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In order to decrease patient waiting time and improve efficiency, healthcare systems in some countries have recently begun to shift away from decentralized systems of patient referral from general practitioners (GPs) to specialists toward centralized ones. From a queueing theory perspective, centralized referral systems can decrease waiting time by reducing the variation in the referral process. However, from a social psychological perspective, a close relationship between referring physician and specialist, which is characteristic of decentralized referral systems, may safeguard against high referral rates; since GPs refer patients directly to the specialists whom they know, they may be reluctant to damage that relationship with an inappropriate referral. The purpose of this paper is to examine the effect upon referral behavior of a relationship between physicians, as is found in a decentralized referral system, vs a centralized referral system, which is characterized by an anonymous GP-specialist relationship. In a controlled experiment where family practice residents made decisions concerning referral to specialists, physicians displaying high confidence referred significantly fewer patients in a close relationship condition than in a centralized referral system, suggesting that for some physicians, referral behavior can be affected by the design of the service system and will, in turn, affect system performance.

The authors used a controlled experiment to test the research hypotheses.

Physicians displaying high confidence referred significantly fewer patients in a close relationship condition than in a centralized referral system, suggesting that for some physicians, referral behavior can be affected by system attributes and will, in turn, affect system performance.

The current study has some limitations, however. First, the sample consisted only of family practice residents and did not have the knowledge and experience of GPs regarding the referral process. Second, the authors used hypothetical patient case descriptions instead of real-world patients. Repeating this experiment with primary care physicians in real setting would be beneficial.

The study indicates that decentralized referral systems may act (rightly or wrongly) as a restraint on the rate of referrals to specialists. Thus, an implementation of a centralized referral system should be expected to produce an increase in referrals simply due to the change in the operational system setup. Even if centralized referral systems are more efficient and can facilitate the referral process by creating a central queue rather than multiple single queues for patients, the removal of social ties such as long-term social relationships that are developed between GPs and specialists in decentralized referral systems may act to counterbalance these theoretical gains.

This study provide support for the idea that non-clinical factors play an important role in referrals to specialists and hence in the quality of provided care, as was suggested by previous studies in this area (Hajjaj et al., 2010; Reid et al., 1999). The design of the service system may inadvertently influence some doctors to refer too many patients to specialists when there is no need for a specialist visit. In high-utilization health systems, this may cause some patients to be delayed (or even denied) in obtaining specialist access. Healthcare systems may be able to implement behavioral-based techniques in order to mitigate the negative consequences of a shift to centralized referral systems. One approach would be to try to create a feeling of close relationship among doctors in centralized referral systems. High communication and frequent interaction among GPs and specialists can boost the feelings of teamwork and personal efficacy through social comparison (Schunk, 1989, 1991) and vicarious learning (Zimmerman, 2000), which can in turn motivate GPs to take control of the patient care process when appropriate, instead of referring patients to specialists.

The authors’ study is the first examining the effect of social relationships between GPs and specialists on the referral patterns. Considering the significant implications of referral decisions on patients, doctors, and the healthcare systems, the study can shed light into a better understanding of the social and behavioral aspects of the referral process.

The purpose of this paper is to present a case study of a healthcare service redesign. In 2005, sleep disorder diagnostic assessments for patients in the Province of Manitoba were conducted at two independent sites. Referrals had accumulated, creating a waiting list of over 3,400 patients while only 1,200 patients were studied annually. Wait times for diagnosis and treatment increased dramatically. No managed patient database existed, nor were there standards to measure the effectiveness of the services.

A systems analysis approach was used which including population demand analysis, value stream mapping and refining the clinical service objectives. The current and desired state of the system was defined and a gap analysis became the foundation of a change management plan.

A system redesign resulted in tripling the throughput with a 35 per cent increase in operating budget, evaluation metrics, elimination of diagnostic handling and treatment start delays, and an increase in treatment rates for positively diagnosed patients from 55 to 70 per cent.

This paper provides an example of how healthcare services can be envisioned using a systems analysis approach.

This article draws upon our perspective as academic-practitioners working in the fields of food insecurity, food systems, and inequality to comment, in the early stages of the pandemic and associated lockdown, on the empirical and ethical implications of COVID-19 for socio-economic inequalities in access to food in the UK. The COVID-19 pandemic has sharpened the profound insecurity of large segments of the UK population, an insecurity itself the product of a decade of “austerity” policies. Increased unemployment, reduced hours, and enforced self-isolation for multiple vulnerable groups is likely to lead to an increase in UK food insecurity, exacerbating diet-related health inequalities. The social and economic crisis associated with the pandemic has exposed the fragility of the system of food charity which, at present, is a key response to growing poverty. A vulnerable food system, with just-in-time supply chains, has been challenged by stockpiling. Resultant food supply issues at food banks, alongside rapidly increasing demand and reduced volunteer numbers, has undermined many food charities, especially independent food banks. In the light of this analysis, we make a series of recommendations. We call for an immediate end to the five week wait for Universal Credit and cash grants for low income households. We ask central and local government to recognise that many food aid providers are already at capacity and unable to adopt additional responsibilities. The government's – significant – response to the economic crisis associated with COVID-19 has underscored a key principle: it is the government's responsibility to protect population health, to guarantee household incomes, and to safeguard the economy. Millions of households were in poverty before the pandemic, and millions more will be so unless the government continues to protect household incomes through policy change.

The purpose of this paper is to describe the background to Chinese libraries and the general development and new trends in document supply in China.

The service operation, copyright protection and management mechanisms of document supply in China are described. New challenges to it and the responses are also identified.

The role of document supply in China is recognized as important and is developing rapidly as economic constraints on purchasing increase.

The paper will be of interest to all document supply librarians interested in developments in China.

Hospital information systems have evolved from data processing systems for patient billing and payroll to decision‐support systems which support decision making at the middle and upper management levels. With the advancements in the areas of database management, expert systems and networks, important hospital functions such as physician recruitment and referral which historically were performed using traditional procedures, are now performed using these computer‐based technologies. Develops a generalizable framework for information systems for physician recruitment and referral using technologies of database management, expert systems and networks. This GIS‐PRR system may be used by hospitals and other health‐care providers to improve the efficiency and effectiveness of the physician recruitment/ referral process.

Developing digital reference services within a large library system requires managing fundamental organizational issues before applying technological strategies. Using the development of library services for distance learners as a catalyst, the University of Minnesota‐Twin Cities Libraries have implemented an organizational model for providing digital reference services to all students, faculty and staff who access the library remotely. The resulting service, InfoPoint, has the dual role of providing reference service and making referrals to over 30 information service units in the library system. Details the planning and implementation process by which the libraries developed this centrally coordinated digital reference service within a historically decentralized environment. Initial conclusions based on the service’s first two years of operation are presented. In conclusion discusses organizational change issues and the value of digital reference services in the digital library.

In providing specialized care for older individuals the skills of many disciplines are often needed to provide the most effective care. At the time of referral, it is not always clear which patients are best served by a medical approach and which ones require psychiatric input. When patients are referred to the less appropriate service, diagnosis and treatment may be delayed to the detriment of the patient. A wide spectrum of specialized services for the elderly is offered at the Hamilton Health Sciences Corporation, a four‐site teaching hospital in Ontario. The authors describe the development of a common intake process which provides rapid triage to the most appropriate services, and facilitates a combined medical and psychiatric approach where indicated. The end result is a single entry point for referrals, more efficient triage and a net reduction in the number of staff needed to accept and process referrals.

The purpose of this paper is to examine the impact of affiliate marketing strategies as a tool for increasing customers' engagement and vulnerability over financial services. This is attempted by examining the connection between affiliate marketing factors and customers' brand engagement and vulnerability metrics.

The authors developed a three-staged methodological context, based on the 7 most known centralized payment network (CPN) firms' website analytical data, which begins with linear regression analysis, followed by hybrid modeling (agent-based and dynamic models), so as to simulate brand engagement and vulnerability factors' variation in a 180-day period. The deployed context ends by applying the cognitive modeling method of producing heatmaps and facial analysis of CPN websites to the selected 47 vulnerable website customers, for gathering more insights into their brand engagement.

Throughout the simulation results of the study, it becomes clear that a higher number of backlinks and referral domains tend to increase CPN firms' brand-engaged and vulnerable customers.

From the simulation modeling process, the implication for backlinks and referral domains as factors that enhance website customers' brand engagement and vulnerability has been highlighted. A higher number of brand-engaged website customers could mean that vulnerable categories of customers would be impacted by CPNs' affiliate marketing. Improving those customers' knowledge of the financial services utility is of utmost importance.

The outcomes of the research indicate that online banking service providers can increase their customers' engagement with their brands by adopting affiliate marketing techniques. To avoid the increase in customers' vulnerability, marketers should aim to apply affiliate marketing strategies to domains relevant to the provided financial services.

The paper's outcomes provide a new approach to the literature, where the website customer's brand engagement comes out as a valuable metric for estimating online banking sector customers' vulnerability.

The substance abuse treatment system is currently confronted with not only more clients but also clients with a complex array of health and human service needs. Existing systems often lack both resources and the institutional structure needed to manage clients with multiple and often chronic needs. Presented in this chapter is a review of a federally funded demonstration project designed to address these client management requirements in the treatment system. The project, Target Cities, focused a variety of interventions designed to improve access to assessments and treatment, client-treatment matching procedures, linkages and referrals to other health and human service providers, and client tracking. Discussed are the history, rationale, implementation, and findings produced by these system changes in one main metropolitan area. The results indicated that centralized intake improved access to treatment while maintaining client satisfaction with the intake process.

The referral system or inter‐personal network is the single most important practice development tool available for surveyors and as such it warrants very close study. Its use should be deliberate, not fortuitous or reactive. The steps to be taken by each practice are simple and represent no more than an ordered methodology which avoids the mistakes of omission and commission.