Search results

1 – 10 of 791
Open Access
Article
Publication date: 9 December 2019

David Stewart Briggs, Richard Nankervis, John Baillie, Catherine Turner, Kevin Rigby and Lorin Livingstone

The purpose of this paper is to review the establishment of Primary Health Network (PHN) in Australia and its utility in commissioning Primary Health Care (PHC) services.

1612

Abstract

Purpose

The purpose of this paper is to review the establishment of Primary Health Network (PHN) in Australia and its utility in commissioning Primary Health Care (PHC) services.

Design/methodology/approach

This study is an analysis of management practice about the establishment and development of a PHN as a case study over the three-year period. The PHN is the Hunter New England and Central Coast PHN (HNECCPHN). The study is based on “insiders perspectives” drawing from documentation, reports and evaluations undertaken.

Findings

HNECCPHN demonstrates a unique inclusive organisation across a substantial diverse geographic area. It has taken an innovative and evidence-based approach to its creation, governance and operation. HNECCPHN addresses the health challenges of a substantial Aboriginal and/or Torres Strait Islander population. It contains significant and diverse urban, coastal and distinct rural, regional and remote populations. It can be described as a “virtual” organisation, using a distributed network of practice approach to engage clinicians, communities and providers. The authors describe progress and learning in the context of theories of complex organisations, innovation, networks of practice, knowledge translation and social innovation.

Research limitations/implications

The study provides initial publication into the establishment phase of a PHN in Australia.

Practical implications

The study describes the implementation and progress in terms of relevant international practice and theoretical concepts. This paper demonstrates significant innovative practice in the short term.

Social implications

The study describes significant engagement and the importance of that with and between communities, service providers and health professionals.

Originality/value

This is the first study of the results of the implementation of an important change in the funding and delivery of PHC in Australia.

Details

Public Administration and Policy, vol. 22 no. 2
Type: Research Article
ISSN: 1727-2645

Keywords

Open Access
Article
Publication date: 15 December 2021

Muhammad Yusuf Shaharudin, Zulkhairi Mohamad and Asmah Husaini

The wake of the novel coronavirus (COVID-19) pandemic had caused substantial disruptions to the usual delivery of healthcare services. This is because of restrictive orders that…

Abstract

The wake of the novel coronavirus (COVID-19) pandemic had caused substantial disruptions to the usual delivery of healthcare services. This is because of restrictive orders that were put in place to curb the spread of the infection. Palliative care services in Brunei also face challenges to deliver effective services during this period. However, the impact of advanced illnesses on patients' health and end-of-life care are issues that cannot be planned, postponed or cancelled. Hence, the palliative care team needs to continue to deliver effective palliative care services. As Brunei faced its second pandemic wave in August 2021, crucial adaptations were made to ensure palliative care service was not disrupted. This reflective case study aims to discuss the adaptations made in providing palliative care during this era of disruptions.

Details

Southeast Asia: A Multidisciplinary Journal, vol. 21 no. 2
Type: Research Article
ISSN: 1819-5091

Keywords

Open Access
Article
Publication date: 25 January 2010

Costa Vakalopoulos

Although first rank symptoms focus on positive symptoms of psychosis they are shared by a number of psychiatric conditions. The difficulty in differentiating bipolar disorder from…

Abstract

Although first rank symptoms focus on positive symptoms of psychosis they are shared by a number of psychiatric conditions. The difficulty in differentiating bipolar disorder from schizophrenia with affective features has led to a third category of patients often loosely labeled as schizoaffective. Research in schizophrenia has attempted to render the presence or absence of negative symptoms and their relation to etiology and prognosis more explicit. A dichotomous population is a recurring theme in experimental paradigms. Thus, schizophrenia is defined as process or reactive, deficit or non-deficit and by the presence or absence of affective symptoms. Laboratory tests confirm the clinical impression showing conflicting responses to dexamethasone suppression and clearly defined differences in autonomic responsiveness, but their patho-physiological significance eludes mainstream theory. Added to this is the difficulty in agreeing to what exactly constitutes useful clinical features differentiating, for example, negative symptoms of a true deficit syndrome from features of depression. Two recent papers proposed that the general and specific cognitive features of schizophrenia and major depression result from a monoamine-cholinergic imbalance, the former due to a relative muscarinic receptor hypofunction and the latter, in contrast, to a muscarinic hypersensitivity exacerbated by monoamine depletion. Further development of these ideas will provide pharmacological principles for what is currently an incomplete and largely, descriptive nosology of psychosis. It will propose a dimensional view of affective and negative symptoms based on relative muscarinic integrity and is supported by several exciting intracellular signaling and gene expression studies. Bipolar disorder manifests both muscarinic and dopaminergic hypersensitivity. The greater the imbalance between these two receptor signaling systems, the more the clinical picture will resemble schizophrenia with bizarre, incongruent delusions and increasingly disorganized thought. The capacity for affective expression, by definition a non-deficit syndrome, will remain contingent on the degree of preservation of muscarinic signaling, which itself may be unstable and vary between trait and state examinations. At the extreme end of muscarinic impairment, a deficit schizophrenia subpopulation is proposed with a primary and fixed muscarinic receptor hypofunction.

The genomic profile of bipolar disorder and schizophrenia overlap and both have a common dopaminergic intracellular signaling which is hypersensitive to various stressors. It is proposed that the concomitant muscarinic receptor upregulation differentiates the syndromes, being marked in bipolar disorder and rather less so in schizophrenia. From a behavioral point of view non-deficit syndromes and bipolar disorder appear most proximate and could be reclassified as a spectrum of affective psychosis or schizoaffective disorders. Because of a profound malfunction of the muscarinic receptor, the deficit subgroup cannot express a comparable stress response. None -theless, a convergent principle of psychotic features across psychiatric disorders is a relative monoaminergic-muscarinic imbalance in signal transduction.

Details

Mental Illness, vol. 2 no. 1
Type: Research Article
ISSN: 2036-7465

Keywords

Open Access
Article
Publication date: 18 December 2020

Maureen Alice Flynn and Niamh M. Brennan

While clinical governance is assumed to be part of organisational structures and policies, implementation of clinical governance in practice (the praxis) can be markedly…

8055

Abstract

Purpose

While clinical governance is assumed to be part of organisational structures and policies, implementation of clinical governance in practice (the praxis) can be markedly different. This paper draws on insights from hospital clinicians, managers and governors on how they interpret the term “clinical governance”. The influence of best-practice and roles and responsibilities on their interpretations is considered.

Design/methodology/approach

The research is based on 40 in-depth, semi-structured interviews with hospital clinicians, managers and governors from two large academic hospitals in Ireland. The analytical lens for the research is practice theory. Interview transcripts are analysed for practitioners' spoken keywords/terms to explore how practitioners interpret the term “clinical governance”. The practice of clinical governance is mapped to front line, management and governance roles and responsibilities.

Findings

The research finds that interpretation of clinical governance in praxis is quite different from best-practice definitions. Practitioner roles and responsibilities held influence practitioners' interpretation.

Originality/value

The research examines interpretations of clinical governance in praxis by clinicians, managers and governors and highlights the adverse consequence of the absence of clear mapping of roles and responsibilities to clinical, management and governance practice.

Details

Journal of Health Organization and Management, vol. 35 no. 9
Type: Research Article
ISSN: 1477-7266

Keywords

Open Access
Article
Publication date: 15 January 2021

Fiorella Pia Salvatore, Simone Fanelli, Chiara Carolina Donelli and Michele Milone

This study aims to analyze the value-based health-care model in defining a strategy to guide the evolution of health-care organizations toward a value-oriented model. To improve…

3539

Abstract

Purpose

This study aims to analyze the value-based health-care model in defining a strategy to guide the evolution of health-care organizations toward a value-oriented model. To improve the quality of care by ensuring economic sustainability, it is necessary to redefine the concept of competition in healthcare and align it with the concept of maximizing value for patients.

Design/methodology/approach

Performance measurement is a crucial aspect of the analysis of health-care organizations. Porter developed an effective analytical technique and presented the measurement of health-care outcomes based on health conditions, the efficiency of health-care organizations and the type of service provided.

Findings

Clinical outcomes and data on the costs of care of each patient are essential to evaluate improvement in treatment value over time. Engaging in the evaluation of what happens to patients in their course of care enables the expansion of the measurement of outcomes because it measures all the health services related to it.

Originality/value

Building a health-care system based on the value and continuous improvement of care and services provided is a goal shared by many countries and international organizations. Today, the analysis of outcomes is important for making informed decisions, directing and planning clinical and organizational changes by improving the quality of care and services.

Details

International Journal of Organizational Analysis, vol. 29 no. 6
Type: Research Article
ISSN: 1934-8835

Keywords

Open Access
Article
Publication date: 22 November 2018

Peter Littlejohns, Katharina Kieslich, Albert Weale, Emma Tumilty, Georgina Richardson, Tim Stokes, Robin Gauld and Paul Scuffham

In order to create sustainable health systems, many countries are introducing ways to prioritise health services underpinned by a process of health technology assessment. While…

4279

Abstract

Purpose

In order to create sustainable health systems, many countries are introducing ways to prioritise health services underpinned by a process of health technology assessment. While this approach requires technical judgements of clinical effectiveness and cost effectiveness, these are embedded in a wider set of social (societal) value judgements, including fairness, responsiveness to need, non-discrimination and obligations of accountability and transparency. Implementing controversial decisions faces legal, political and public challenge. To help generate acceptance for the need for health prioritisation and the resulting decisions, the purpose of this paper is to develop a novel way of encouraging key stakeholders, especially patients and the public, to become involved in the prioritisation process.

Design/methodology/approach

Through a multidisciplinary collaboration involving a series of international workshops, ethical and political theory (including accountability for reasonableness) have been applied to develop a practical way forward through the creation of a values framework. The authors have tested this framework in England and in New Zealand using a mixed-methods approach.

Findings

A social values framework that consists of content and process values has been developed and converted into an online decision-making audit tool.

Research limitations/implications

The authors have developed an easy to use method to help stakeholders (including the public) to understand the need for prioritisation of health services and to encourage their involvement. It provides a pragmatic way of harmonising different perspectives aimed at maximising health experience.

Practical implications

All health care systems are facing increasing demands within finite resources. Although many countries are introducing ways to prioritise health services, the decisions often face legal, political, commercial and ethical challenge. The research will help health systems to respond to these challenges.

Social implications

This study helps in increasing public involvement in complex health challenges.

Originality/value

No other groups have used this combination of approaches to address this issue.

Details

Journal of Health Organization and Management, vol. 33 no. 1
Type: Research Article
ISSN: 1477-7266

Keywords

Open Access
Article
Publication date: 6 April 2020

Aoife De Brún and Eilish McAuliffe

Achieving integrated care is a key focus for health systems and has resulted in various structures between and within organisations. The reorganisation of the Irish health system…

3358

Abstract

Purpose

Achieving integrated care is a key focus for health systems and has resulted in various structures between and within organisations. The reorganisation of the Irish health system into hospital networks/groups aims to encourage work across hospitals to integrate care. This study evaluated if collective leadership emerged over time through increased interaction and collaboration following the organisation of hospitals into a network. A secondary aim was to elucidate the potential for collective leadership, through understanding the barriers and enablers perceived by participants.

Design/methodology/approach

This study employed social network analysis and qualitative interviews. Leaders across the hospital group were invited to participate in an online network survey and interviews (analysed using thematic analysis) at three time points over an 18-month period.

Findings

Although there was evidence that some parts of network were beginning to operate collectively, the structures observed were more typical of a hierarchical network. Disruption in the network and uncertainty regarding permanence of the organisational structure had a negative impact on the potential for collective leadership. Yet, progress was evident in terms of establishing building blocks for collective leadership and integration, including developing trust, mutual understanding and creating space for change.

Practical implications

This study contributes to the literature by reflecting on the mechanisms and initiatives perceived as enabling/inhibiting collective leadership. Based on this research, it is important to communicate a clear and consistent message about the plans for the organisations involved and be clear regarding the roles and expectations for those involved in introducing new approaches to leadership and integration. Honest collaboration, openness and certainty in communication will likely be important in order to help create the contextual conditions to enable collective and system approaches to introduce “stepping stones” to change. These conditions include developing interpersonal relationships between leaders, creating time and space for deep and shared reflection, and enhancing trust among colleagues.

Originality/value

A key strength of this study is the linking of leadership-as-networks theory with social network methods to investigate collective leadership in practice. This study contributes to the literature by reflecting on the mechanisms and initiatives perceived as enabling/inhibiting collective leadership.

Details

Journal of Health Organization and Management, vol. 34 no. 4
Type: Research Article
ISSN: 1477-7266

Keywords

Open Access
Article
Publication date: 20 November 2020

Emmanuel Arhin, Raymond Webrah Kazapoe and Fulera Salami

The purpose of this study was to define and outline areas prone to disease causing elements by analyzing the spatial distribution and concentration of toxic and essential elements…

Abstract

Purpose

The purpose of this study was to define and outline areas prone to disease causing elements by analyzing the spatial distribution and concentration of toxic and essential elements in a section of the Voltaian sedimentary basin.

Design/methodology/approach

A total of 2,668 soil samples were analysed by the inductively coupled plasma mass spectrometry technique and were re-appraised by comparing with baseline values of elements accepted globally to be in soils. The concentrations of arsenic (As), chromium (Cr), iron (Fe) and magnesium (Mg) were evaluated. Factor analysis, hierarchical cluster analysis and principal component analysis multivariate techniques were used to identify the source patterns of the elements in the soils. The Getis-Ord Gi method was used to generate the optimised maps for these selected elements. These maps spatially defined and outlined high value clusters which imply potential pollution or areas with high background values (hotspots), whereas the low value clusters imply areas with low background values (cold-spots).

Findings

The multivariate analysis supports a dominant geogenic source of these heavy elements with obvious influences from variably metamorphosed mafic–ultramafic rocks known to have contributed to the deposition of sediments in the basin. The hotspots for As were located around Nalerigu and to the east of Nawchugu. A Cr hotspot was located to the east of Nawchugu with Cr cold-spots located within Nalerigu and Yunyuo. Fe hotspots were observed to the south of Nalerigu and the east of Nawchugu with Fe cold-spots around Yunyuo, Bongo-Da and Nagbo. The spatial maps demonstrated the presence of toxic and deficient areas of all the selected elements used in the investigation. Therefore, it suggested the likely health implications depending on the exposed elements, their pathways and recommended the usefulness of using the results displayed in the spatial maps to guide in devising appropriate remediation techniques.

Originality/value

This paper fulfils an identified need to study the distribution of elements and the possible effects it may have on the health and livelihoods of those residing in these areas.

Details

Ecofeminism and Climate Change, vol. 2 no. 1
Type: Research Article
ISSN: 2633-4062

Keywords

Open Access
Article
Publication date: 9 May 2022

Kevin Wang and Peter Alexander Muennig

The study explores how Taiwan’s electronic health data systems can be used to build algorithms that reduce or eliminate medical errors and to advance precision medicine.

1630

Abstract

Purpose

The study explores how Taiwan’s electronic health data systems can be used to build algorithms that reduce or eliminate medical errors and to advance precision medicine.

Design/methodology/approach

This study is a narrative review of the literature.

Findings

The body of medical knowledge has grown far too large for human clinicians to parse. In theory, electronic health records could augment clinical decision-making with electronic clinical decision support systems (CDSSs). However, computer scientists and clinicians have made remarkably little progress in building CDSSs, because health data tend to be siloed across many different systems that are not interoperable and cannot be linked using common identifiers. As a result, medicine in the USA is often practiced inconsistently with poor adherence to the best preventive and clinical practices. Poor information technology infrastructure contributes to medical errors and waste, resulting in suboptimal care and tens of thousands of premature deaths every year. Taiwan’s national health system, in contrast, is underpinned by a coordinated system of electronic data systems but remains underutilized. In this paper, the authors present a theoretical path toward developing artificial intelligence (AI)-driven CDSS systems using Taiwan’s National Health Insurance Research Database. Such a system could in theory not only optimize care and prevent clinical errors but also empower patients to track their progress in achieving their personal health goals.

Originality/value

While research teams have previously built AI systems with limited applications, this study provides a framework for building global AI-based CDSS systems using one of the world’s few unified electronic health data systems.

Details

Applied Computing and Informatics, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 2634-1964

Keywords

Open Access
Article
Publication date: 4 December 2017

Peter O’Meara, Gary Wingrove and Michael Nolan

In North America, delegated practice “medical direction” models are often used as a proxy for clinical quality and safety in paramedic services. Other developed countries favor a…

13366

Abstract

Purpose

In North America, delegated practice “medical direction” models are often used as a proxy for clinical quality and safety in paramedic services. Other developed countries favor a combination of professional regulatory boards and clinical governance frameworks that feature paramedics taking lead clinician roles. The purpose of this paper is to bring together the evidence for medical direction and clinical governance in paramedic services through the prism of paramedic self-regulation.

Design/methodology/approach

This narrative synthesis critically examines the long-established North American Emergency Medical Services medical direction model and makes some comparisons with the UK inspired clinical governance approaches that are used to monitor and manage the quality and safety in several other Anglo-American paramedic services. The databases searched were CINAHL and Medline, with Google Scholar used to capture further publications.

Findings

Synthesis of the peer-reviewed literature found little high quality evidence supporting the effectiveness of medical direction. The literature on clinical governance within paramedic services described a systems approach with shared responsibility for quality and safety. Contemporary paramedic clinical leadership papers in developed countries focus on paramedic professionalization and the self-regulation of paramedics.

Originality/value

The lack of strong evidence supporting medical direction of the paramedic profession in developed countries challenges the North American model of paramedics practicing as a companion profession to medicine under delegated practice model. This model is inconsistent with the international vision of paramedicine as an autonomous, self-regulated health profession.

Details

International Journal of Health Governance, vol. 22 no. 4
Type: Research Article
ISSN: 2059-4631

Keywords

1 – 10 of 791