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The aim of the study was to further our understanding of the nature of care at home for people with dementia, with particular emphasis on routines, control and care goals. Its objective was to examine the nature of care as a form of social organisation in the home of people with dementia whose care was at least partly provided by relatives or friends. Twenty situations were included in which the carers and people with dementia were interviewed. Each participating pair was observed for an average of nine hours.Findings cover the ways in which carers and people with dementia accomplished personal and household care through routines and exerting control, and how they dealt with aspects like setting and matching care goals. Accomplishing care is shown to be a major challenge for people with dementia and their caregivers, yet in most cases participants developed effective coping strategies. Three themes emerged from the findings: handling competing goals or means to goals, controlling the situation and maintaining a preferred sense of self. This study shows that observational research in the homes of people with dementia is feasible and, when combined with conversational interviewing, is valuable in understanding the processes of caring and what it means to live with dementia. The expertise of carers and care‐receivers in managing home care has been identified. Policies and practices that acknowledge such expertise will go some way towards encouraging and helping people to continue, and rewarding them for the vital part they play.

The purpose of this paper is to evaluate an approach to automating goals for supporting home care, with a view to understanding user experience when defining such goals and hence identifying improvements that could be made to the approach.

The study was designed to answer the key research question of whether users can understand, formulate and relate to automated goals for home care. In order to do this, a fictional text-based scenario was used about a couple with care needs. This helped to explore the feasibility, acceptability and usability of goals to manage care at home. Face-to-face qualitative interviews were undertaken with ten participants with a background in social care: four social care professionals; one health care professional; one formal carer; one informal carer; and three end users.

Overall, participants were positive about being able to control the MATCH (Mobilising Advanced Technologies for Care at Home) system through the use of goals. The results from the participant interviews will be used to help guide potential improvements to the home care system. The main issue that emerged from the study is that it would be valuable to think in terms of outcomes as a higher level than goals. A second consideration is that it would be desirable to adopt terminology that can be understood by all stakeholders.

The study has demonstrated that automated goals for home care have a useful role to play and can be successfully used by end users and carers. Although the range of participants in the study was limited, it has allowed confidence to be built in the approach and has identified useful pointers for future development.

With the evaluation and validation of the goal-based approach, it has encouraged the developers to make automated goals more widely available in future deployment of the home care system.

The use of automated goals to support home care has been shown to be acceptable to end users and carers. This will allow future home care systems to offer more personal and better customised services to those receiving telecare.

The study provides a unique evaluation of the use of automated goals to support home care. Previous use of goals in the literature has been for highly technical applications, so their application to home care is novel and speculative. The study has demonstrated that the approach is viable, useful, and usable by end users and carers.

Principal-agent theory (PAT) has been used to understand relationships among different professional groups and explain performance management between organisations, but is rarely used for research within primary care. The purpose of this paper is to explore whether PAT can be used to attain a better understanding of performance management in primary care.

Purposive sampling was used to identify a range of general practices in the North-west of England. Interviews were carried out with directors, managers and clinicians in commissioning and regional performance management organisations and within general practices, and the data analysed using matrix analysis techniques to produce a case study of performance management.

There are various elements of the principal-agent framework that can be applied in primary care. Goal alignment is relevant, but can only be achieved through clear, strategic direction and consistent interpretation of objectives at all levels. There is confusion between performance measurement and performance management and a tendency to focus on things that are easy to measure whilst omitting aspects of care that are more difficult to capture. Appropriate use of incentives, good communication, clinical engagement, ownership and trust affect the degree to which information asymmetry is overcome and goal alignment achieved. Achieving the right balance between accountability and clinical autonomy is important to ensure governance and financial balance without stifling innovation.

The principal-agent theoretical framework can be used to attain a better understanding of performance management in primary care; although it is likely that only partial goal alignment will be achieved, dependent on the extent and level of alignment of a range of factors.

This paper aims to trace the relational and material ways in which workplace teams come together (or fail to) in the provision of patient care.

Six interprofessional scholars brought their unique theoretical and disciplinary lenses to understand the contextualized experiences of the patient and the team. Adopting a critical narrative inquiry (CNR) approach, the experiences of 19 participants were documented as they interacted in the care of an elderly patient over a three-week period. Actor network theory constructs enabled the analysis of multiple artefacts implicated in the interactions to learn of their contribution to the enactment of her care.

The study gives empirical insights about ways in which knowledge circulates amongst the workplace and how systemic structures may impede effective and quality patient care. Various types of knowledge are held by different team members, and both individuals and materials (e.g. technologies) can influence the way those knowledges are shared (or not).

Focusing on a rich data set surrounding one patient documented as theatre serves pedagogical purposes and serves as a shared “boundary-breaking” object to interrogate from multiple stakeholder perspectives. CNR provides for recursive, dynamic learning as readers critically consider experiences within their own contexts.

Despite research that documents competing political, systemic and economic goals, sedimented policies and practices persist in ways that undermine care goals.

Tackling the urgent issue of an aging population will require expanding collaboration (for planning, research and so on) to include a broader set of stakeholders, including operational, administrative and post-discharge organizations. Attention to social infrastructure as a means to assemble knowledges and improve relationships in the care process is critical.

Building a boundary-breaking shared object to represent the data offers a unique opportunity for multiple stakeholder groups to enter into dialogue around barriers to workplace interaction and collaboration progress, linking problems to critical perspectives.

In Canada, integrated care pilot projects are often implemented as a local reform strategy to improve the quality of patient care and system efficiencies. In the qualitative study reported here, the authors explored the experiences of healthcare professionals when first implementing integrated care pilot projects, bringing together physical and mental health services, in a community hospital setting.

Engaging a qualitative descriptive study design, semi-structured interviews were conducted with 24 healthcare professionals who discussed their experiences with implementing three integrated care pilot projects one year following project launch. The thematic analysis captured early implementation issues and was informed by an institutional logics framework.

Three themes highlight disruptions to established logics reported by healthcare professionals during the early implementation phase: (1) integrated care practices increased workload and impacted clinical workflows; (2) integrating mental and physical health services altered patient and healthcare provider relationships; and (3) the introduction of integrated care practices disrupted healthcare team relations.

Study findings highlight the importance of considering existing logics in healthcare settings when planning integrated care initiatives. While integrated care pilot projects can contribute to organizational, team and individual practice changes, the priorities of healthcare stakeholders, relational work required and limited project resources can create significant implementation barriers.

The purpose of this paper is to describe the development and application of the KIPP-list of care activities. The acronym KIPP stands for Knowledge and Insight into Primary Processes. The instrument is intended as a tool for family coaches to systematically report care activities conducted in the Dutch family support programme Ten for the Future (in Dutch: Tien voor Toekomst).

The design of the instrument was based on the components of the programme and a literature search for similar instruments used in the Netherlands, complemented by a staff survey. A series of three studies was carried out to test the instrument’s validity and user-friendliness, and to assess its potential for programme evaluation.

The majority of care activities were performed in cooperation with one or both parents alone, and less frequently with children or external professionals. Although the main focus of the work of the family coaches fell into the categories of “collecting information” and “working towards (behavioural) change” with families, the relatively high frequency of all the types of care contacts emphasises the intensity of this family support programme with a complex target group.

Data gathered with the instrument provided meaningful information by descriptive analysis. KIPP thereby proved its general feasibility in increasing insight into service provision. The instrument can be useful in several stages and on several levels of quality assurance and service optimisation, including reflective practice, supervision, team management and research.

Research I universities are increasingly requiring a “diversity” course as part of the general education curriculum. In this chapter, the authors explore how diversity requirement course (DRC) proposals are framed at their institution and share how instructors at their university are framing their own student learning outcomes for these courses: from the perspective of multiculturalism or from the perspective of social justice? The authors describe how a lens of multicultural education frames discussions of diversity as appreciation, awareness, and tolerance, and contend that this approach alone is not sufficient to meet either the intent of DRC initiatives or the goals of equity and inclusion in academia. The authors argue that social justice education (SJE) is a more appropriate instructional framework for DRCs, as it is a humanizing approach that necessitates the crafting of student learning outcomes which specifically address actionable strategies toward opposing marginalization. The authors include selected results from a campus-wide DRC outcomes survey and separate focus group feedback, emphasizing the critical assessment and campus climate aspects of these data. Finally, the authors examine how their faculty development programs and resources are currently assisting DRC instructors with identifying and meeting their needs, and how other faculty developers can expand their support structures in the future to align with the philosophy of SJE.

As healthcare continues to become more expensive and complex, considering the voice of the patient in the design and operation of healthcare practices is important. Wound care and rural healthcare scenarios pose additional complexities for providers and patients. This study sought to identify key determinants of patient service quality in wound care.

Patients at the wound care/ostomy clinic (WOC) in a rural hospital were surveyed using the Kano model. The Kano model enables the categorization of quality attributes based on the attributes' contribution to the subject's overall satisfaction (and dissatisfaction). Chi-square goodness-of-fit testing, multinomial analysis and power analysis were then used to determine the Kano categories for each satisfaction-related attribute.

The analyses resulted in 14 one-dimensional attributes and 3 indeterminable attributes. For the one-dimensional attributes, customer satisfaction is directly proportional to the level of performance for that attribute. The one-dimensional attributes included providing correct care on the first, provision of necessary supplies for care, appropriately qualified medical staff and confidence in care provided by medical staff, among others. Understanding the attributes important to the patient drive patient-centered care, which improves positive patient outcomes and recovery. These attributes can then be used by healthcare professionals to design patient-centric processes and services. This research provides a framework for incorporating the voice of the patient into healthcare services.

While the research methodology can be used in other healthcare settings, the findings are not generalizable to other wound care clinics. This research was conducted in one small, rural hospital. In addition, the sample size was small due to the size of the wound clinic; therefore, an analysis of the differences between demographics could not be performed.

Considering the perspectives of rural wound care patients is important, as the patients are an under-served population with unique challenges related to patient care. The research findings detail rural patients' expectations during wound care treatments, which enable the clinic to focus on improving patient satisfaction. This research contributes to understanding the factors that are important to patient satisfaction in wound care. Further, the methodology presented can be applied to other healthcare settings.

While studies exist using the Kano model in healthcare and the literature is sparse in rural healthcare, this is the first case study using the Kano model in wound care to understand patient preferences.

This paper aims to extend the consideration of distributed leadership in health-care settings. Leadership is typically studied from the classical notion of the place of single leaders and continues to examine distributed leadership within small teams or horizontally. The purpose is to develop a practical understanding of how distributed leadership may occur vertically, between different layers of the health-care leadership hierarchy, examining its influence on health-care outcomes across two hospitals.

Using semi-structured interviews, data were collected from 107 hospital employees (including executive leadership, clinical management and clinicians) from two hospitals in Australia and the USA. Using thematic content analysis, an iterative process was adopted characterized by alternating between social identity and distributed leadership literature and empirical themes to answer the question of how the practice of distributed leadership influences performance outcomes in hospitals?

The perceived social identities of leadership groups shaped communication and performance both positively and negatively. In one hospital a moderating structure emerged as a leadership dyad, where leadership was distributed vertically between hospital hierarchal layers, observed to overcome communication limitations. Findings suggest dyad creation is an effective mechanism to overcome hospital hierarchy-based communication issues and ameliorate health-care outcomes.

The study demonstrates how current leadership development practices that focus on leadership relational and social competencies can benefit from a structural approach to include leadership dyads that can foster these same competencies. This approach could help develop future hospital leaders and in doing so, improve hospital outcomes.

In their conceptualization of the principal/agent relationship, Jensen and Meckling were not referring to a knowledge worker (KW) agent. Agency theory is extended to the context of a KW agent to identify a key role for IS/IT in facilitating the monitoring function. To test this, the dynamics of a critical principal‐KW agent relationship in the health‐care industry are investigated. It is demonstrated that IS/IT goes beyond just alleviating the agency problem to enabling the KW agent to perform “self‐monitoring”. The results are significant for health care, agency relationships and the use of IS/IT with knowledge workers.