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This article aims to discuss the relevancy of different instruments used to gather information on homecare service quality from multiple stakeholders and the challenges encountered when trying to blend their views for prioritizing areas needing improvement.

The study centers on four homecare agencies: one public, one private for‐profit and two not‐for‐profit services, implementing continuous quality improvement (CQI) programs. Various instruments were tested with random and convenience elderly service user, family caregiver and front‐line worker samples. Instrument evaluation included operational effectiveness and agency manageability.

A qualitative approach, centered on small stakeholder samples, is fairly effective at assessing service quality, yet demands a strong commitment from agencies in personnel time and resources, as well as the necessary skills. Small‐size, private homecare providers seem less‐well equipped to handle comprehensive assessments without external support. More importantly, assessments have to be done strategically, such that timing and work needed does not undermine program viability.

The approach and instruments tested have practical implications for decision makers and homecare organization managers interested in CQI.

The article systematically evaluates quality assessment and priority‐setting instruments applied to various stakeholders and homecare settings.

The objective is to explore how the professionalisation of care jobs is constructed in the public and private sectors and to discuss whether the instruments used by public and private care providers contribute to solve the ambiguities linked to this type of work and which are the consequences for caregivers.

This paper compares the way in which the professionalisation of home care services for elderly people is achieved in the public and private sectors in the region of Brussels. The findings are based on the analysis of interviews with professional actors working in the care sector in Brussels.

The analysis shows that there is no agreement over the best way of professionalising home care services for the elderly and that the efforts made by public and private providers are profoundly different.

The divergencies are not only the result of the strict institutional framework to which public care providers are bound, in opposition to the relative freedom of the private sector, but they also derive from a different understanding of care work.

The purpose of this paper is to disseminate a new model that addresses the urgent social challenge of providing adequate long-term care in rural circumstances through innovative use of existing resources, and to suggest future research.

This paper is exploratory in and is based upon the analysis of qualitative observations (interviews and site visits) framed in the financial and operational records of the facility studied, macro- and micro-level demographics, and the scholarly and practice literatures.

Significant cost savings upon implementation, improvements in quality of care and both worker and client satisfaction were observed.

The model has been in operation only one year; the trend has been positive, however, more research is needed to identify its stability and develop a more refined description of its components: while essential features of this innovative model can be applied in any residential long-term care situation, replicating its success is obviously linked with the skill and authority of the director. Evaluation research is currently in progress.

The paper suggests budget-neutral solutions to persistent challenges of caring for older adults in rural circumstances.

Quality and financing of long-term residential care for elders is insufficient and worsening. This model addresses problems central to financing and quality of care by connecting existing resources in new ways. It does not require additional funding or changes in qualifications required for jobs.

The model is the original creation of a residential long-term care facility director working with a network of partnerships that he discovered and developed: partnerships include a broad range of organizations in the public and non-profit sectors, and the state university.

Clinical front-line staff are best positioned within the organizations to identify patient safety problems and craft solutions. However, in traditional models, safety committees are led by senior executives who are not clinically responsible for patients. This top-down approach can result in missed opportunities to address patient-centered challenges and better manage the health of the defined populations served by these organizations.

To foster teamwork, enhance empowerment, and improve the patient care environment, Operations Councils led by trained front-line staff were deployed in 15 clinical areas at the Ohio State University Wexner Medical Center (OSUWMC) as a performance improvement tool.

Standardized training of Council facilitators was designed and implemented to guide the performance improvement process. Balanced scorecards were developed in each Council based on the risks and concerns of that particular clinical area. After initial implementation of the Operations Councils, patient safety events declined and team engagement improved by over 34% across the medical center; the highest changes were seen in areas where Operations Councils had been deployed. Additionally, outcome metrics including area-specific and system-wide mortality and readmissions improved after implementation.

We suggest that this type of approach may be an appropriate strategy to consider in other health care organizations as such institutions are challenged to better manage the health of their defined patient populations.

This paper aims to show the advantages that social marketing training programs for disability professionals can play in improving the approach to the problems faced by people with disabilities, offering a necessary mutual understanding between both sectors. So, describing what are the training needs in social marketing expressed by disability professionals and providing an initial shared theoretical framework of both fields that could contribute to implementing social marketing strategies in the field of disability as an inducer of quality of life.

This is a mixed-method approach combining: a quantitative analysis with a web-based self-administered questionnaire completed in six European countries and a qualitative analysis: interviews to experts pre and post questionnaire.

Quantitative data has identified that: front-line professionals working directly with people with disabilities have high social marketing training needs; these needs are mostly related to the assessment and modification of clients’ behavior and the development of interventions according to the concept of value co-creation. Qualitative data has shown that: both fields share some similar theoretical frameworks. Therefore, it is stated that social marketing has the potential to be better implemented in the disability field.

Considering public policy; stigma and discrimination; regulations; other models and improving the sampling method.

Sharing theoretical framework of both fields, social marketing strategies into the disability field as an inductor for quality of life. No research has analyzed the needs of disability professionals when they have to face a problem and find a solution that social marketing strategies could offer into the disability field.

The assignment is to design a plan that aligns patient satisfaction scores with quality care metrics. The instructor’s manual (IM) introduces models for designing and implementing a strategic plan to approach the quality improvement process.

This is a field research case. The author(s) had access to the Chief Operating Officer (COO) and other members of the management team, meeting with them on numerous occasions. Cleveland Clinic Florida (CCF) provided the data included in the appendices. Additionally, relevant hospital data, also included in the appendices, is required to be made public on Centers for Medicare and Medicaid Services (CMS) databases. Accordingly, all data and information are provided by original sources.

Osmel “Ozzie” Delgado, MBA and COO of CCF was faced with a dilemma. Under the new CMS reimbursement formula, patient satisfaction survey scores directly impacted hospital reimbursement. However, the CCF patient satisfaction surveys revealed some very unhappy patients. Delgado pondered these results that really made no sense to him because CCF received the highest national and state rankings for its clinical quality at the same time. Clearly, patients were receiving the best medical care, but they were still unhappy. Leaning back in his chair, Delgado shook his head and wondered incredulously how one of the most famous hospitals in the world could deliver such great care but receive negative patient feedback on CMS surveys. What was going wrong and how was the hospital going to fix it?

This case is designed for graduate Master’s in Business Administration (MBA), Master’s in Health Sciences Administration (MHSA) and/or Public Health (PA) audiences. While a healthcare concentration is useful, the case raises the generic business problems of satisfying the customer to increase brand recognition in the marketplace and displacing competition to increase annual revenues. Indeed, the same analysis can be applied in other heavily regulated industries also suffering from a change in liquidity and growth occasioned by regulatory change.

The purpose of this paper is to evaluate the implementation of a broad-scale team resource management (TRM) program on safety culture in a Dutch eye hospital, detailing the program’s content and procedures. Aviation-based TRM training is recognized as a useful approach to increase patient safety, but little is known about how it affects safety culture.

Pre- and post-assessments of the hospitals’ safety culture was based on interviews with ophthalmologists, anesthesiologists, residents, nurses, and support staff. Interim observations were made at training sessions and in daily hospital practice.

The program consisted of safety audits of processes and (team) activities, interactive classroom training sessions by aviation experts, a flight simulator session, and video recording of team activities with subsequent feedback. Medical professionals considered aviation experts inspiring role models and respected their non-hierarchical external perspective and focus on medical-technical issues. The post-assessment showed that ophthalmologists and other hospital staff had become increasingly aware of safety issues. The multidisciplinary approach promoted social (team) orientation that replaced the former functionally-oriented culture. The number of reported near-incidents greatly increased; the number of wrong-side surgeries stabilized to a minimum after an initial substantial reduction.

The study was observational and the hospital’s variety of efforts to improve safety culture prevented us from establishing a causal relation between improvement and any one specific intervention.

Aviation-based TRM training can be a useful to stimulate safety culture in hospitals. Safety and quality improvements are not single treatment interventions but complex socio-technical interventions. A multidisciplinary system approach and focus on “team” instead of “profession” seems both necessary and difficult in hospital care.

Nurses need to display organizational citizenship behavior (OCB) for taking care of patients; uninterrupted care to coronavirus disease 2019 (COVID-19) patients in a stressful situation may result in emotional exhaustion and it hinders nurses' exercise of OCB. One perceives support when positive exchanges with team leaders and members (LMX) and team and members (TMX) take place for the benefit of self and the unit and lead to a feeling of commitment to the work team; the exchange facilitates the discharge of OCB. The study aims to explore the mediation effect of team commitments on the relationship between these factors with OCB of nurses in handling COVID patients.

The cross-sectional exercise attempts to find the impact of emotional exhaustion, LMX and TMX on the OCB of the nurses and mediating effects of team commitments on OCB; correlation analysis and multiple regressions are in use for examining the relationships. The use of Sobel test and bootstrapping exercise confirm the mediation and consistency of mediation results on a larger sample.

The paper finds that LMX, TMX and team commitments significantly relate to OCB; emotional exhaustion negatively impacts OCB and team commitments fully mediate the relationship between emotional exhaustion and OCB and partially mediate the relation between LMX and TMX with OCB.

Tests demonstrate that team commitments can neutralize the effects of emotional exhaustion resulting from handling COVID-19 patients on OCB of the nurses and is an addition to organizational behavior literature. The study also presents a model that shows how positive LMX, TMX and resultant team commitments support generating OCB and offset the impact of emotional exhaustion. Theoretical and managerial implications, limitations and scope for further research discussed in the paper.

The purpose of this paper is to describe and analyze nurses’ perceptions and evaluations of healthcare developmental work after the introduction of Lean and Six Sigma and, how nurses aspire to maintain a high reliability organization (HRO).

Nurses’ roles and the way they respond to new efficiency and quality working methods are crucial. Underlying themes were analyzed from in-depth, semi-structured interviews with (n=17) nurses at two Swedish hospitals.

The nurses perceived that Lean worked better than Six Sigma, because of its bottom-up approach, and its similarities with nurses’ well-known work qualities. Nurses coordinate patients care, collaborate in teams and take leadership roles. To maintain high reliability and to become quality developers, nurses need stable resources. However, professional’s logic collides with management’s logic. Expert knowledge (top-down approach) without nurses’ local knowledge (bottom-up approach) can lead to problems. Healthcare quality methods are standardized but must be used with flexibility. However, HROs ensue not only from method quality but also from work attitudes, commitment and continuous work-improvement.

Management can support personnel in developmental work with: continuous education, training, teamwork, knowledge sharing and cooperation. Authoritarian method structures that limit the healthcare professionals’ autonomy should be softened or abandoned.

The study uses theoretical concepts from HROs, which were developed for unexpected events, to explain the consequences of implementing Lean and Six Sigma in healthcare.