Search results

Children in majority world countries (MWC) have high rates of unmet mental health needs, with limited access to specialist resources. Integration of child mental health in existing psychosocial care can improve provision. Through a Train-the-Trainer (ToT) cascade approach, this study aimed to provide a framework for such integration in resource-constrained communities in Karachi, Pakistan and to establish hindering and enabling factors.

Eight practitioners attended a child mental health ToT program, including training on a five-domain service transformation framework. Trainers co-designed and implemented interventions that integrated child mental health knowledge and skills on each domain. These were attended by 136 end-users (youth, parents, teachers, managers), of whom a sub-sample of 47 stakeholders, as well as the trainers, attended focus groups on their experiences. Data were analysed through a thematic codebook.

Established themes reflected common ingredients across all domains/interventions that were deemed important for child mental health care integration. These included child-centric approaches, positive parenting, community mobilization and systemic changes.

Integrated child mental health care informed by the Train-of-Trainer approach can be a useful model for resource-constrained MWC contexts. Integrated interventions should be co-produced with communities.

The involvement of clients in service encounters and service development has become a central principle for contemporary health and social care organizations. However, in day-to-day work settings, the shift toward client involvement is still in progress. We examined how health and social care professionals, together with clients and managers, co-develop their conceptions of client involvement and search for practical ways in which to implement these in organizational service processes.

The empirical case of this study was a developmental intervention, the client involvement workshop, conducted in a Finnish municipal social and welfare center. The cultural-historical activity theory (CHAT) framework was used to analyze the development of client involvement ideas and the modes of interaction during the intervention.

Analysis of the collective discussion revealed that the conceptions of client involvement developed through two interconnected object-orientations: Enabling client involvement in service encounters and promoting client involvement in the service system. The predominant mode of interaction in the collective discussion was that of “coordination.” The clients' perspective and contributions were central aspects in the turning points from coordination to cooperation; professionals crossed organizational boundaries, and together with clients, constructed a new client involvement-based object. This suggests that client participation plays an important role in the development of services.

The CHAT-based examination of the modes of interaction clarifies the potential of co-developing client-involvement-based services and highlights the importance of clients' participation in co-development.

Integrated care (IC) is mainly studied from the perspectives of organisations or employees. However, less research is focussed on how patients themselves experience person-centred (PC) IC in practice. This context-specific, small-scale study examines what PC-IC means to older patients who went through joint replacement surgery (JRS).

The data consists of ten in-depth interviews of older patients, focussing on their experiences of care during their patient journey related to joint knee or hip replacement surgery. The data were analysed with thematic analysis.

Three central dimensions of PC-IC for older patients were identified: information sharing, continuity of care and compassionate encountering. Human validation and compassionate encountering were experienced as important aspects of PC-IC. Compassionate encountering was concretised through professionals’ very small everyday practices, which made the patient feel comfortable and respected. Instead, probably due to the medical and quite straight-forward nature of the joint replacement care process, patients seem to be pleased to trust the expertise of professionals and did not necessarily expect an active role or participation in the decision-making.

This Finnish case study focusses on the patients’ authentic perceptions of what is central to person-centred IC in the specific context of JRS.

The purpose of this paper is to understand if and how industrialized house building (IHB) could support productivity developments for housebuilding on project and industry levels. The take is that fragmentation of construction is one explanation for the lack of productivity growth, and that IHB could be an integrating method of overcoming horizontal and vertical fragmentation.

Singe-factor productivity measures are calculated based on data reported by IHB companies and compared to official produced and published research data. The survey covers the years 2013–2020 for IHB companies building multi-storey houses in timber. Generalization is sought through descriptive statistics by contrasting the data samples to the used means to control vertical and horizontal fragmentation formulated as three theoretical propositions.

According to the results, IHB in timber is on average more productive than conventional housebuilding at the company level, project level, in absolute and in growth terms over the eight-year period. On the company level, the labour productivity was on average 10% higher for IHB compared to general construction and positioned between general construction and general manufacturing. On the project level, IHB displayed an average cost productivity growth of 19% for an employed prefabrication degree of about 45%.

Empirical evidence is presented quantifying so far perceived advantages of IHB. By providing analysis of actual cost and project data derived from IHB companies, the article quantifies previous research that IHB is not only about prefabrication. The observed positive productivity growth in relation to the employed prefabrication degree indicates that off-site production is not a sufficient mean for reaching high productivity and productivity growth. Instead, the capabilities to integrate the operative logic of conventional housebuilding together with logic of IHB platform development and use is a probable explanation of the observed positive productivity growth.

The purpose of this research is to identify novel ways of tackling health inequalities of underserved populations. It explores the opportunities presented by the changes in health and social care legislation to employ historically underused services, such as police custody healthcare providers, in addressing health inequalities.

This research analyses the policy approaches to tackling health inequalities in the UK in the past 40 years with an emphasis on those experienced by the people detained in English police custodies. It analyses the current model of healthcare in police custody and proposes a novel integrated model of care and joint commissioning opportunities in funding it.

Policies to tackle health inequalities have largely failed, as they became entrenched. But recent changes in the health and social care legislation in England offer opportunities to address them by employing historically underused healthcare services, such as those operating in police custodies.

The research does not touch upon ethical considerations related to the patient privacy aspect of integrated care. Interventions by and interactions with police custody healthcare providers would be visible to all professionals with access to the patient’s health record. As with all novel interventions or innovative models of care, the effectiveness of such clinical interventions remains to be established by further research. It opens a new line of research on quality improvement through integration of care and explores understudied aspects of joint commissioning of integrated care.

It offers health commissioners and public health leaders the opportunity to employ police custody healthcare services in reaching their population health management objectives and meeting their health inequalities objectives at local level. It also gives police and crime commissioners the opportunity to address the health drivers of criminal behaviour that overlap with health inequalities. It offers funding opportunities presented by jointly commissioning services at lower costs to both police and health commissioners alike. It improves the health outcomes of historically underserved populations by facilitating access to health and social care services and facilities.

Reducing health inequalities and disparities in health outcomes can decrease the costs of the healthcare services over the long term and might contribute to reducing criminality by addressing inequities and some health drivers of criminal behaviour.

The paper explores understudied opportunities offered by the recent changes in health and social care legislation in England and includes underused resources to tackle health inequalities.

The study compares the social services functioning in two local contexts, one urban and one rural, in the same Italian region, to understand how contextual features affect frontline workers' work.

By applying the framework of the street-level bureaucracy theory (SLB) and proposing a framing of the spatial contexts under analysis, the present study adopts a qualitative approach. In particular, semi-structured interviews were conducted among street-level workers, decision-makers and privileged witnesses.

The study shows how the typical features of the rural and urban Italian contexts analyzed impact differently on the working conditions of frontline workers, leading to substantive differences in the possibility of exercise their role at the street-level.

The article contributes to a wider understanding of social services provision in a highly fragmented system like the Italian one by taking into consideration contexts that are usually little investigated in SLB and welfare studies in the Mediterranean Europe area: those rural and, in particular, those belonging to the so-called “inner areas”.

This study aims to facilitate access to vascular disease screening for low-income individuals living in remote and conflict areas based on the results of a pilot trial in Colombia. Also, to increase the amount of diagnosis training of vascular surgery (VS) in civilians.

The operation method includes five stages: strategy development and adjustment; translation of the strategy into a real-world setting; operation logistics planning; strategy analysis and adoption. The operation plan worked efficiently in this study’s sample. It demonstrated high sensibility, efficiency and safety in a real-world setting.

The authors developed and implemented a flow model operating plan for screening vascular pathologies in low-income patients pro bono without proper access to vascular health care. A total of 140 patients from rural areas in Colombia were recruited to a controlled screening session where they underwent serial noninvasive ultrasound assessments conducted by health professionals of different training stages in VS.

The plan was designed to be implemented in remote, conflict areas with limited access to VS care. Vascular injuries are critically important and common among civilians and military forces in regions with active armed conflicts. As this strategy can be modified and adapted to different medical specialties and geographic areas, the authors recommend checking the related legislation and legal aspects of the intended areas where we will implement this tool.

Different sub-specialties can implement the described method to be translated into significant areas of medicine, as the authors can adjust the deployment and execution for the assessment in peripheral areas, conflict zones and other public health crises that require a faster response. This is necessary, as the amount of training to which VS trainees are exposed is low. A simulated exercise offers a novel opportunity to enhance their current diagnostic skills using ultrasound in a controlled environment.

Evaluating and assessing patients with limited access to vascular medicine and other specialties can decrease the burden of vascular disease and related complications and increase the number of treatments available for remote communities.

It is essential to assess the most significant number of patients and treat them according to their triage designation. This management is similar to assessment in remote areas without access to a proper VS consult. The authors were able to determine, classify and redirect to therapeutic interventions the patients with positive findings in remote areas with a fast deployment methodology in VS.

Access to health care is limited due to multiple barriers and the assessment and response, especially in peripheral areas that require a highly skilled team of medical professionals and related equipment. The authors tested a novel mobile assessment tool for remote and conflict areas in a rural zone of Colombia.

The resource crisis in healthcare can be alleviated by engaging external stakeholders and resources in healthcare delivery. The authors use value and open innovation concepts to understand what motivates the stakeholders to join the healthcare innovation ecosystem and what value such an ecosystem brings to healthcare.

A systematic literature review following the PRISMA framework method was applied to reach the research objective. Out of a total of 509 identified articles published till 2021, 25 were selected as relevant for this review.

Six categories of actors were identified, including innovation intermediaries, which were so far neglected in the healthcare innovation literature. Furthermore, patients, healthcare providers, innovation suppliers, investors and influencers were described. The authors also distinguished internal and external stakeholders. The authors show why and how open innovation projects contribute to involving external stakeholders and resources in healthcare delivery by contributing to patient autonomy, relationship building, knowledge transfer, improving collaborative mindset and culture, advancing know-how and bringing additional finances.

This article is the first one to systematically describe the value of open innovation in healthcare. The authors challenge the positivist approach in value presented by value-based healthcare. The authors show how openness contributes to addressing the resource crisis by involving new stakeholders and resources in the care delivery process.

This paper aims to analyze practices, processes and outcomes related to construction supply chain management (CSCM) in Brazil to identify opportunities and direct actions and strategies to improve the Brazilian sector through blockchain technology (BT).

The study collected empirical data through semi-structured interviews with consumers and distributors to identify how the CSCM functions today. The interviews were structured and analyzed around the following topics: processes, digitalization, quality and weakness of the activities performed. The opportunities for using BT in CSCM were identified by crossing these results with evidence in the bibliography.

The study identified deficiencies, gaps and good practices applied to information management in the sector. Also, it analyzed the features, drivers and barriers of BT from a practical perspective. The findings suggested that BT is feasible and promising, reducing costs and enhancing process transparency. The need to overcome cultural and economic barriers is a challenging task.

This study brings a new perspective on using BT in CSCM, relating it to the demands and particularities of the construction sector in Brazil. The study identifies a limited panorama of chronic CSCM concerns, given BT’s infinite opportunities. And it motivates a gradual transition toward installing a new technological culture based on BT that focuses on priority care for the sector’s chronic deficiencies. The results can guide practical actions for the successful insertion of BT in the CSCM, laying the foundations for significant future research.

High-density development requires large land parcels, but fragmented land ownership can impede redevelopment. While earlier compact city development in Sydney occurred on large-scale brownfield sites, redeveloping and re-amalgamating older strata-titled properties is now integral to further densification. The purpose of this study is to examine collective sales activity in one Sydney suburb where multiple strata-titled redevelopments and re-amalgamations have been attempted. The authors explore how owners navigate the process of selling collectively, focusing on their experience of legislation introduced to facilitate this process, the Strata Schemes Development Act 2015 [New South Wales (NSW)].

By reviewing sales listings, development applications and media coverage, and interviewing owners, lawyers and estate agents, the authors map out collective sale activity in a case study area in Sydney’s northwest.

Strata collective sales are slow and difficult to complete, even when planning and market drivers align. Owners find the Strata Scheme Development Act 2015 (NSW) difficult to navigate and it has not prevented strategic blocking attempts by competing developers. The long timelines required to organise collective sales can result in failure if the market shifts in the interim. Nonetheless, owners remain interested in selling collectively.

This case study is important for understanding the barriers to redevelopment to achieve a more compact city. It highlights lessons for other jurisdictions considering similar legislative changes. It also suggests that legislative change alone is insufficient to resolve the planning challenges created by hyper-fragmentation of land through strata-title development.