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Article
Publication date: 10 September 2020

Vincent Peters, Mervi Vähätalo, Bert Meijboom, Alice Barendregt, Levinus Bok and Esther de Vries

This study examines how modular interfaces manifest in multi-provider contexts and how they can improve coordination and customization of services. The aim of the study is…

Abstract

Purpose

This study examines how modular interfaces manifest in multi-provider contexts and how they can improve coordination and customization of services. The aim of the study is to describe interfaces in multi-provider contexts and elaborate on how they support the delivery of integrated patient care.

Design/methodology/approach

A qualitative, multiple case study was conducted in two multi-provider contexts in healthcare services: one representing paediatric Down syndrome care in the Netherlands and one representing home care for the elderly in Finland. Data collection involved semi-structured interviews in both contexts.

Findings

This study provides insight into several types of interfaces and their role in multi-provider contexts. Several inter- and intra-organizational situations were identified in which the delivery of integrated patient care was jeopardized. This study describes how interfaces can help to alleviate these situations.

Originality/value

This study deepens the understanding of interfaces in service modularity by describing interfaces in multi-provider contexts. The multi-provider contexts studied inspired to incorporate the inter-organizational aspect into the literature on interfaces in service modularity. This study further develops the typology for interfaces in modular services by adding a third dimension to the typology, that is, the orientation of interfaces.

Details

International Journal of Operations & Production Management, vol. 40 no. 9
Type: Research Article
ISSN: 0144-3577

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Book part
Publication date: 16 October 2014

Denise C. Tahara and Richard P. Green

This paper proposes an organizational change process to prepare physicians and other health professionals for their new roles in patient-centered medical homes (PCMHs). It…

Abstract

Purpose

This paper proposes an organizational change process to prepare physicians and other health professionals for their new roles in patient-centered medical homes (PCMHs). It provides physician-centered tools, models, concepts, and the language to implement transformational patient-centered medical care.

Design/methodology/approach

To improve care delivery, quality, and patient engagement, a systems approach to care is required. This paper examines a systems approach to patient care where all inputs that influence patient interactions and participation are considered in the design of health care delivery and follow-up treatment plans. Applying systems thinking, organizational change models, and team-building, we have examined the continuum of this change process from ideation through the diffusion of new methods and behaviors.

Findings

PCMHs make compelling business sense. Studies have shown that the PCMH improves patient satisfaction, clinical outcomes and reduces underuse and overuse of medical services. Patient-centered care necessitates transitioning from an adversarial to a collaborative culture. It is a transformation process predicated on strong leadership able to align an organization toward a vision of patient-centered care, creating a collaborative culture committed to health-goal achievement.

Originality/value

This paper proposes that the PCMH is a rigorous team-building transformational organizational change, a radical departure from the current hierarchical, silo-oriented, medical practice model. It requires that participants within and across health care organizations learn new skills and behaviors to achieve the anticipated quality and efficiency improvements. It is an innovative health care organization model of the future whose success is premised on teams supplanting the individual as the building block and unit of health care performance.

Details

Population Health Management in Health Care Organizations
Type: Book
ISBN: 978-1-78441-197-8

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Article
Publication date: 27 February 2009

Alan K. Duncan and Margaret A. Breslin

The structure of health care financing, the lack of vertical and horizontal integration, and the slow translation of basic research into meaningful health outcomes for the

Abstract

Purpose

The structure of health care financing, the lack of vertical and horizontal integration, and the slow translation of basic research into meaningful health outcomes for the population conspire to make innovation in health service delivery a difficult task. However, health service organizations that can more effectively and systematically understand patient needsneeds that are now poorly understood and often unarticulated – have an intrinsic advantage in delivering high value care. This ‐paper aims to describe a program for translating those needs into health services innovations.

Design/methodology/approach

The Mayo Clinic, a large integrated multispecialty medical group based in Rochester, Minnesota developed an in‐house design program, the SPARC Innovation Program, to bring design thinking and business analysis together to develop innovations in care delivery. A project example is described to illustrate how designers, business strategists, health care professionals, and patients create new high‐value health care experiences.

Findings

The paper finds that health service organizations need to pay more attention to the patient experience if they are to meet patient needs. The design program described here is one approach that organizations can take if they are serious about deeply understanding patient needs and developing innovations to address them.

Originality/value

While the discipline of design is the core of innovation in many industries, it is not widely known or practiced in health service organizations despite a natural affinity between design and medicine. Understanding and employing the power of design in health services will allow medical institutions to develop more effective health services, enhance patient satisfaction, and meet important human needs.

Details

Journal of Business Strategy, vol. 30 no. 2/3
Type: Research Article
ISSN: 0275-6668

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Article
Publication date: 10 May 2019

Shefali Srivastava and Gyan Prakash

The purpose of this study is to assess the relationship between patient-centricity, care coordination and delivery of quality care for older people with multiple chronic…

Abstract

Purpose

The purpose of this study is to assess the relationship between patient-centricity, care coordination and delivery of quality care for older people with multiple chronic conditions. Care coordination is defined as a process where physicians, nurses and allied professionals work together to clarify responsibilities, care objectives, treatment plans and discharge plans for delivery of unified care. Patient-centricity is defined as an approach of delivering quality care to patients that focuses on creating a positive experience for them.

Design/methodology/approach

A literature review was used to identify measures of care coordination and then partial least square structural equation modeling was used to assess interrelationship among patient-centricity, measures of care coordination and delivery of quality care.

Findings

Results reveal that care coordinated pathways consist of IT-enabled coordination, interprofessional teamwork, information sharing and facilitative infrastructure requirements and are influenced by patient-centricity. These are deliberate requisites for delivering of quality care. Results of this study present a validated model of care coordination for older people, which may be further explored to refine the concept of care coordination.

Practical implications

Based on these results, practitioners may develop an overarching strategy to deliver seamless care and to achieve better health outcomes. Measures of care coordination may be used as a performance benchmarking tool and will also help in the process mapping of hospitals.

Social implications

This paper highlights how patient-centricity may be achieved by focusing on coordinated care processes. This understanding may help in designing processes, which in turn deliver health as a social good in an effective manner.

Originality/value

Results of this study present such a validated model for care coordination, which can be used by researchers.

Details

Journal of Indian Business Research, vol. 11 no. 4
Type: Research Article
ISSN: 1755-4195

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Article
Publication date: 1 December 2004

Dennis A. Pitta and Michael V. Laric

The supply chain concept aided marketing by highlighting relationships that form a network of firms creating products for consumers. It helped change the focus from…

Abstract

The supply chain concept aided marketing by highlighting relationships that form a network of firms creating products for consumers. It helped change the focus from individual transactions to a more comprehensive view of the entire system. The value chain concept in marketing extends the supply chain view in an important way: it explicates the value that is created at each stage of the chain. For marketers, it is a vital tool in satisfying consumers – the final part of the value chain. This value chain can be viewed as having two components: the value delivery system and the consumer. This paper explores several approaches to value that are important in the functioning of the value chain. It then delineates three main elements of the value chain and traces them as they apply to services. It then focuses on one of the more complex services, the health care delivery system. It goes on to describe the health care value network and examine the critical factors that affect the success of the health care process. Finally, it delineates several important implications for health care marketers.

Details

Journal of Consumer Marketing, vol. 21 no. 7
Type: Research Article
ISSN: 0736-3761

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Article
Publication date: 1 June 2008

Palmer Orovwuje

Various attempts have been made to understand and resolve the enduring lack of cohesiveness of multidisciplinary teams (MDTs), their dysfunctional service delivery and the…

Abstract

Various attempts have been made to understand and resolve the enduring lack of cohesiveness of multidisciplinary teams (MDTs), their dysfunctional service delivery and the feelings of distress among some of the professionals who work in them. Distortions in forensic MDTs have sometimes compromised service delivery and effective risk management. Several public inquiries relating to high‐profile incidents in forensic mental health have noted the role of dysfunctional MDTs. This paper describes the philosophy, structure, functions and achievements of a forensic community MDT in Wellington, New Zealand. It explains a model of care that is adaptable, comprehensive, effective and evidence‐based. It highlights the role of the extended MDT and embedded cultural units from which care professionals work together, share a common philosophy of care and tailor their care to the needs of the individuals or populations they serve.

Details

Mental Health Review Journal, vol. 13 no. 2
Type: Research Article
ISSN: 1361-9322

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Book part
Publication date: 25 July 2012

Peter Lazes, Liana Katz, Maria Figueroa and Arun Karpur

Purpose – This chapter explores the use of adaptive and disruptive change strategies to create an integrated health care delivery system that is both economically…

Abstract

Purpose – This chapter explores the use of adaptive and disruptive change strategies to create an integrated health care delivery system that is both economically sustainable and patient-centered.

Design/methodology – This case study of Montefiore Medical Center is based on a year of research that included focus-group interviews; individual interviews with executives, frontline staff, and union leaders; site visits; analysis of internal data; and a literature review.

Findings – Montefiore Medical Center is using both adaptive and disruptive strategies to develop an integrated delivery system driven by capitated payments from health insurance companies, a focus on primary care and chronic disease management programs, and community outreach. The growth of these delivery system components in conjunction with Montefiore's Care Management Corporation (to help manage the health plan contracts) has contributed to an affordable cost of care, improved clinical outcomes, and proactive patient and community engagement.

Originality and value – There is a paucity of case studies describing how safety-net hospitals – and health systems in general – can integrate the services they provide to create a positive, seamless, and economical patient experience. The story of Montefiore Medical Center offers an overview of how health care infrastructure and payment methods can be transformed to align financial and clinical incentives and to better serve a patient population that largely depends on government health insurance.

Details

Organizing for Sustainable Health Care
Type: Book
ISBN: 978-1-78190-033-8

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Article
Publication date: 27 August 2020

Timothy J. Vogus, Andrew Gallan, Cheryl Rathert, Dahlia El-Manstrly and Alexis Strong

Healthcare delivery faces increasing pressure to move from a provider-centered approach to become more consumer-driven and patient-centered. However, many of the actions…

Abstract

Purpose

Healthcare delivery faces increasing pressure to move from a provider-centered approach to become more consumer-driven and patient-centered. However, many of the actions taken by clinicians, patients and organizations fail to achieve that aim. This paper aims to take a paradox-based perspective to explore five specific tensions that emerge from this shift and provides implications for patient experience research and practice.

Design/methodology/approach

This paper uses a conceptual approach that synthesizes literature in health services and administration, organizational behavior, services marketing and management and service operations to illuminate five patient experience tensions and explore mitigation strategies.

Findings

The paper makes three key contributions. First, it identifies five tensions that result from the shift to more patient-centered care: patient focus vs employee focus, provider incentives vs provider motivations, care customization vs standardization, patient workload vs organizational workload and service recovery vs organizational risk. Second, it highlights multiple theories that provide insight into the existence of the tensions and how they may be navigated. Third, specific organizational practices that engage the tensions and associated examples of leading organizations are identified. Relevant measures for research and practice are also suggested.

Originality/value

The authors develop a novel analysis of five persistent tensions facing healthcare organizations as a result of a shift to a more consumer-driven, patient-centered approach to care. The authors detail each tension, discuss an existing theory from organizational behavior or services marketing that helps make sense of the tension, suggest potential solutions for managing or resolving the tension and provide representative case illustrations and useful measures.

Details

Journal of Service Management, vol. 31 no. 5
Type: Research Article
ISSN: 1757-5818

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Article
Publication date: 6 June 2016

Kofi Osei-Frimpong

Considering the increasing conceptualization of value creation, this paper aims to empirically examine the influence of pre-encounter value needs of patients on the…

Abstract

Purpose

Considering the increasing conceptualization of value creation, this paper aims to empirically examine the influence of pre-encounter value needs of patients on the clinical encounter process and how this impacts on their perceived experiential value, and contributes to the patient’s role in value creation in healthcare service delivery.

Design/methodology/approach

A model is proposed to suggest the antecedent and consequences of key elements of the patient–doctor encounter process. Following survey design approach, data collected from 332 outpatients from two clinics in Accra, Ghana, are examined through structural equation modeling using AMOS 23.0.

Findings

The findings reveal that patient pre-encounter value needs significantly influence key elements of the patient–doctor encounter process (care delivery approach, level of trust and shared-decision making approach). This in turn affects patient’s perceived experiential value and satisfaction evaluation. The results also suggest that patient characteristics (e.g. educational background and frequency of visit) had no significant effect on the encounter process leading to perceived experiential value; however, patient’s age had significant influence on the encounter process.

Research limitations/implications

This study empirically establishes a need to understand patient’s pre-encounter value needs, which fundamentally influence the patient-doctor encounter process and their perceived experiential value. However, the research only focused on the patient, which could limit the findings considering the multi-actors involved in the service delivery.

Practical implications

Creating value with patients suggests a need for providers to understand patient value needs or goals and adopt an approach to engage in a holistic manner that would result in positive experiences. This would empower and increase confidence of patients in consultations.

Originality/value

Using a quantitative research approach, this research engages in a highly focused investigation of the influence of patient’s pre-encounter value needs on key elements of the patient–doctor encounter process, which has received limited attention in the extant literature. The study also furthers our understanding of the effects of fundamental patient characteristics on encounter process and how this influence actor perceived experiential value.

Details

International Journal of Pharmaceutical and Healthcare Marketing, vol. 10 no. 2
Type: Research Article
ISSN: 1750-6123

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Article
Publication date: 6 October 2020

Elisabetta Garagiola, Alessandro Creazza and Emanuele Porazzi

Due to the evolution of the health-care scenario and the growing role of the primary care setting, the distribution processes of health technologies will be more and more…

Abstract

Purpose

Due to the evolution of the health-care scenario and the growing role of the primary care setting, the distribution processes of health technologies will be more and more in demand in the near future. This paper aims to investigate this theme, analyzing the performance, strengths and weaknesses of the current distribution practices, with the ultimate overarching aim to improve the provision of the primary care services.

Design/methodology/approach

The research framework is twofold. First, a tool to monitor the economic/quantitative performance of the distribution models was designed; second, the tool was applied to measure the performance of distribution models of absorbent devices for incontinence adopted by Local Health Authorities (LHA) in Lombardy Region (Italy). Quantitative data were collected by LHAs (from 2012 to 2016) and compared through data-benchmarking. Qualitative data from interviews and focus groups complemented the outcomes.

Findings

Two main distribution models were investigated: distribution through pharmacies and home delivery. Results show that there is no winning/preferable model in terms of economic/quantitative performance and service quality level, but a counterbalanced combination of strengths and weaknesses exists. Moving from the highlighted weaknesses and building on the strengths, an alternate distribution model is proposed for testing.

Originality/value

The present study approaches the theme of primary care services with a holistic approach, filling a literature gap. It also provides practitioners with a tool of performance analysis and management and real data, applicable also in international contexts. The collected real-world data also gives insights on the area of the quality of care, with particular reference to the patients’ experience. As a lesson learned, policymakers and the National Healthcare Service should re-think their current distribution models/practices in the light of the highlighted criticisms and opportunities for improvement.

Details

Measuring Business Excellence, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 1368-3047

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