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This paper aims to critically examine the emerging policy agenda of payment by results (PbR) and care clusters in order to identify how to engage with it to ensure it is supportive of social inclusion and recovery.

Care clusters and PbR for mental health care are critically examined.

There is scope in the ongoing development of care clusters and associated pathways to continue the progressive developments towards recovery and social inclusion in the commissioning and delivery of mental health care, but they need to be nurtured and actively pursued.

The care clusters and developments building on them provide scope for supporting social inclusion and recovery practice, but also some risks; hence, those with an interest in furthering such practice need to engage now locally and nationally with care clusters developments.

PbR is being pursued as a policy for commissioning mental health care in England, based on a model of care clusters. This paper discusses the move to PbR and its possible implications for the recovery and social inclusion agenda.

With care clusters an established framework for mental health services it is timely to consider how to use them to deliver high quality, evidence based care that is socially inclusive and recovery oriented. This paper aims to describe conceptual thinking about these issues, specifically in relation to the challenges and balances inherent in the care packages approach. It seeks to describe work to develop an internet based, high‐level description of such packages for each care cluster.

The background to the project is described, along with a discussion of the conceptual and practice issues behind the work.

With mental health care now trying to make sense of local services in terms of care clusters the authors offer a high‐level framework to help people in this sensemaking. Coherent, socially inclusive and recovery oriented packages are set out on the website.

The work discussed in the article is highly innovative, being the first systematic attempt to provide evidence‐based, high‐level care packages for the care clusters model. Hence, a limitation is the challenge remaining to operationalise the work to real world care contexts.

The website sets out a framework to help local services and commissioners plan and organise their services, drawing on the best guidance and evidence and developing care packages on the basis of the right ethos of care.

In moving to services fully commissioned and organised around the care clusters model, there remain major conceptual and practice challenges to address including operationalising evidence‐based care packages and means of flexibly delivering individual care.

This is the first view of socially inclusive packages for each of the care clusters that also draw together the best of guidance and standards of care.

The purpose of this paper is to explore potential differences in how nursing home residents rate care quality and to explore cluster characteristics.

A cross-sectional design was used, with one questionnaire including questions from quality from patients’ perspective and Big Five personality traits, together with questions related to socio-demographic aspects and health condition. Residents (n=103) from four Norwegian nursing homes participated (74.1 per cent response rate). Hierarchical cluster analysis identified clusters with respect to care quality perceptions. χ² tests and one-way between-groups ANOVA were performed to characterise the clusters (p<0.05).

Two clusters were identified; Cluster 1 residents (28.2 per cent) had the best care quality perceptions and Cluster 2 (67.0 per cent) had the worst perceptions. The clusters were statistically significant and characterised by personal-related conditions: gender, psychological well-being, preferences, admission, satisfaction with staying in the nursing home, emotional stability and agreeableness, and by external objective care conditions: healthcare personnel and registered nurses.

Residents assessed as having no cognitive impairments were included, thus excluding the largest group. By choosing questionnaire design and structured interviews, the number able to participate may increase.

Findings may provide healthcare personnel and managers with increased knowledge on which to develop strategies to improve specific care quality perceptions.

Cluster analysis can be an effective tool for differentiating between nursing homes residents’ care quality perceptions.

The article aims to discuss the process of assessment within the developing model of care clusters for mental health being implemented in England as a potential basis for a payment by results (PbR) system. Assessment, leading to allocation to care cluster, determines the care package individuals receive from services. Hence, assessment needs to be thorough and holistic and, it is argued, grounded in the philosophy upon which all care processes should be based.

The process of assessment is critically reviewed in the context of allocation to care clusters. An innovative approach of recovery focused conversations (RFCs) is outlined, along with its theoretical grounding in Buber's philosophy of “dialogue”, to help ensure assessment processes in PbR are fit for purpose.

Care clusters present opportunities to deliver high quality care, actively engaging people in their care and supporting their recovery. These are not a given, though. Further means are required to operationalise all the desirable ingredients of what care is delivered and how it is done. RFCs are outlined as an addition to the care cluster to ensure that care planning starts from a co‐produced understanding between professionals and service users.

RFCs are a technology for delivering assessment and cluster allocation with mutually respectful dialogue between professionals and people with mental health problems, and that promotes a recovery oriented approach throughout the subsequent care pathway.

This is the first critical review of assessment processes in care cluster allocation and first description of RFCs as an inclusive, integrative approach.

Integrating health, social and informal care and seeking for new effective collaborations is a major topic in many countries, and requires innovation and improvement in current practices. Conceptual quality management models can facilitate practice improvement. However, a generic quality management model for integrated care was lacking. The purpose of this paper is to describe the results of multiple studies that resulted in a validated generic quality management model for integrated care. The Development Model for Integrated Care (DMIC) is the basis for a digital tool for self-evaluation and is being used in multiple ways in a large number of integrated care settings.

A literature review, a Delphi study and concept mapping study were executed to identify the essential ingredients of integrated care. A next step was an expert study on the development process of integrated care over time. Lastly, a survey study in 84 integrated care networks was performed to empirically validate the model. Based on the model, a digital self-assessment tool was created to apply the model in practice.

The studies showed that integrated care is a complex and multi-component concept but generic elements can be assessed. The literature and expert study resulted in a set of 89 elements of integrated care. The elements were grouped in nine clusters; “quality care”, “performance management”, “inter-professional teamwork”, “delivery system”, “roles and tasks”, “patient-centredness”, “commitment”, “transparent entrepreneurship” and “result-focused learning”. Four developmental phases named “the initiative and design phase”, “the experimental and execution phase”, “the expansion and monitoring phase” and “the consolidation and transformation phase” were found. The findings showed that the model is applicable for multiple integrated care settings.

The DMIC has the potential to serve as a research framework for integrated care, and the use as an evaluation tool on multiple levels. Further research is suggested about more explicitly involving the perspectives of clients, research on the involvement of multiple stakeholders and their professional backgrounds and the use of the model in other countries.

The DMIC is the basis of a digital web-based assessment tool, which is being used in the Netherlands in multiple integrated care settings. Applying the tool helps in assessing the current state of integrated care practice and defining suggestions for further improvement and development. It is also being used to benchmark multiple settings and is adopted in guidelines or care standards for integrated care.

A generic conceptual and validated model that can be supportive for integrated care practices, policy and research was lacking. The results of the summarized studies in this paper present such a conceptual model for integrated care and gives suggestions for further use in an international audience. Results in a Canadian study showed that the model can also be used in other settings and countries. This contributes to the opportunities for use of the model in integrated care practice, policy and research also in other countries.

This study aims to map and analyze health-care pricing information research. This work highlights current gap in pricing information research in health care and proposes future research avenues to academia and industry professionals.

A bibliometric method was adopted to analyze extant literature on pricing information asymmetry. Semistructured interviews were conducted with key stakeholders in health care to triangulate the findings.

Pricing information is crucial for all stakeholders including health-care consumers, providers and regulators. The popular research areas were the rising health-care cost, cost-saving, outcome-based pricing, price based on service supply and demand, insurance and out-of-pocket spending. Cost–quality perceived linkages, cost–demand correlation in health-care service and cost–price interlinked drivers were the dominant themes in extant literature. The study highlighted that pricing information asymmetry pushed patients from weaker sections into a debt trap due to unplanned out-of-pocket health-care expenses. The study suggests areas of research to minimize this pricing information asymmetry.

The emerging themes in health pricing asymmetry will help key stakeholders to identify areas for improvement and take remedial actions in the health-care domain.

This study is a pioneering effort to summarize extant literature published in the health-care information pricing domain and analyze it from a bibliometric perspective. The study also triangulates the finding with primary data from key stakeholders and highlights emerging research areas.

The purpose of this paper is to develop a typology of different family policy systems in Europe and evaluate their impact on the employment strategy of mothers with care responsibilities for dependent children.

The paper outlines a typology of family policy regimes in Europe – covering the 26 countries. A typology based on a cluster analysis of macro indicators of family policy – coverage of childcare, effective parental leave and spending on family policies. The cluster analysis is based on data from OECD family data base. Then follows an analysis of the impact of the different family policy regimes on mothers' employment strategies when they return into gainful employment, based on data from the European Social Survey, 2008.

The authors have identified four different family policy models: extensive family policy, long parental leave, family care, and cash for care. For each of the models, different strategies are found for take up of employment for mothers with dependent children.

The paper includes 26 European countries, thereby covering the East and Central Europe, which is not the case in most welfare typologies. Furthermore, the authors distinguish clearly in the analyses between the institutional dimension and the outcome – mothers' employment strategies.

The purpose of this exploratory, empirical study is to identify motivations for expatriation among religious and humanitarian (R&H) workers.

A sample of 158 active expatriate Christian R&H workers from 25 countries, representing 48 international organizations, completed a survey with 45 reasons for expatriation, derived from literature on corporate expatriation, international volunteering, and international migration. Data analysis includes factor analysis and cluster analysis.

In total, eight latent motivation factors were found: career development; economics; international experience; escapism; altruism; outsider support; family life; and location. Workers in the not‐for‐profit sector are primarily motivated by altruism, and thus integrate organizational mission with personal purpose in their decision to work abroad. Using cluster analysis, four groups of humanitarian and religious workers in the Christian sub‐sector were identified: Caring Missionary; Focused Worker; Self‐Directed Careerist; and International Family Custodian. Workers from developed versus developing countries exhibit different motivators.

The findings provide insight into differences between developed versus developing country workers and between R&H workers. Recognizing the differences in motivation can assist international human resource managers in the effective recruitment, selection, training and development, career management, and support and encouragement of non‐profit organizations (NPO) expatriates. The authors provide propositions to be tested based on the application of self‐determination theory to expatriate motivation.

This exploratory, empirical study of Christian R&H workers extends the organizational and country context and builds on motivation for expatriation research to include this sub‐sector of workers from both developed and developing countries operating in global organizations. The findings provide new insights into motivation for expatriation and lead to propositions for future research.

The purpose of this paper is to explore the issues surrounding a long planned expansion of Payment by Results (PbR) into mental health services and to highlight the factors responsible for the delay.

PbR relies upon “standardisation” of conditions and treatments. This depends upon a scheme of classification that can realistically predict resources required to execute treatment of any one case. Plans to fund NHS mental health services on the basis of tariffs derived in this way have been delayed, and a key reason is the lack of high-quality data. This would require effective “standardisation-to the-average” of both a system of classification and a repertoire of costed treatment pathways. This paper investigated the delay implementation by exploring the difficulties in applying standardisation principles to service provision and tariff calculation.

The paper identified the fundamental difficulty with PbR’s implementation in applying “standardisation” to practice. This is defining the mental disorder that the patient is suffering and designing care pathways at clinical level considering the balance between practical applicability and conceptual/constructional validity. This is necessary to enable the calculation of a national tariff. The conceptual flaws of the Health of the Nation Outcome Scale led to the constructional shortcomings which compromised the credibility and validity of Mental Health Clustering Tool regarding making accurate classification in a standardised way. The validity and credibility of calculating a national tariff thus became contentious on the basis of this inaccurate clinical classification system.

This paper explored the driving factors of delay in implementing PbR in mental health through connecting the recent reform with the fundamental assumptions of “standardisation-to the-average”, which provided another perspective to illustrate the current obstacles.

The Central Mental Hospital in Ireland is one of the oldest forensic mental health units in Europe. The hospital is currently in the process of transforming from a single inpatient site to a modern national forensic mental health service. Central to this transformation is the need to move from the traditional security‐focused model of care to a model of recovery. The challenge incumbent within this transformation is to incorporate a sophisticated amalgamation of the patients' needs while recognising the broad range of security requirements in a forensic setting. This paper considered that adopting an integrated care pathway (ICP) approach would provide the service with a vehicle to re‐engineer our principles and systems of care. Likewise we hypothesised that the ICP would enable us to consolidate best practices such as multi‐ disciplinary working, structured professional judgement and the involvement of the patient and their carers. Thus far it has afforded us the opportunity to examine many aspects of the care delivered within the service. It has provided a shared understanding of key standards among clinicians, service users and carers that are necessary to implement a quality care pathway. It has certainly not been a stagnant process, and the initial work often bears no resemblance to the current process. In turn, we expect that it will continue to change as the path travelled is as important as the outcome and the ICP becomes a dynamic part of the organisation.