Search results

The purpose of this paper is to show how modularity manifests in a service context, more specifically in the provision of care and services to independently living elderly.

Four case studies provide insight into the specification of relevant components and their subsequent assembly into a customized package of care and services.

In all cases, component specification and package construction take place in two phases: partly before and partly during care delivery. Early client involvement allows for a combination of standard components that have a lower level of customization, whereas late client involvement allows for adaptation of these components resulting in a higher level of customization. The paper proposes that modularity theory should distinguish between the creation of modular offerings in care provision versus their creation in goods production, since the findings are the exact reverse of the state‐of‐the art knowledge in manufacturing modularity.

The empirical part of this paper is limited to providers of elderly care and services in The Netherlands and is exploratory in nature. However, the newness of care and service modularity justifies the exploratory research approach.

This paper offers elderly care organizations in‐depth understanding of their complex and multi‐faceted specification process. The insights help both care and service providers to make well‐considered decisions as to what level of client involvement to allow and the type of modularity to apply.

This paper contributes to the emerging literature on service modularity.

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 examine the outcomes of chiropractic manipulative and manual therapy (MMT) provided to residents experiencing spinal pain in a substance misuse therapeutic community (TC).

Clinical audit to explore the potential benefits of the interventions offered to residents experiencing spinal pain in a TC. Residents seeking care underwent an assessment by either general practitioner or chiropractic intern. Eligible participants could choose one of the four interventions: usual care without any additional treatment (Group 1), usual care with simple analgesics (Group 2), usual care plus MMT without simple analgesics (Group 3), or usual care plus MMT with simple analgesics (Group 4). Outcome measures were the RAND-36-item short form health-related quality-of-life survey and the patient satisfaction questionnaire (PSQ). Data were collected at baseline and after six weeks for each participant, with those participants choosing MMT receiving up to six treatments over the study period. Two cycles of six weeks of data collection was used. Data were analysed for statistically significant (repeated measures ANOVA with Bonferroni correction) and clinically meaningful changes in scores.

Of 71 self-presenting residents seeking care, 68 were eligible to participate. Of these, 32 chose usual care with simple analgesics (Group 2) and 36 chose usual care plus the package of MMT but without simple analgesics (Group 3). None chose usual care without additional treatment or usual care plus the package of MMT with analgesics, thus offering only the data from two groups for analysis. Group allocation was non-random and based on patient choice. Between-group analysis of the cumulative and component RAND-36 data indicated a significant difference between the two groups (p=0.034), particularly in the physical outcomes (p=0.012), indicating that Group 3 had improved scores over Group 2. Group 3 showed a significant change in RAND-36 scores (p<0.01) when compared with Group 2 (p=0.23) over the six-week treatment period. The PSQ scores of the two groups showed a statistically significant difference (p=0.0093), suggesting that Group 3 had greater patient satisfaction with care. The outcomes suggest that the package of MMT in Group 3, delivered by an appropriately trained clinician may have added to therapeutic effect that extended beyond physical outcomes but also influenced psychological outcomes.

The results of this clinical outcome-based audit suggest that the addition of a package of chiropractic MMT to usual care may be of benefit over usual care with simple analgesics for residents of a TC with spinal pain. The results intimate that benefits may extend across both the physical and psychological components of the pain experience, although a confirmatory study is recommended to substantiate these insights.

As far as the authors are aware, this trial is the first of this type in a TC, with the insights and experience gained supporting a definitive trial.

This article summarises and provides commentary upon the case of Peters v East Midlands Strategic Health Authority [2009] EWCA Civ 71 and considers its likely effect on claims for future care in personal injury litigation. In future, there should be less impetus on case managers and deputies to pursue applications for state funding of care packages on behalf of injured claimants, where those claimants intend to claim the future costs of such packages from defendants. A state‐funded package is likely to be regarded as an interim measure pending the Court's final award of damages.

This article considers the application of upper cost policies to domiciliary care packages and the problems and pitfalls that can occur in practice.

There have been few economic evaluations of joint working between social and health care. This paper focuses on collaboration between professionals providing care for people aged 75 and over, and examines the economic costs of contacts made by social workers with community nurses, GPs and older people or their carers. Two areas were studied, one where social care and primary care services were co‐located, and the other with social work teams located separately from local health services. The two forms of social care location had an impact on contacts and costs but overall it was fairly small. Contact costs made up only a small amount of the overall costs of care These findings suggest that altering the organisational arrangements for care delivery may improve the process of care delivery, but result in only minor changes to the proportion of overall resources directed to older service users.

This chapter integrates organization design and sustainability concepts to describe an accelerated transformational change at the Fairview Medical Group (United States).

A case study of the transformation at Fairview Medical Group’s primary care clinics was developed from interviews and first-person accounts of the change. Objective data regarding outcomes was used to evaluate the effectiveness of the redesign process.

The Fairview Medical Group developed an innovation and change capability to transform 35 primary care clinics in six months. All of the clinics were certified by the state of Minnesota as complying with their healthcare standards. Clinical outcomes, costs, and employee and physician engagement also increased. All of the improved measures are sustained.

Healthcare reform in the United States struggles because the organization design challenges are great and the change difficulties even greater. Fairview’s experience provides important evidence and lessons that can help advance our understanding of effective healthcare and create more sustainable healthcare systems. This chapter provides healthcare system administrators evidence and alternatives in the pursuit of implementation.

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.

Providers of healthcare services face increasing performance demands in terms of cost-efficiency as well as client centeredness. Dementia care is an illustrative example in this respect. Due to the aging society, the number of dementia clients is expected to grow significantly, which implies increasing costs. At the same time, demands in terms of coherent and high-quality care for dementia clients are increasing, putting a stronger emphasis on demand driven, responsive care and service processes. Literature shows that case management in dementia care is beneficial for persons with dementia and caregivers, but costly. Using insights from operations management (OM), the purpose of this paper is to develop a new model for case management in dementia care.

To address both cost containment and customer orientation, insights from OM, in particular front/back office (FO/BO) configuration and modularity theory, are used to develop an innovative conceptual model for case management in dementia care.

This framework offers a new way of conceptualizing care provision throughout the different phases of a chronic disease process. Linking FO/BO configurations and modular organizing with case management makes it possible to create a cost-effective and client-centered system of healthcare management.

A new model is developed to address both cost containment and customer orientation based on insights from OM, in particular FO/BO configuration and modularity theory.

Competition in the care home sector for older people is encouraged as a means of increasing efficiency, driving down prices and raising quality. Choice is promoted to meet user expectations of healthcare and to improve service provision. The purpose of this study is to consider the evidence of care home provider competition and enhanced user choice through analysis of a discrete market area in the south of England. Data were collected from care home directories compiled by the National Care Standards Commission and the inspection reports on care homes. Longitudinal changes to the structure of the care home market are analysed from 1999‐2003. Choice is investigated with reference to fees paid and vacancy rates in homes. Results indicate that the Surrey market reflects national evidence. This exemplifies how immediate choice is only realistically available for those with a willingness and ability to pay higher fees.