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Book part
Publication date: 22 July 2021

Iris Wallenburg, Anne Essén and Roland Bal

Performance metrics have become widely used and much lamented – about tools for measuring healthcare quality. In this paper, the authors reflect on the development and use…

Abstract

Performance metrics have become widely used and much lamented – about tools for measuring healthcare quality. In this paper, the authors reflect on the development and use of performance metrics in healthcare regulation and clinical practice. Studying multi-actor settings of performance measurement systems in healthcare in Sweden and the Netherlands, the authors show how regulatory agencies (i.e., the inspectorate and national registries), patients, hospitals, and practitioners engage in the constitution of healthcare practices through developing performance indicators that form the input for ranking, ensuing intensive dialogues on what should be measured and accounted for, and to what effects. The authors analyze this process as caring for numbers. The authors discern two practices of caring for numbers: validating and contexting. Validating refers to the practices of making numbers reflect those practices they intend to depict; contexting is about how with the use of numbers specific contexts of healthcare are built. These processes together emphasize the performative character of numbers as well as the reflexive uses of performativity. The paper shows how collaborative and rather pragmatic practices of caring for numbers co-construct specific practices of healthcare. Though this reflexive entanglement of production and use of numbers actors not only constitute specific performance metrics and ranking practices but also perform healthcare.

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Article
Publication date: 12 November 2020

Beata Segercrantz, Annamari Tuori and Charlotta Niemistö

Drawing on a performative ontology, this article extends the literature on health promotion in organizations by exploring how health promotion is performed in care work…

Abstract

Purpose

Drawing on a performative ontology, this article extends the literature on health promotion in organizations by exploring how health promotion is performed in care work. The focus of the study is on health promotion in a context of illness and/or decline, which form the core of the studied organizational activities. The paper addresses the following question: how do care workers working in elderly care and mental health care organizations accomplish health promotion in the context of illness and/or decline?

Design/methodology/approach

The article develops a performative approach and analyses material-discursive practices in health promoting care work. The empirical material includes 36 semi-structured interviews with care workers, observations and organizational documents.

Findings

Two central material-discursive health promoting practices in care work are identified: confirming that celebrates service users as residents and the organizations as a home, and balancing at the limits of health promotion. The practices of balancing make the limitations of health promotion discernible and involve reconciling health promotion with that which does not neatly fit into it (illness, unachievable care aims, the institution and certain organizing). In sum, the study shows how health promotion can structure processes in care homes where illness and decline often are particularly palpable.

Originality/value

The paper explores health promotion in a context rarely explored in organization studies. Previous organization studies have to some extent explored health promotion and care work, but typically separately. Further, the few studies that have adopted a performative approach to material-discursive practices in the context of care work have typically primarily focused on IT. We extend previous organization studies literature by producing new insights: (1) from an important organizational context of health promotion and (2) of under-researched entanglements of human and non-human actors in care work providing a performative theory of reconciling organizational tensions.

Details

Qualitative Research in Organizations and Management: An International Journal, vol. 16 no. 1
Type: Research Article
ISSN: 1746-5648

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Article
Publication date: 14 September 2018

Rachel Trees and Dianne Marion Dean

This purpose of this study is to examine the fluidity of family life which continues to attract attention. This is increasingly significant for the intergenerational…

Abstract

Purpose

This purpose of this study is to examine the fluidity of family life which continues to attract attention. This is increasingly significant for the intergenerational relationship between adult children and their elderly parents. Using practice theory, the aims are to understand the role of food in elderly families and explore how family practices are maintained when elderly transition into care.

Design/methodology/approach

A phenomenological research approach was used as the authors sought to build an understanding of the social interactions between family and their lifeworld.

Findings

This study extends theory on the relationship between the elderly parent and their family and explores through practice theory how families performed their love, how altered routines and long standing rituals provided structure to the elderly relatives and how care practices were negotiated as the elderly relatives transitioned from independence to dependence and towards care. A theoretical framework is introduced that provides guidance for the transition stages and the areas for negotiation.

Research limitations/implications

This research has implications for food manufacturers and marketers, as the demand for healthy food for the elderly is made more widely available, healthy and easy to prepare. The limitations of the research are due to the sample located in East Yorkshire only.

Practical implications

This research has implications for brand managers of food manufacturers and supermarkets that need to create product lines that target this segment by producing healthy, convenience food.

Social implications

It is also important for health and social care policy as the authors seek to understand the role of food, family and community and how policy can be devised to provide stability in this transitional and uncertain lifestage.

Originality/value

This research extends the body of literature on food and the family by focussing on the elderly cared for and their family. The authors show how food can be construed as loving care, and using practice theory, a theoretical framework is developed that can explain the transitions and how the family negotiates the stages from independence to dependence.

Details

European Journal of Marketing, vol. 52 no. 12
Type: Research Article
ISSN: 0309-0566

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Book part
Publication date: 30 December 2004

Thomas T.H. Wan, Yen Ju Lin and Bill B.L. Wang

The relationships of physician practice characteristics, care management effectiveness, autonomy, and managed care involvement, and physicians’ practice and career…

Abstract

The relationships of physician practice characteristics, care management effectiveness, autonomy, and managed care involvement, and physicians’ practice and career satisfaction were investigated. A panel sample (N=660) of 6800 physicians was made up of eleven physicians randomly selected from each of the sixty communities. Three latent constructs include care management effectiveness, practice autonomy, and openness in private practice. Multilevel modeling was performed. A statistically insignificant association was found between the perceived effectiveness of care management and physician satisfaction, holding the practice characteristics and other perception factors constant. The study demonstrated direct effects of practice characteristics and care management effectiveness on the practice of gate-keeping functions and on earnings. Only two contextual variables, managed care penetration and median income in the study communities, were related to physicians’ practice.

Details

Chronic Care, Health Care Systems and Services Integration
Type: Book
ISBN: 978-1-84950-300-6

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Book part
Publication date: 12 December 2007

Greg A. Greenberg

In this chapter organizational theory is used to clarify and synthesize the large and diverse literature on the relationship between managed care (MC) and ethnic…

Abstract

In this chapter organizational theory is used to clarify and synthesize the large and diverse literature on the relationship between managed care (MC) and ethnic differences in access to health services. MC practices are classified by whether they are used by health care organizations to define their boundaries or to coordinate care. MC practices used to coordinate care are further categorized as one of five types: rules and programs, authority, goal setting, culture, or client coordination. This review also presents hypotheses derived from this literature that specify the predicted effects of MC practices on ethnic differences in access to health services. It was found that few of these hypotheses had been empirically investigated and although some evidence was found that MC boundary-setting practices disadvantage minorities, there were not consistent findings with respect to those practices used to coordinate care.

Details

Inequalities and Disparities in Health Care and Health: Concerns of Patients, Providers and Insurers
Type: Book
ISBN: 978-0-7623-1474-4

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Article
Publication date: 2 July 2020

Joshua Ray, John Pijanowski and Kara Lasater

The purpose of this study was to explore the well-being of school principals and the job-embedded demands responsible for challenging their adoption of healthy self-care practices.

Abstract

Purpose

The purpose of this study was to explore the well-being of school principals and the job-embedded demands responsible for challenging their adoption of healthy self-care practices.

Design/methodology/approach

Drawing upon a multidisciplinary theoretical framework that included contributions from the fields of neurobiology and psychology, three tiers of self-care needs were established to inform the study: basic physiological needs such as sleep, hydration, and nutrition; active self-care practices such as exercise, relaxation, and stress relief; and higher order needs such as belongingness and love addressed through work-life balance, volunteerism, and relational belonging. A 45-question survey containing Likert scale items and open-ended questions was returned from 473 practicing building administrators (a 24.4% response rate).

Findings

Findings from this study, compared to estimates from the literature, indicate that school leaders work longer hours, are more sleep deprived, more dehydrated, have poorer diet practices, exercise less regularly, and spend less time with their friends and family than the general population. Administrators struggled to find ways within their control to improve their self-care behavior and offered suggestions regarding how the structure of the job itself might be changed to facilitate improving the health of school leaders.

Originality/value

This work offers insight into the current well-being of school principals, and by better understanding administrators’ self-care practices, this study can inform the field in developing supports, practices, and expectations, which promote the health and well-being of building-level leaders. Unhealthy self-care practices may influence their effectiveness, happiness, and possibly their longevity within the profession. Data collected through this study informed ideas about policies and procedures that could promote greater opportunities for healthier, more effective leaders within schools.

Details

Journal of Educational Administration, vol. 58 no. 4
Type: Research Article
ISSN: 0957-8234

Keywords

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Article
Publication date: 28 September 2020

Rocco Agrifoglio, Paola Briganti, Luisa Varriale, Concetta Metallo and Maria Ferrara

Building upon the practice-based framework, this paper aims to focus on working practices for understanding how knowledge is transferred among health-care professionals…

Abstract

Purpose

Building upon the practice-based framework, this paper aims to focus on working practices for understanding how knowledge is transferred among health-care professionals within hospitals.

Design/methodology/approach

Using an ethnographic and interpretative approach, the authors conducted preliminary research based on a quali-quantitative methodology within one of the largest hospitals in Southern Italy.

Findings

This study allowed to achieve several results that could be significant and relevant within the health-care sector. First, this paper identified some of the main working practices and their associated activities in health care. Moreover, this paper identified the main organizational forms and/or tools enabling hospital personnel to share and learn the various types of knowledge for each of the prior identified practices.

Practical implications

Hospital managers should develop strategies and policies that take into account the nature and typology of knowledge-sharing processes among health-care professionals in terms of practices.

Originality/value

The paper contributes to practice-based studies identifying identified some of the main working practices, as well as the main tools for sharing and learning of the various types of knowledge.

Details

International Journal of Organizational Analysis, vol. 29 no. 4
Type: Research Article
ISSN: 1934-8835

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Article
Publication date: 1 December 2001

Waleed M. S. Al‐Shaqha and Mohamed Zairi

Institutional pharmaceutical services have widely evolved over the past 20‐30 years. Hospital pharmacy practice has changed from a profession concerned chiefly with the…

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Abstract

Institutional pharmaceutical services have widely evolved over the past 20‐30 years. Hospital pharmacy practice has changed from a profession concerned chiefly with the bulk preparation and distribution of drug products to one centred on ensuring optimal drug therapy. Whereas hospital pharmacists were charged with maintaining large drug stock on nursing units, many of them now provide individualised patient therapies. The practice of hospital pharmacy has therefore become one encompassing all aspects of drug therapy, from the procurement of drugs and drug delivery devices, their preparation and distribution, to their most appropriate selection and use for each patient. Hospital pharmacy services have traditionally had little involvement at the key stages in patients’ hospital care. This leads to the conclusion that the model of clinical pharmacy practice adopted by many pharmacy department hospitals is no longer appropriate for the demands of today’s health‐care services. Reviews many new models proposed for clinical pharmacy practice including an integrated model for providing a pharmaceutical care management approach in the health‐care system. This model is a response to the failures of traditional drug therapy. It is primarily an idea about how health professionals and patient should integrate their work to obtain outcomes important to patients and clinicians.

Details

International Journal of Health Care Quality Assurance, vol. 14 no. 7
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 28 August 2018

Jeannine Therese Moreau and Trudy Rudge

This paper examines how certain care values permeate, legitimize and authorize hospitalized-older-adults’ care, technologies and practices. The purpose of this paper is to…

Abstract

Purpose

This paper examines how certain care values permeate, legitimize and authorize hospitalized-older-adults’ care, technologies and practices. The purpose of this paper is to expose how values are not benign but operate discursively establishing “orders of worth” with significant effect on the ethics of the care-setting.

Design/methodology/approach

The paper draws from a discursive ethnography to see “up close” on a surgical unit how values influence nurse/older-adult-patient care occasions in the domain of older-adults and functional decline. Data are from participant observations, conversations, interviews, chart reviews and reviewed literature. Foucauldian discursive analytics rendered values recognizable and analyzable as discursive practices. Discourse is a social practice of knowledge production constituting and giving meaning to what it represents.

Findings

Analysis reveals how care values inhere discourses like measurement, efficiency, economics, risk and functional decline (loss of capacity for independent living) pervading care technologies and practices, subjugating older adults’ bodies to techniques, turning older persons into measurable objects of knowledge. These values determine social conditions of worth, objectifying, calculating, normalizing and homogenizing what it means to be old, ill and in hospital.

Originality/value

Seven older adult patients and attendant nurses were followed for their entire hospitalization. The ethnography renders visible how care values as discursive practices rationalize the social order and operations of everyday care. Analytic outcomes offer insights of how dominant care values enabled care technologies and practices to govern hospitalized-older-adults as a population to be ordered, managed and controlled, eliding possibilities of engaging humanistic patient-centered care.

Details

Journal of Organizational Ethnography, vol. 8 no. 3
Type: Research Article
ISSN: 2046-6749

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Article
Publication date: 1 November 2007

Di Bailey

This paper is the first of two linked articles that explores a shared learning approach to developing a module on collaborative working for graduate primary care mental…

Abstract

This paper is the first of two linked articles that explores a shared learning approach to developing a module on collaborative working for graduate primary care mental health workers (PCMHWs). The article describes how the policy context shaped the training agenda and how the requirements of the roles and responsibilities in respect of collaborative practice were mapped against the Ten Essential Capabilities of the mental health workforce. The process of constructive alignment (Biggs, 1999) that involves matching teaching and assessment methods to intended learning objectives was used alongside evidence from the research literature on systems working and interprofessional education to inform the design of the modular curriculum in more detail.The second paper will provide an in‐depth evaluation of the module as it was delivered using a framework derived from the academic literature (See Bailey & Littlechild, 2001 and Barr et al, 1999a; 1999b). Included in the evaluation will be a discussion of how the context of workforce change in primary care mental health influenced the training inputs together with a reflection on the training methodologies employed to promote collaborative practice. Different levels of evaluating the training will be discussed including the impact of the module on practice outcomes such as attitudes of the workers and changes in their practice. The lessons learned from the evaluation will be discussed in relation to the models of best practice emerging from the IPE literature and the challenges of implementing a new workforce strategy in primary care mental health.

Details

The Journal of Mental Health Training, Education and Practice, vol. 2 no. 3
Type: Research Article
ISSN: 1755-6228

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