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The theme of this volume is reorganizing health care delivery systems: problems of managed care and other models of health care delivery. The volume contains 11 papers, organized into four sections. The sections cover, in order, managed care issues and organizational features, special groups of patients and health issues, lessons from other countries, and broader policy concerns and health insurance reform. Issues of how to best organize a health care delivery system are not new, but the amount of interest in this topic in the U.S. (as well as in other countries) has grown in recent decades. Reorganizing health care delivery systems is a concern of many of the systems of the world, and this volume contains some papers from countries other than the U.S., although the majority of the papers do relate issues to the U.S. health care delivery system. While the majority of the papers in this volume relate to structural and organizational factors, the impact of individual patients is not neglected. One section focuses very much on more specialized groups of patients, and several other papers use surveys of patients or other individual level data as part of their discussion of these issues. Before discussing the specific papers briefly, it is useful to review some material about the organization of the health care delivery system, especially within the U.S. This includes some discussion of how issues of organization of care and special forms of delivering care such as managed care have become major issues in the U.S. health care system at this point in time.

Bureaucracy to a large extent entrenches orderliness and productive means of achieving goals in both public and private organisations across the world. However, bureaucracy is not suitable in the management of hospitals due to its peculiar nature of operations. This study investigates the conundrum of bureaucratic processes and health-care service delivery in government hospitals in Nigeria.

The study surveyed 600 outpatients and attendees visiting tertiary and government hospitals in Nigeria using descriptive design to obtained data from the respondents. A research instrument, questionnaire, was used to gather data. Out of the 600 outpatients visiting the 20 hospitals in government and tertiary hospitals, 494 responses were returned from the attendees. The study employed random sampling strategy to collect the information.

The findings of this study were that service delivery in government hospitals were in adverse position on all the four constructs of bureaucratic dimensions as against quality of service delivery in hospitals in Nigeria. It discovered that bureaucratic impersonality cannot impact on the quality of service delivery in government hospitals in Nigeria. Separation and division of labour among health workers have no significant effect on quality service delivery in government hospitals. Formal rules and regulations (administrative procedure, rules, and policies) prevent quality service delivery in government hospitals in Nigeria. Also, patient’s waiting time was not significant to the quality of service delivery in government hospitals.

The results are constrained with dimensions of bureaucratic processes. Thus, the implication of this study is that bureaucracy in the Nigerian public hospitals is an unnecessary marriage which should be carefully separated and de-emphasised for quality service delivery in the hospitals to thrive.

Largely, this study is practical essential as it unearths the irrelevant operations procedure that hinder progress in Nigerian hospitals.

The study accomplishes recognised importance to survey how bureaucracy impedes quality service delivery in government hospitals. This study has provided a vital clue to elements that will bring rapid attention to patients’outcome in Nigerian hospitals and health-care facilities which hitherto has not been emphasised. The study has contributed to the existing body of knowledge associated to healthcare service quality in developing country.

High quality health-care delivery is not only the governments’ responsibility but also every prisoner’s right. Health care in prison and, particularly, of Iranian prisoners is increasingly important topic because of the rising number of the prison population. This paper aims to explore health-care managers’ perspectives and experiences of prisons and the barriers to health-care delivery in Iranian prisons.

A qualitative research design was conducted in Iran from October 2018 to August 2019. The participants consisted of 51 health-care managers (50 men and one woman) from Iranian prisons. A combination of face-to-face (N = 42) and telephonic (N = 9) semi-structured interviews were used because of the geographical distribution of the respondents. The first part of the interview guide consisted of demographic characteristics, and the second part consisted of three main open ended-questions. Interviews were recorded and transcribed, and thematic descriptive analysis was used to interpret the data.

The barriers to health-care delivery in Iranian prisons were categorized into four main topics: human resources, financing, facilities and barriers related to the health-care delivery process. Data synthesis identified the following themes for barriers to human resources: barriers to human resources planning (with eight sub-themes); barriers to education (with three sub-themes); and motivational barriers (with seven sub-themes). Moreover, barriers to financing consisted of five sub-themes. The barriers to facilities consisted of barriers related to physical infrastructures (with two sub-themes) and barriers related to equipment (with six sub-themes). Finally, barriers to the health-care delivery process included the following themes: communication barriers (with six sub-themes); legal barriers (with five sub-themes); and environmental-demographic factors (with seven sub-themes).

Identifying the barriers to health-care delivery in Iranian prisons plays a critical role in the improvement of planning, decision-making and the health-care delivery process.

Healthcare services in the USA have been described as being fragmented and uncoordinated. Integrated delivery systems are frequently promoted as being instrumental in efforts to improve the coordination of care and, thus, enhancing the quality of clinical care and patient services while ensuring optimum cost‐efficiencies. This study seeks to analyze and compare the performance of hospitals participating in highly integrated systems with non‐integrated hospitals based on outcome measures involving hospital performance.

The study compares the performance of 50 flagship hospitals participating in the most highly integrated delivery systems in the USA with a representative sample of non‐system hospitals utilizing one‐way analysis of variance. The comparative analysis was based on three key performance measures; clinical quality of medical care, patient satisfaction, and cost‐efficiency considerations.

The results of the review demonstrate that there is a statistically significant positive difference between the clinical quality performance of the highly integrated hospitals compared with the quality performance of non‐highly integrated facilities. No difference was identified between the two sample groups of hospitals for the performance measures related to patient satisfaction or cost‐efficiencies.

The study is an attempt to evaluate the implications and effectiveness of integration within the health care delivery system. It suggests that integrated delivery systems may provide the organization structure appropriate to help support and enhance the quality of clinical care for patients.

Objective – Nepal's Safe Delivery Incentive Programme (SDIP) was introduced nationwide in 2005 with the aim of encouraging greater use of professional care at childbirth. It provided cash to women giving birth in a public health facility and an incentive to the health provider for each delivery attended, either at home or in the facility. We aimed to assess the impact of the programme on neonatal mortality and health care seeking behaviour at childbirth in one district of Nepal.

Methods – Impacts were identified using an interrupted time series approach, applied to household data. We estimated a model linking the level of each outcome at a point in time to the start of the programme, demographic controls, a vector of time variables and community-level fixed effects.

Findings – The recipients of the cash transfer in the programme's first two years were disproportionately wealthier households, reflecting existing inequality in the use of government maternity services. In places with women's groups – where information about the policy was widely disseminated – the SDIP substantially increased skilled birth attendance, but failed to impact on either neonatal mortality or the caesarean section rate. In places with no women's groups, the SDIP had no impact on utilisation outcomes or neonatal mortality.

Implications for policy – The lack of any impact on neonatal mortality suggests that greater increases in utilisation or better quality of care are needed to improve health outcomes. The SDIP changed health care seeking behaviour only in those areas with women's groups highlighting the importance of effective communication of the policy to the wider public.

Integrated health care delivery (IHCD), as a major issue of managed care, was considered the panacea to rising health care costs. In theory it would simultaneously provide high-quality and continuous care. However, owing to the backlash of managed care at the turn of the century many health care providers today refrain from using further integrative activities. Based on transaction cost economics, this chapter investigates why IHCD is deemed appropriate in certain circumstances and why it failed in the past. It explores the new understanding of IHCD, which focuses on actual integration through virtual integration instead of aggregation of health care entities. Current success factors of virtually integrated hybrid structures, which have been evaluated in a long-term case study conducted in the San Francisco Bay Area from July 2001 to September 2002, will elucidate the further development of IHCD and the implications for other industrialized countries, such as Germany.

The purpose of this paper is to identify if aspects of organizational culture may indicate a new terrain in the cultural influences‐quality healthcare relationship. This research stems from the author's belief that viewing the role of head of department or directorate as pivotal to health care management is critical to health care planning and quality healthcare delivery.

Interviews were undertaken among 50 professional clinician and non‐clinician managers working in the role of head of department, in acute care hospitals in Ireland. The sample was drawn from the total population of 850 managers, utilized in a previous survey study.

Organizational culture is more complex than was previously thought. Several cultural influences such as excellence in care delivery, ethical values, involvement, professionalism, value‐for‐money, cost of care, commitment to quality and strategic thinking were found to be key cultural determinants in quality care delivery.

Health care managers perceive that in order to deliver quality focused care they need to act in a professional, committed manner and to place excellence at the forefront of care delivery, whilst at the same time being capable of managing the tensions that exist between cost effectiveness and quality of care. These tensions require further research in order to determine if quality of care is affected in a negative manner by those tensions.

Originality relates to the new cultural terrain presented in this paper that recognizes the potential of health service managers to influence the organizations' culture and through this influence to take a greater part in ensuring that quality health care is delivered to their patients. It also seems to be important that value‐for‐money is viewed as an ethical means of delivering healthcare, and not as a conflict between quality and cost.

The supply chain concept aided marketing by highlighting relationships that form a network of firms creating products for consumers. It helped change the focus from individual transactions to a more comprehensive view of the entire system. The value chain concept in marketing extends the supply chain view in an important way: it explicates the value that is created at each stage of the chain. For marketers, it is a vital tool in satisfying consumers – the final part of the value chain. This value chain can be viewed as having two components: the value delivery system and the consumer. This paper explores several approaches to value that are important in the functioning of the value chain. It then delineates three main elements of the value chain and traces them as they apply to services. It then focuses on one of the more complex services, the health care delivery system. It goes on to describe the health care value network and examine the critical factors that affect the success of the health care process. Finally, it delineates several important implications for health care marketers.

Purpose – This chapter examines the impact of technology on sustainable effectiveness by focusing on the dynamic synchronization between the technical and the social subsystems at the Villa Beretta Rehabilitation Hospital (VBRH) and illustrates that technology can trigger and enable sustainable health care organizations.

Design/methodology/approach – The case study of VBRH relies on several data sources. They include interviews with key informants (VBRH executives, health care professionals, and technology suppliers), follow-up e-mails and phone conversations, direct observations of actors’ behavior, and notes of processes in action and archival data, such as patient pathway protocols, technical information systems documentation, performance and managerial reports, and administrative guidelines.

Findings – VBRH was capable to dynamically synchronize the social subsystem with the continuous innovation of the technical subsystem. This capability enabled sustainable effectiveness in three main areas. First, the correct alignment between technology and professionals’ practices and behaviors improved triple-bottom-line performance by promoting a more conscious use of the environmental, social, and financial resources. Second, technology-based initiatives promoted research-oriented plans of action that nurtured a culture of change and continuous improvement. Third, technology facilitated the extension of the research and operation networks that generated new ideas and initiatives for achieving sustainable effectiveness. Additionally, evidence from VBRH demonstrated that organization design, change management, and learning mechanisms are essential when institutionalizing new technology that requires the disruption of current professional practices and individuals’ behavior.

Originality/value – Previous contributions about sustainable effectiveness in health care failed to unveil and frame the complexity of dynamic synchronization between the technical and the social subsystems that is at the core of the sustainability of health care delivery. This chapter provides new insights that pave the way for a deeper-level understanding of the role that technology plays in sustainable effectiveness dynamics and outcomes in health care delivery. The chapter illustrates how different groups of technology contribute to sustainable effectiveness and the mechanisms that make them work.

Systems of care and evidence-based practice possess distinct histories. Though each developed out of attempts to improve services to youth with emotional and behavioral disorders, they did so from perspectives so different as to appear diametrically opposed. Service systems exist at multiple levels, including the practice, program, and system levels (Rosenblatt, 1988, 2005; Rosenblatt & Woodbridge, 2003). Research on health and mental health service systems similarly varies, often by level of the service system, with the research methods, independent and dependent variables, populations of interest, and ultimately the consumers of the research product interacting differentially in the creation and understanding of what constitutes a knowledge base for service delivery. Systems of care and, with limited exceptions, evidence-based practices exist at different levels of the service delivery structure, require and derive from different research approaches, and speak to overlapping but historically different audiences.