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1 – 10 of over 121000Iris 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 of…
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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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 relationship…
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.
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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. The focus…
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.
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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 satisfaction…
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.
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…
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.
Arianna Maever Loreche, Veincent Christian F. Pepito and Manuel M. Dayrit
This review aimed to identify and map published studies on self-care practices to manage common acute health conditions in the Philippines.
Abstract
Purpose
This review aimed to identify and map published studies on self-care practices to manage common acute health conditions in the Philippines.
Design/methodology/approach
The authors conducted a scoping review in PubMed, Scopus, Cumulative Index of Nursing and Allied Health Literature (CINAHL), ProQuest Central, Journal Storage (JSTOR) and the Philippine Council for Health Research and Development – Health Research and Development Information Network (HERDIN). The authors included all studies on self-care practices to manage common acute conditions, namely low back pain, allergic rhinitis, general acute pain, cough, cold, diarrhea, constipation and stress, published up to 2021 in the Philippines. Information on the article type, aim of the study, study design and setting, population characteristics and size, and self-practices employed for the conditions were extracted and synthesized.
Findings
The authors identified various self-care practices for acute conditions among the general population and indigenous peoples in the Philippines from 26 studies included in the review: the use of medicines with and without a prescription, appropriate and inappropriate antibiotic use, use of medicinal plants and other traditional and alternative therapies and products, recreational activities and healthy habits and behaviors, and self-management or seeking care from traditional healers (albularyo or manggagamot) or health professionals. A number of considerations influenced their decision on how to manage symptoms, including perceived severity of the condition, availability and perceived effectiveness of treatment, cost, and advice from trusted sources of health information.
Research limitations/implications
The authors searched five major databases and a local research database, but some studies may still have been missed in the review. The review also excluded intervention studies on the outcomes of self-care, which limits the authors' ability to make conclusions on the effectiveness of the different modalities of self-care.
Social implications
Filipinos engage in a variety of “safe” (or evidence-informed) and “unsafe” (or harmful) self-care practices. While the term “self-care” is not routinely used by the general population and health providers, it is widely enculturated and practiced in the Philippines. Self-care benefits individuals and the health system, but there are also practices that increase risk of adverse outcomes and death including inappropriate antibiotic use, prescription sharing and reuse, and delays in seeking adequate treatment from a health professional. To leverage on self-care in advancing Universal Health Coverage (UHC) goals, the authors recommend a national strategy that provides guidance on how to practice responsible self-care, further research on the effectiveness and safety of alternative medicine and other priority areas, and better integration of self-care in the formal education and health systems. The authors also propose that the research agenda on self-care include acute health conditions, given their impact and burden on health and the economy.
Originality/value
This is the first published review of self-care practices for managing common acute health conditions, which captured practices of various groups and populations including indigenous peoples.
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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.
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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 bulk…
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.
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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 within…
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.
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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 expose…
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.
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