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1 – 10 of over 1000Humans care about things. The truth of this claim is obvious, yet scholars who have evaluated student interventions and outcomes in higher education have largely neglected how…
Abstract
Humans care about things. The truth of this claim is obvious, yet scholars who have evaluated student interventions and outcomes in higher education have largely neglected how student values might inform their experience with those interventions and outcomes. This chapter will rely on a philosophical conceptualization of a particular type of value known as “caring” to explore what students value as they weigh various collegiate decisions. Elaborating on findings from a qualitative study of 143 college students from eight American universities, I will summarize previous findings related to what students cared about, how those cares were structured, and what the cares and structures meant for students' pathways through college. The categorical and theoretical patterns I share demonstrate how students approached values in ways that have not typically been considered by scholars or institutional administrators. After summarizing my previous findings, I offer a conceptual argument for a “dialectical” approach that considers the mutually formative interaction between student and institutional values. The practical result of naming and understanding the dialectic realities of values in higher education is the opportunity for institutions to use their relatively greater agency to help individual students pursue what is worth pursuing without reducing the agency of those students. Thus, the dialectic places necessary boundary lines on both the institution and the student while also clarifying the opportunity to help students develop moral expertise and navigate their collegiate pathways successfully.
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Value-based healthcare suggested using patient-reported information to complement the information available in the medical records and administrative healthcare data to provide…
Abstract
Purpose
Value-based healthcare suggested using patient-reported information to complement the information available in the medical records and administrative healthcare data to provide insights into patients' perceptions of satisfaction, experience and self-reported outcomes. However, little attention has been devoted to questions about factors fostering the use of patient-reported information to create value at the system level.
Design/methodology/approach
Action research design is carried out to elicit possible triggers using the case of patient-reported experience and outcome data for breast cancer women along their clinical pathway in the clinical breast network of Tuscany (Italy).
Findings
The case shows that communication and engagement of multi-stakeholder representation are needed for making information actionable in a multi-level, multispecialty care pathway organized in a clinical network; moreover, political and managerial support from higher level governance is a stimulus for legitimizing the use for quality improvement. At the organizational level, an external facilitator disclosing and discussing real-world uses of collected data is a trigger to link measures to action. Also, clinical champion(s) and clear goals are key success factors. Nonetheless, resource munificent and dedicated information support tools together with education and learning routines are enabling factors.
Originality/value
Current literature focuses on key factors that impact performance information use often considering unidimensional performance and internal sources of information. The use of patient/user-reported information is not yet well-studied especially in supporting quality improvement in multi-stakeholder governance. The work appears relevant for the implications it carries, especially for policymakers and public sector managers when confronting the gap in patient-reported measures for quality improvement.
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Armando Calabrese, Antonio D'Uffizi, Nathan Levialdi Ghiron, Luca Berloco, Elaheh Pourabbas and Nathan Proudlove
The primary objective of this paper is to show a systematic and methodological approach for the digitalization of critical clinical pathways (CPs) within the healthcare domain.
Abstract
Purpose
The primary objective of this paper is to show a systematic and methodological approach for the digitalization of critical clinical pathways (CPs) within the healthcare domain.
Design/methodology/approach
The methodology entails the integration of service design (SD) and action research (AR) methodologies, characterized by iterative phases that systematically alternate between action and reflective processes, fostering cycles of change and learning. Within this framework, stakeholders are engaged through semi-structured interviews, while the existing and envisioned processes are delineated and represented using BPMN 2.0. These methodological steps emphasize the development of an autonomous, patient-centric web application alongside the implementation of an adaptable and patient-oriented scheduling system. Also, business processes simulation is employed to measure key performance indicators of processes and test for potential improvements. This method is implemented in the context of the CP addressing transient loss of consciousness (TLOC), within a publicly funded hospital setting.
Findings
The methodology integrating SD and AR enables the detection of pivotal bottlenecks within diagnostic CPs and proposes optimal corrective measures to ensure uninterrupted patient care, all the while advancing the digitalization of diagnostic CP management. This study contributes to theoretical discussions by emphasizing the criticality of process optimization, the transformative potential of digitalization in healthcare and the paramount importance of user-centric design principles, and offers valuable insights into healthcare management implications.
Originality/value
The study’s relevance lies in its ability to enhance healthcare practices without necessitating disruptive and resource-intensive process overhauls. This pragmatic approach aligns with the imperative for healthcare organizations to improve their operations efficiently and cost-effectively, making the study’s findings relevant.
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The purpose of this research is to identify novel ways of tackling health inequalities of underserved populations. It explores the opportunities presented by the changes in health…
Abstract
Purpose
The purpose of this research is to identify novel ways of tackling health inequalities of underserved populations. It explores the opportunities presented by the changes in health and social care legislation to employ historically underused services, such as police custody healthcare providers, in addressing health inequalities.
Design/methodology/approach
This research analyses the policy approaches to tackling health inequalities in the UK in the past 40 years with an emphasis on those experienced by the people detained in English police custodies. It analyses the current model of healthcare in police custody and proposes a novel integrated model of care and joint commissioning opportunities in funding it.
Findings
Policies to tackle health inequalities have largely failed, as they became entrenched. But recent changes in the health and social care legislation in England offer opportunities to address them by employing historically underused healthcare services, such as those operating in police custodies.
Research limitations/implications
The research does not touch upon ethical considerations related to the patient privacy aspect of integrated care. Interventions by and interactions with police custody healthcare providers would be visible to all professionals with access to the patient’s health record. As with all novel interventions or innovative models of care, the effectiveness of such clinical interventions remains to be established by further research. It opens a new line of research on quality improvement through integration of care and explores understudied aspects of joint commissioning of integrated care.
Practical implications
It offers health commissioners and public health leaders the opportunity to employ police custody healthcare services in reaching their population health management objectives and meeting their health inequalities objectives at local level. It also gives police and crime commissioners the opportunity to address the health drivers of criminal behaviour that overlap with health inequalities. It offers funding opportunities presented by jointly commissioning services at lower costs to both police and health commissioners alike. It improves the health outcomes of historically underserved populations by facilitating access to health and social care services and facilities.
Social implications
Reducing health inequalities and disparities in health outcomes can decrease the costs of the healthcare services over the long term and might contribute to reducing criminality by addressing inequities and some health drivers of criminal behaviour.
Originality/value
The paper explores understudied opportunities offered by the recent changes in health and social care legislation in England and includes underused resources to tackle health inequalities.
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Nijs Bouman and Lianne Simonse
Engaging with customers and addressing unmet value have become increasingly challenging within multi-stakeholder environments of service innovation. Therefore, this paper aims to…
Abstract
Purpose
Engaging with customers and addressing unmet value have become increasingly challenging within multi-stakeholder environments of service innovation. Therefore, this paper aims to address this challenge by studying how strategic design abilities address unmet value in service engagement strategies.
Design/methodology/approach
The authors conducted a qualitative inductive study at a multinational corporation and interviewed marketing and design professionals on their innovation practices in service engagement strategies.
Findings
From the inductive analysis, this study identified three strategic design abilities that effectively contribute to addressing unmet value throughout the co-evolving process of service engagement: envisioning value, modelling value and engaging value. Based on this, this study proposes the emerging co-evolving loop framework of service engagement strategies.
Research limitations/implications
The limitation of this emerging theory is a lack of broad generalizability with mutual exclusivity or collective exhaustiveness across industries. A theoretical implication of the framework is the integration of strategic design and services marketing towards co-created engagement strategies.
Practical implications
The service engagement loop framework can be of great value to service innovation processes, for which an integrated, cross-functional approach is often missing.
Social implications
The findings further suggest that next to a methodological skillset, strategic design abilities consist of a distinct mindset.
Originality/value
This paper introduces strategic design abilities to address unmet value and proposes a novel co-evolving loop framework of service engagement strategies.
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Meryem Zoghlami and Kaouther Saied Ben Rached
This paper aims to examine the health technology use in health information seeking, communication and personal health information management, as well as in the effects they may…
Abstract
Purpose
This paper aims to examine the health technology use in health information seeking, communication and personal health information management, as well as in the effects they may have on his relationship with the physician and on the consumption of medical resources.
Design/methodology/approach
An online survey was conducted. The questionnaires were distributed via online health discussion forums using Google's survey software with a summary presentation of the study’s objective. The final selection of 362 individuals was made using social media, direct email and collaboration with community groups. The empirical validation of the causal model was conducted using the partial least square approach.
Findings
The results show that the use of e-health strengthens the quality of the patient–physician relationship and patient empowerment while increasing the consumption of medical resources.
Originality/value
The results of this research indicate that the internet has transformed the relationship of patients to health, to their doctors and to the health-care system. In this new context, a reconsideration of the status of the patient must be considered by health service providers.
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Karen Humphries, Caroline Clarke, Kate Willoughby and Jake Smithson
The purpose of this paper is to develop an understanding of the experience of secure care from the patients’ perspective.
Abstract
Purpose
The purpose of this paper is to develop an understanding of the experience of secure care from the patients’ perspective.
Design/methodology/approach
A systematic review of qualitative literature was conducted. The data was sourced from the electronic databases: PsychINFO, CINAHL, Medline and the Web of Science Core Collection using pre-defined search terms. A total of 17 studies, conducted in various countries worldwide and covering high, medium and low secure inpatient settings, were included for review. The analysis involved integrating findings from across the literature and was guided by thematic synthesis.
Findings
A total of eight themes were generated from the data, three of which provided an understanding of the experience of forensic secure care, and the remaining five themes provided an understanding of the factors which may influence the experience of secure care.
Practical implications
Developing understanding of patient experience can lead to service improvements, potentially impacting patients’ motivation and engagement and thus reducing admission times, potential recalls and recidivism.
Originality/value
To the best of the authors’ knowledge, this is the first systematic review to date to exclusively explore the broad topic of the patient experience of secure mental health care.
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Henriikka Anne-Mari Seittu, Anneli Hujala and Minna Kaarakainen
Integrated care (IC) is mainly studied from the perspectives of organisations or employees. However, less research is focussed on how patients themselves experience person-centred…
Abstract
Purpose
Integrated care (IC) is mainly studied from the perspectives of organisations or employees. However, less research is focussed on how patients themselves experience person-centred (PC) IC in practice. This context-specific, small-scale study examines what PC-IC means to older patients who went through joint replacement surgery (JRS).
Design/methodology/approach
The data consists of ten in-depth interviews of older patients, focussing on their experiences of care during their patient journey related to joint knee or hip replacement surgery. The data were analysed with thematic analysis.
Findings
Three central dimensions of PC-IC for older patients were identified: information sharing, continuity of care and compassionate encountering. Human validation and compassionate encountering were experienced as important aspects of PC-IC. Compassionate encountering was concretised through professionals’ very small everyday practices, which made the patient feel comfortable and respected. Instead, probably due to the medical and quite straight-forward nature of the joint replacement care process, patients seem to be pleased to trust the expertise of professionals and did not necessarily expect an active role or participation in the decision-making.
Originality/value
This Finnish case study focusses on the patients’ authentic perceptions of what is central to person-centred IC in the specific context of JRS.
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Anya Ahmed, Lorna Chesterton and Matthew J. Ford
The purpose of this paper is twofold: to explore the existing evidence around dementia services and interrogate the overarching UK policy development relating to service inclusion…
Abstract
Purpose
The purpose of this paper is twofold: to explore the existing evidence around dementia services and interrogate the overarching UK policy development relating to service inclusion of black and minoritised groups. The paper will go on to identify the implications for the dementia wellness pathway and make recommendations regarding how services can be more inclusive.
Design/methodology/approach
This paper examines the policy/practice landscape around dementia care provision and observes if lessons can be learnt to improve health outcomes for people living with dementia from black and minoritised communities.
Findings
A review of dementia policy demonstrates how opportunities to improve the awareness, diagnosis and post-diagnostic support for minoritised communities are being missed. The outcomes of this mean that individuals are denied vital treatment and support, which could enhance quality of life and delay the progression of dementia.
Practical implications
The authors’ premise is that not meeting the dementia support needs of less-heard communities has negative financial as well as social and health-related outcomes and has wider resonance and implications for all stages of the dementia wellness pathway. Moreover, there is a legal responsibility for public services to provide culturally sensitive, responsive, appropriate and available care, to all people, without discrimination.
Originality/value
This paper offers a valuable review of policy and practice around dementia care in the UK and makes recommendations to improve health outcomes for people living with dementia from black and minoritised communities.
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Angelo Rosa, Teresa Angela Trunfio, Giuliano Marolla, Antonietta Costantino, Davide Nardella and Olivia McDermott
Cardiovascular diseases are the leading cause of death worldwide. In Italy, acute myocardial infarction (AMI) is a major cause of hospitalization and healthcare costs. AMI is a…
Abstract
Purpose
Cardiovascular diseases are the leading cause of death worldwide. In Italy, acute myocardial infarction (AMI) is a major cause of hospitalization and healthcare costs. AMI is a myocardial necrosis event caused by an unstable ischemic syndrome. The Italian government has defined an indicator called “AMI: 30-day mortality” to assess the quality of the overall care pathway of the heart attacked patient. In order to guarantee high standards, all hospitals had to implement techniques to increase the quality of care pathway. The aim of the paper is to identify the root cause and understand the mortality rate for AMI and redesign the patient management process in order to improve it.
Design/methodology/approach
A Lean Six Sigma (LSS) approach was used in this study to analyze the patient flow in order to reduce 30-days mortality rate from AMI registered by Complex Operative Unit (COU) of Cardiology of an Italian hospital. Value stream mapping (VSM) and Ishikawa diagrams were implemented as tools of analysis.
Findings
Process improvement using LSS methodology made it possible to reduce the overall times from 115 minutes to 75 minutes, with a reduction of 35%. In addition, the corrective actions such as the activation of a post-discharge outpatient clinic and telephone contacts allowed the 30-day mortality rate to be lowered from 16% before the project to 8% after the project. In this way, the limit value set by the Italian government was reached.
Research limitations/implications
The limitation of the study is that it is single-centered and was applied to a facility with a limited number of cases.
Practical implications
The LSS approach has brought significant benefits to the process of managing patients with AMI. Corrective actions such as the activation of an effective shared protocol or telephone interview with checklist can become the gold standard in reducing mortality. The limitation of the study is that it is single-centered and was applied to a facility with a limited number of cases.
Originality/value
LSS, applied for the first time to the management of cardiovascular diseases in Italy, is a methodology which has proved to be strategic for the improvement of healthcare process. The simple solutions implemented could serve as a guide for other hospitals to pursue the national AMI mortality target.
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