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The dermatology service on the islands of Orkney, with a population of approximately 22,500, was taken over by National Health Service (NHS) Tayside in August 2018. This paper aims to provide an overview of the planning and review of a highly efficient and effective dermatology service for a rural island population.

The service includes visiting dermatology consultants, enhanced electronic referral vetting, skin surgery services, a General Practice (GP) with extended role (GPwER) in dermatology, specialist virtual clinics, urgent advice for inpatients at the local district general hospital and remote systemic therapy monitoring. A new phototherapy service has been set up in an island GP practice.

Local GPs and consultant dermatologists find the enhanced vetting service useable, efficient and educational. Between August 2018 and November 2022, there have been 1,749 referrals. Of these referrals, 60% were seen in clinic or a GPwER surgery, with 40% managed remotely by providing advice back to the referring GP. The number of consultations performed by the GPwER has grown over the past 3 years, and in the last year, it accounted for more than 50% of patient appointments. The waiting time has been significantly reduced using this model.

This remote service uses an integrated approach of teledermatology (TD) whilst offering continual in-person services using local capabilities including a GPwER and island general surgeons. New treatment facilities are provided to the island population. Continual educational feedback to the primary care referrer is provided, and it enhances relationships that greatly aid the high-quality dermatology service provided.

The purpose of this paper is to examine the influence of electronic referral (eReferral) marketing and electronic word-of-mouth (eWOM) on brand image and purchase intention, coupled with the moderating effect of gender in the relationship.

Structural equation modeling was applied to examine the interplay between the proposed variables, using a random sample of 308 respondents in Cyprus.

The empirical results suggest the following: eReferral does influence brand image, and the impact is significant with women only; eWOM influences brand image, and the impact is more significant with women than men; eWOM influences purchase intention, and the impact is the same for both genders; brand image influences purchase intention, and the impact is more significant with women than men.

Marketing managers can benefit from these competitive advantage tools. Brand image, awareness and sales volume can be increased by utilizing eWOM or eReferral, depending on the product and/or service functionality as well as gender.

While there is a substantial research stream on eWOM, to the best of the authors’ knowledge no research has differentiated eReferral from eWOM. This paper provides useful insights regarding the two concepts.

Little empirical attention has been paid to the effects of electronic word-of-mouth (eWOM), electronic referral (eReferral), familiarity and cultural distance on behavioral outcomes, especially within the context of educational tourism. Based on the social network theory, this paper aims to explore the effects of eReferral, eWOM, familiarity and cultural distance on enrollment intention.

Survey data (n = 931) were obtained from educational tourists using a judgmental sampling technique. Linear modeling and artificial intelligence (i.e. artificial neural network [ANN]) techniques were used for training and testing the proposed associations.

The results suggest that eReferral, eWOM, familiarity and cultural distance predict intention to enroll both symmetrically (linear modeling) and asymmetrically (ANN). The asymmetric modeling possesses greater predictive validity and relevance.

This study contributes theoretically and methodologically to the management literature by validating the proposed relationships and deploying contemporary methods such as the ANN. Implications for practice and theory are discussed.

是否在线推荐, 在线口碑, 熟悉度, 还有文化距离决定参加意图吗？人工智能科技的应用

很少有研究检测过在线口碑（eWOM）, 在线推荐（eReferral）, 熟悉度, 和文化距离对行为结果的影响, 特别是在教育旅游的领域里。本论文基于社交网络理论探索eReferral, eWOM, 熟悉度, 和文化距离对参加意图的作用。

研究样本数据为931位教育旅游的游客, 通过判断抽样技术。本论文通过线性建模和人工智能（即人工神经网络）技术来培训和检测提出的关系。

研究结果表明, eRefferal, eWOM, 熟悉度, 和文化距离对参与意图起到决定作用, 其中包括对称（线性建模）和非对称地（人工神经网络）方式。非对称建模将增加有效性和相关性的决定度。

本论文通过证实提出的关系和采用现代方法, 比如人工神经网络, 对管理文献做出理论和实践的贡献。本论文还讨论了对实践和理论的启示。

The purpose of this paper is to investigate the distinct reasons and more common reasons that reduce customer satisfaction and are antecedents to customer churn behavior in the telecommunication industry.

The study adopted the netnography approach to investigate churn behavior by utilizing online user-generated content in qualified social media communities.

The investigation revealed that “data speed issue”, “ineffective relationship building”, “service area coverage issues” and “billing issues” are some of the most important attributes that influence a consumers' decision to churn. Further, the churn consequence influencers model summarizes the attributes that contribute to overall dissatisfaction and finally results in churn behavior. The study found out the application of the netnography approach in a quantitatively dominant research area and stands out with its insights from a rich qualitative data.

Proper clarification of customer expectations and pain points can help reduce customer churn. The study will serve as the basis for developing future churn prediction models that will contribute to the informed decision-making process.

Contributing to research on customer churn behavior, the study offers a novel attempt to study customer satisfaction and customer churn behavior jointly. The paper is the first attempt that contributes to the extant literature by adopting the unique qualitative approach to understand the reasons for telecommunication churn behavior in the emerging Indian market. Another contribution of this research is that the paper shifts the focus of the electronic word-of-mouth (eWOM) literature to the telecommunications industry, thus adding another block to ongoing research in eWOM communication.

The peer review history for this article is available at: https://publons.com/publon/10.1108/ OIR-02-2020-0048

The purpose of this paper is to identify the influential agents that led to the successful acceptance and diffusion of the Concerto clinical workstation at the Northern District Health Board.

The paper draws on Rogers’ diffusion of innovation theory to interpret and analyse the factors that enabled acceptance and successful implementation of the innovative Concerto clinical workstation.

The authors conclude that human factors (clinicians) and non-human factors (the software package) simultaneously influenced the ready acceptance of the innovation. The reason for the positive acceptance and full diffusion of Concerto as compared to iHealth is the increased functionality it offers and its ability to provide clinicians with comprehensive patient records over a period of time, which assists in making informed decisions regarding the treatment, discharge, hospitalisation and recommendations for the future well-being of patients.

The study focused on only one district health board (DHB); therefore, the outcomes may not be representative of all DHBs.

The study has practical implications for clinicians, DHB members and public health regulators. The outcomes illuminate the “agents” that positively influenced the diffusion of Concerto. The regulators and the DHBs can use this as a benchmark to determine how to lead the successful diffusion of information technology (IT) innovation in the public health sector.

The impact on society is evident in the paper, as the use of an innovation, such as Concerto, saves time taken by clinicians to make more informed decisions regarding their patient care.

This study contributes to new knowledge by investigating the diffusion process of IT innovation with an intention of establishing the factors that enabled this process.

Effective knowledge management (KM) enables the health care organisations to reach their goals. In modern health care the empowered patients are active partners, whose preferences, needs and values should be taken into account. Shared decision making (SDM) aims at involving the patient and the health professionals as equal partners in care. The purpose of this paper is to present a new model of health care information and knowledge processes (IKPs) as a KM framework. The aim is to scrutinise what types of knowing can be identified the IKPs and how do the knowledge processes support SDM. The role of patients in the IKPs is discussed.

The qualitative case study was conducted in two Finnish university hospital districts in integrated care pathways of childhood obesity. In total, 30 professionals and three mothers and children were interviewed 2009-2011 and the findings were supported with a survey (n=13) and document material.

The findings indicate that the patients and families involvement in the IKPs is modest. This implies that SDM is not completely fulfilled which may affect the families commitment to positive lifestyle changes.

The data of the patients and families were limited due to the challenges with recruitment.

The detailed IKP model enables the health organisations to scrutinise their own IKPs and to identify the shortages in order to change practices.

This paper presents a new model of health care KM which recognises the patients as active partners.

The purpose of this paper is to evaluate the implementation and potential value of an electronic referral system to improve integrated discharge planning for hospitalised older adults with complex care needs. This new technology formed part of the “Common Assessment Framework for Adults” policy in England.

Mixed methods were undertaken as part of a case study approach within an acute hospital in the North West of England. First, qualitative interviews were undertaken with practitioners to explore early experiences using the new technology. Second, routinely collected administrative data were analysed, comparing referrals made using the new technology and those made through the usual paper-based process.

Qualitative interviews found that an electronic discharge system has, in principle, the potential to improve the efficiency and suitability of integrated care planning. However, the implementation proved fragile to decisions taken elsewhere in the local care system, meaning its scope was severely curtailed in practice. Several “socio-technical” issues were identified, including the loss of valuable face-to-face communication by replacing manual with electronic referrals.

The small number of patients referred during the implementation phase meant that patient outcomes could not be definitively judged. Research into the longer-term implications and value of electronic referral systems is needed.

There is concern that attempts to integrate health and social care are stymied by incompatible systems for recording service user information. This research explores a novel attempt to share assessment information and improve support planning across health and social care boundaries.

The purpose of this work is to test several incentive strategies for attaining new customers via electronic referrals, or e‐referrals. The paper aims to examine: the roles of both the magnitude of the incentive offered to the sender and the magnitude of the incentive offered to the receiver; and the effect of equity versus inequity of financial incentives for the two parties.

The study consisted of a large‐scale field experiment conducted with 45,000 members of an online mall. The participants were divided into eight conditions in an incomplete two‐factor 4×4 between‐subjects design, where not every combination of incentive magnitudes was utilized and the magnitude of the incentive offered the receiver and sender varied in size such that sometimes rewards were equal, sometimes receivers of the e‐referral had larger rewards, and sometimes senders of the e‐referral s received more. Dependent measures included the number of e‐referrals sent, the number of those e‐referrals that lead to a new customer registering, and the number of new registrants that converted to buyers from completing a purchase.

The results demonstrate that both the magnitude of financial incentives, and the relative magnitude of the incentives for the senders and receivers both influence e‐referral rates. Specifically, it was found that offering higher incentives to senders and receivers led to an increase in referral invitations sent, new member sign‐ups and new buyers. It was also found that the disparity between incentives offered to senders and receivers affected e‐referral rates and that inequity should favor the sender to enhance results.

This paper offers marketers valuable insights as to how different combinations of financial incentives to receivers and senders can affect e‐referral rates. The findings suggest that potential referrers respond not only to referral incentives but also to the disparity between their incentives and the receivers' incentives.

This study aims to improve the efficiency of the assessment process within a Step4 Psychological Therapies Service by identifying factors related to assessment non-attendance and service suitability for referred clients.

Referral and assessment information was accessed between October 2019 and March 2020 from Step4 routine service data, electronic client records where necessary and Step4 staff self-report questionnaires.

All clients offered an assessment during this time attended. Findings indicated several factors could influence service suitability in meeting client need. These included individual differences such as readiness to change, which was not necessarily identified at referral or prior to assessment, and potential systemic factors, such as the opt-in procedure, which possibly impeded access. Though the necessity for assessment in clarifying client needs and treatment was indicated, an assessment (from referral to assessment appointment) that led to discharge could take an excess of one working day of service time, associated with considerable opportunity cost to other clients awaiting assessment. Recommendations are made for improving assessment efficiency.

With a high prevalence of poor mental health in the UK, efforts must be made to identify and reduce additional demand upon service time and resources within mental health services to effectively meet people’s needs. Recommendations to improve assessment process efficiency include the use of a standardised referral form, offer of follow-up support procedures, increased client involvement, a streamlined opt-in battery and ongoing monitoring to ensure shared practice between clinicians. These are transferable to other mental health services, with implications for subsequent quality and timeliness of care.

With the rise of customer engagement in online products and services innovation, enterprises are seeking effective referral reward program (RRP) to encourage customers’ follow-up electronic-referral (e-referral) behaviors. Therefore, how to stimulate more customers to participate in the RRP is very important to enterprises. However, little empirical work has systemically investigated the impact of RRP on customers’ follow-up e-referral, as well as the moderating effects of customers’ characteristics. To fill those research gaps, the purpose of this paper is to explore the effects of RRP (particularly, reward amount and reward type) on customers’ follow-up e-referral, and the role of creative self-efficacy.

Based on the self-perception theory and the context of online customer innovation, this paper establishes a theoretical model and uses an experiment with 160 participants to test the hypotheses on the role of reward (amount and type) and the moderating effect of creative self-efficacy.

The results of the experiment suggest that both reward amount and reward type in RRP positively impact customers’ follow-up e-referral. Furthermore, customers’ creative self-efficacy moderates the relationship between rewards and customers’ follow-up e-referral. Customers with low creative self-efficacy, reward amount significantly stimulate their follow-up e-referral, but such effect is insignificant when customers’ creative self-efficacy is high. In terms of reward type, gift reward has more positive effect on customers’ follow-up e-referral when they have high (rather than low) creative self-efficacy, but cash reward has more positive effect on those with low (rather than high) creative self-efficacy.

First, based on the self-perception theory, the study clarifies the inconsistent relationship between reward and customers’ e-referral and contributes to related research. Second, the study broadens the existing research perspective by introducing creative self-efficacy, which shows interesting and powerful moderating effect but has been ignored in previous studies. Third, the study provides valuable advice on how enterprises design an effective RRP to enhance customers’ follow-up e-referral.