe and useful methods of deploying the mental health nurse on the ward. Many nurses have the prerequisite approach but there remains a wide scope to enhance those skills. Many see the approach as axiomatic though nurse education often prepares nurses with a biomedical view of the ward.

Practical implications

Currently, philosophical tenets of recovery are enshrined in contemporary health policy and professional directives but, as yet, have not been translated into high-secure settings. Drawing on preliminary findings, attention is given to the value of socially situated approaches in challenging historic dominance of a medical model.

Social implications

It is concluded that recovery could be a forerunner of reforms necessary for the continued relevance of high-secure care into the twenty-first century.

Originality/value

This research is located in high-secure setting. The social situation is marked by the extent of the isolation involved. A value is in this situation. First it is akin to the isolation of the tribe utilised by many anthropologists for their ability to adopt the “social laboratory” status to test out theories of behaviour in industrial society. The authors urge others to utilise this research in this way. Second, the situation represents the locus of so many of societies dilemmas, paradoxes and fears that moral issues morph from what is the mundane in wider society. In this way humanistic approaches are tested via action research with nurses in some rigouous ways.

Details

Mental Health and Social Inclusion, vol. 18 no. 4
Type: Research Article
ISSN: 2042-8308

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Article
Publication date: 1 September 2005

Jason L. Powell and Tim Owen

Anti‐reductionist social theory is a relatively ‘new’ but methodically eclectic body of theory which analyses the complexity of the tripartite theory, policy and practice…

Abstract

Anti‐reductionist social theory is a relatively ‘new’ but methodically eclectic body of theory which analyses the complexity of the tripartite theory, policy and practice. The work of Roger Sibeon (1996, 1999 and 2004) has contributed to a sensitising frame work in regard to a sociology of knowledge: generating epistemic narratives for theoretical construction and re‐construction, contrasting to a substantive sociology for knowledge based upon methodological generalisations for empirical or practical use: although the of/for distinction is not inflexible as there are circumstances when they form a process of what Powell and Longino (2001) call ‘articulation’: a united or connected analysis of/for theorising and practice.

Details

International Journal of Sociology and Social Policy, vol. 25 no. 9
Type: Research Article
ISSN: 0144-333X

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Article
Publication date: 11 January 2016

Rocco Palumbo

The purpose of this paper is to contextualize the concepts of “service co-production” and “value co-creation” to health care services, challenging the traditional…

Abstract

Purpose

The purpose of this paper is to contextualize the concepts of “service co-production” and “value co-creation” to health care services, challenging the traditional bio-medical model which focusses on illness treatment and neglects the role played by patients in the provision of care.

Design/methodology/approach

For this purpose, the author conducted a systematic review, which paved the way for the identification of the concept of “health care co-production” and allowed to discuss its effects and implications. Starting from a database of 254 records, 65 papers have been included in systematic review and informed the development of this paper.

Findings

Co-production of health care services implies the establishment of co-creating partnerships between health care professionals and patients, which are aimed at mobilizing the dormant resources of the latter. However, several barriers prevent the full implementation of health care co-production, nurturing the application of the traditional bio-medical model.

Practical implications

Co-production of health care is difficult to realize, due to both health care professionals’ hostility and patients unwillingness to be involved in the provision of care. Nonetheless, the scientific literature is consistent in claiming that co-production of care paves the way for increased health outcomes, enhanced patient satisfaction, better service innovation, and cost savings. The establishment of multi-disciplinary health care teams, the improvement of patient-provider communication, and the enhancement of the use of ICTs for the purpose of value co-creation are crucial ingredients in the recipe for increased patient engagement.

Originality/value

To the knowledge of the author, this is the first paper aimed at systematizing the scientific literature in the field of health care co-production. The originality of this paper stems from its twofold relevance: on the one hand, it emphasizes the pros and the cons of health care co-production and, on the other hand, it provides with insightful directions to deal with the engagement of patients in value co-creation.

Details

International Journal of Public Sector Management, vol. 29 no. 1
Type: Research Article
ISSN: 0951-3558

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Article
Publication date: 27 February 2009

Jason L. Powell and Jon Hendricks

The purpose of this concluding paper is to reflect on the theories of ageing well delineated by the papers of the special issue. It sets research themes that social…

Abstract

Purpose

The purpose of this concluding paper is to reflect on the theories of ageing well delineated by the papers of the special issue. It sets research themes that social theorists of ageing should reflect upon in creating conceptual tools to understanding the power dynamics of older people and modern society.

Design/methodology/approach

The paper is an overview of the key issues that have been found by theories introduced throughout the special edition. It attempts to look ahead to seeing how social theory and ageing will need to be strengthened so that theory and experiences are inter‐locked.

Findings

This concluding paper cites how social theory can be analysed in variety of international and national contexts that gives an holistic and not eurocentric approach to social gerontology.

Originality/value

The paper is original in that it points to the future challenges social gerontology in terms of theorising ageing. The great value of social theory is that it provides critical questions about the nature of modern society and the implications this has for older people. This is original in getting researchers to see the creative use of theories of ageing.

Details

International Journal of Sociology and Social Policy, vol. 29 no. 1/2
Type: Research Article
ISSN: 0144-333X

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Article
Publication date: 1 January 2016

Fredrik Bååthe, Gunnar Ahlborg Jr, Lars Edgren, Annica Lagström and Kerstin Nilsson

The purpose of this paper is to uncover paradoxes emerging from physicians’ experiences of a patient-centered and team-based ward round, in an internal medicine department.

Abstract

Purpose

The purpose of this paper is to uncover paradoxes emerging from physicians’ experiences of a patient-centered and team-based ward round, in an internal medicine department.

Design/methodology/approach

Abductive reasoning relates empirical material to complex responsive processes theory in a dialectical process to further understandings.

Findings

This paper found the response from physicians, to a patient-centered and team-based ward round, related to whether the new demands challenged or confirmed individual physician’s professional identity. Two empirically divergent perspectives on enacting the role of physician during ward round emerged: We-perspective and I-perspective, based on where the physician’s professional identity was centered. Physicians with more of an I-perspective experienced challenges with the new round, while physicians with more of a We-perspective experienced alignment with their professional identity and embraced the new round. When identity is challenged, anxiety is aroused, and if anxiety is not catered to, then resistance is likely to follow and changes are likely to be hampered.

Practical implications

For change processes affecting physicians’ professional identity, it is important for managers and change leaders to acknowledge paradox and find a balance between new knowledge that needs to be learnt and who the physician is becoming in this new procedure.

Originality/value

This paper provides increased understanding about how physicians’ professional identity is interacting with a patient-centered ward round. It adds to the knowledge about developing health care in line with recent societal requests and with sustainable physician engagement.

Details

Leadership in Health Services, vol. 29 no. 2
Type: Research Article
ISSN: 1751-1879

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Article
Publication date: 13 June 2016

Vikas Thakur and Ramesh Anbanandam

The World Health Organization identified infectious healthcare waste as a threat to the environment and human health. India’s current medical waste management system has…

Abstract

Purpose

The World Health Organization identified infectious healthcare waste as a threat to the environment and human health. India’s current medical waste management system has limitations, which lead to ineffective and inefficient waste handling practices. Hence, the purpose of this paper is to: first, identify the important barriers that hinder India’s healthcare waste management (HCWM) systems; second, classify operational, tactical and strategical issues to discuss the managerial implications at different management levels; and third, define all barriers into four quadrants depending upon their driving and dependence power.

Design/methodology/approach

India’s HCWM system barriers were identified through the literature, field surveys and brainstorming sessions. Interrelationships among all the barriers were analyzed using interpretive structural modeling (ISM). Fuzzy-Matrice d’Impacts Croisés Multiplication Appliquée á un Classement (MICMAC) analysis was used to classify HCWM barriers into four groups.

Findings

In total, 25 HCWM system barriers were identified and placed in 12 different ISM model hierarchy levels. Fuzzy-MICMAC analysis placed eight barriers in the second quadrant, five in third and 12 in fourth quadrant to define their relative ISM model importance.

Research limitations/implications

The study’s main limitation is that all the barriers were identified through a field survey and barnstorming sessions conducted only in Uttarakhand, Northern State, India. The problems in implementing HCWM practices may differ with the region, hence, the current study needs to be replicated in different Indian states to define the waste disposal strategies for hospitals.

Practical implications

The model will help hospital managers and Pollution Control Boards, to plan their resources accordingly and make policies, targeting key performance areas.

Originality/value

The study is the first attempt to identify India’s HCWM system barriers and prioritize them.

Details

International Journal of Health Care Quality Assurance, vol. 29 no. 5
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 2 September 2021

Nicola Walker, Madeleine Vernon-Smith and Michael Townend

No current psychotherapeutic intervention is designed to enhance job retention in employees with moderate–severe recurrent depression. The aim of this study is to test the…

Abstract

Purpose

No current psychotherapeutic intervention is designed to enhance job retention in employees with moderate–severe recurrent depression. The aim of this study is to test the feasibility of a new, interdisciplinary work-focused relational group cognitive behavioural therapy (CBT) treatment programme for moderate–severe depression.

Design/methodology/approach

The programme was based on a theoretical integration of occupational stress, psychological, social/interpersonal and bio-medical theories. It consisted of up to four 1:1 psychotherapy sessions; 12 work-focused, full-day, weekly CBT sessions facilitated by a cognitive behavioural therapist and occupational therapist; and up to four optional 1:1 sessions with an occupational therapist. Depression severity (primary outcome) and a range of secondary outcomes were assessed before (first CBT session) and after (twelfth CBT session) therapy using validated instruments.

Findings

Eight women (26–49 years) with moderate–severe depression participated. Five were on antidepressant medication. While there was no statistically significant change in Hamilton Depression Rating Scale depression scores after therapy (n = 5; p = 0.313), Beck Depression Inventory-II depression scores significantly decreased after therapy (n = 8; –20.0 median change, p = 0.016; 6/8 responses, 7/8 minimal clinically important differences, two remissions). There were significant improvements in the secondary outcomes of overall psychological distress, coping self-efficacy, health-related quality of life and interpersonal difficulties after therapy. All clients in work at the start of therapy remained in work at the end of therapy. The intervention was safe and had 100% retention.

Research limitations/implications

A major limitation was recruitment shortfall, resulting in a small sample of middle-aged women, which reduces representativeness and increases the possibility of methodological weaknesses in terms of the statistical analysis. A definitive trial would need much larger samples to improve statistical power and increase confidence in the findings. Another major limitation was that two of the authors were involved in delivering the intervention such that its generalisability is uncertain.

Practical implications

This novel programme was evaluated and implemented in the real world of clinical practice. It showed promising immediate positive outcomes in terms of depressive symptoms, interpersonal difficulties and job retention that warrant further exploration in a longer-term definitive study.

Social implications

Empirical studies focused on enhancing job retention in employees with moderate–severe recurrent depression are lacking, so this study was highly relevant to a potentially marginalised community.

Originality/value

While limited by a recruitment shortfall, missing data and client heterogeneity, this study showed promising immediate positive outcomes for the new programme in terms of depressive symptoms, interpersonal difficulties and job retention that warrant exploration in a definitive study.

Details

Mental Health Review Journal, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 1361-9322

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Article
Publication date: 3 May 2019

Pandia Rajan Jeyaraj and Edward Rajan Samuel Nadar

The purpose of this paper is to focus on the design and development of computer-aided fabric defect detection and classification employing advanced learning algorithm.

Abstract

Purpose

The purpose of this paper is to focus on the design and development of computer-aided fabric defect detection and classification employing advanced learning algorithm.

Design/methodology/approach

To make a fast and effective classification of fabric defect, the authors have considered a characteristic of texture, namely its colour. A deep convolutional neural network is formed to learn from the training phase of various defect data sets. In the testing phase, the authors have utilised a learning feature for defect classification.

Findings

The improvement in the defect classification accuracy has been achieved by employing deep learning algorithm. The authors have tested the defect classification accuracy on six different fabric materials and have obtained an average accuracy of 96.55 per cent with 96.4 per cent sensitivity and 0.94 success rate.

Practical implications

The authors had evaluated the method by using 20 different data sets collected from different raw fabrics. Also, the authors have tested the algorithm in standard data set provided by Ministry of Textile. In the testing task, the authors have obtained an average accuracy of 94.85 per cent, with six defects being successfully recognised by the proposed algorithm.

Originality/value

The quantitative value of performance index shows the effectiveness of developed classification algorithm. Moreover, the computational time for different fabric processing was presented to verify the computational range of proposed algorithm with the conventional fabric processing techniques. Hence, this proposed computer vision-based fabric defects detection system is used for an accurate defect detection and computer-aided analysis system.

Details

International Journal of Clothing Science and Technology, vol. 31 no. 4
Type: Research Article
ISSN: 0955-6222

Keywords

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