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This study aims to describe and understand the contributions of frontline, middle and top management healthcare professionals in detecting areas of potential improvement in hospital patient flow and proposing solutions.

This is a qualitative interview study. Semistructured interviews were conducted with 22 professionals in the orthopedic department of a 250-bed academic teaching hospital. Data were analyzed through a thematic framework analytical approach by using an a priori framework. The Consolidated Criteria for Reporting Qualitative (COREQ) checklist for qualitative studies was followed.

When dealing with a hospital-wide process, the involvement of all professionals, including nonhealth professionals, can reveal priority areas for improvement and for services integration. The improvements identified by the professionals largely focus on covering major gaps detected in the technical and administrative quality.

This study focused on the professional viewpoint and the connections between services and further studies should explore the role of patient involvement. The study design could limit the generalizability of findings.

Improving high-quality, efficient hospital patient flow cannot be accomplished without learning the perspective of the healthcare professionals on the process of service delivery.

Few qualitative studies explore professionals' perspectives on patient needs in hospital flow management. This study provides insights into what produces value for the patient within a complex process by analyzing the contribution of professionals from their particular role in the organization.

The study compares how distinct mechanisms that connect pre-established policy objectives to professionals' practices, and the health policy implementation context influenced different approaches to frontline staff participation. The authors analysed 26 teams in six cities from two Brazilian states, during the last cycle of the National Program for Improving Access and Quality of Primary Care (PMAQ).

About 172 in-depth interviews were conducted with frontliners – community health workers (78), nurses (37), doctors (30) – and managers (27). Interview guides were based on key issues identified in the implementation and pay-for-performance (P4P) literature. Drawing on thematic analysis and synthesis of the literature, three types of participation mechanisms were identified: relational, motivational and incremental learning. They were analysed considering distinct contexts at the local level to understand how they influenced different forms of participation: mere adherence, result-oriented and transformative.

Administrations with stronger institutional organizational structures were able to control work processes and reduce professional discretion. However, sustained participation was more likely where there was greater integration between management and frontline health care teams. Motivation based only on financial incentives could not bring about transformative participation. This depended on the degree of professional's ideational motivation towards primary care. Finally, contexts with unfavourable working conditions tend to demotivate professionals, but incremental learning helps teams cope with these obstacles.

The study overcomes gaps in the literature in relation to PMAQ's implementation process. Overall, the study delves into which/how mechanisms alter frontliners participation in performance-oriented health programs.

The purpose of this paper is to describe a Finnish pilot project aiming to support high-needs clients in their everyday lives by developing an integrated care approach based on the multi-sectoral collaboration of care professionals. The Help Team for school-aged children will be described as an example of the integrative practices developed on the project.

Altogether 250 professionals from primary and secondary health care and social care and from the education sector were designated to collaborate in 37 local, multi-sectoral teams, aiming to develop integrated care practices for high-needs clients. Teamwork was supported by coaches and project seminars, the Breakthrough method and other LEAN methods. The project was evaluated internally by means of a survey and interviews with the participants.

As a result of the project, all 37 teams developed a specific collaboration model for their selected target group comprising different kinds of high-needs clients.

The sustainability of the outcomes of the project depends on how managers and decision-makers are committed to applying the collaboration models in future.

Many of the collaboration models developed in the project will be implemented in practice in a wider area.

The project highlighted the need to pay attention to the problems of people with multiple care needs and the challenges they pose for integrated care.

The project was based on the client-centered development work done by frontline professionals. Due to the high level of involvement of the professionals themselves, the project proved highly instructive for them. It is extremely important to engage frontline level professionals in development work and support them in collaborating beyond the traditional “silos”.

The purpose of this paper is to present findings from a mixed-methods study on the impact that COVID-19 has had on adult safeguarding. The research sought to explore the challenges and opportunities presented by COVID-19 to both frontline and non-frontline professionals working in adult safeguarding.

A mixed-methods project was undertaken comprising a literature review, survey, semi-structured interviews and a small number of freedom of information requests. This paper presents the findings predominantly from the survey and interviews.

Unsurprisingly, COVID-19 has presented a variety of challenges for professionals working in adult safeguarding. The themes that occurred most often were the day-to-day changes and challenges, relationships across sectors, information and navigating the ethical questions in safeguarding.

To the best of the authors’ knowledge, the findings represent the first focused qualitative mixed-method study aimed at understanding more about the impact the pandemic has had on adult safeguarding through the eyes of those professionals working in that field.

This chapter argues that substantial potential exists for service encounter-based innovation in tourism. However, there are also a number of obstacles. Based on theoretical discussions on potentials and obstacles, a Knowledge Chain Model of service encounter-based innovation in tourism is developed. It suggests how weak or broken knowledge chains limit companies’ potential for benefiting from service encounter-based innovation. The relevance of the model is illustrated by a comparative case study of four tourism companies. In light of the theoretical frameworks and empirical findings, the chapter suggests how experimental methods can join research and practice to enhance the innovative potential of tourism companies while providing the research community with valuable knowledge.

The purpose of this paper is to examine the relational consequences of electronic patient records based on co-produced data from pregnant women’s IT supported self-reporting. The analysis unfolds how the clinical encounter between patient and professional is reconfigured in the digitized society.

The paper provides a grounded theory analysis based on observations and interviews in an antenatal care unit. The study draws on empirical material generated through observations of the clinical encounters between pregnant women and midwifes, interviews with managers and midwifes, field notes and policy documents.

The author argues that the use of technology and co-produced data displace tasks and relations between healthcare professional and patient. The analysis shows that four modes of organizational patient involvement are enacted: involvement in administrative tasks, involvement in professional resistance, individualized involvement, and homogenized involvement of patients that tends to categorize the pregnancy roughly as either “normal” or “abnormal.”

This study contributes to qualitative research in digitization and patient involvement in health organization studies by showing how digital technology distributes the midwife’s autonomy, tasks and knowledge about the patient with both intended and unintended consequences. The argument goes beyond the prevalent prescriptive approaches to e-government and co-production, instead providing a critical analytical perspective on the promises of delivering efficient and patient-centered healthcare.

Partnership between people who use services, their carers, and professionals is seen as an increasingly important aspect of providing a quality service across health and social care. The concept is enshrined in national policy, but the application of it is patchy at best, and has partly been undermined by constant restructuring and organisational change ‐ both in partnership working and in the organisations set up to deliver health and social care. Partnership that recognises service user/survivor expertise and assets and promotes equal and reciprocal working between staff and users is being recast as ‘co‐production’ or ‘co‐creation’ in UK public policy. The Jersey Partnership Project demonstrates a co‐productive approach, which is being seen as a way forward for adult social care service development and design.The Partnership Project, which commenced in the summer of 2009, and which is reaching the conclusion of its first stage at the time of writing, brings together experts by experience and mental health professionals, including a number of the latter who use services themselves, in a way that is designed to map out a new way of working, in partnership, across services. The Project is due to complete its first stage in June 2010, and further stages, perhaps bringing in a wider range of community services, are under discussion, following a presentation to the Jersey Minister for Health in November 2009.This article explores the notion of partnership as both ‘truth‐telling’ and ‘walking on common ground’, allowing those who provide and those who make use of services to enter into a sharing of experiences and knowledge, and an integrated spirit, that provides a clearer direction for developing adult mental health services in Jersey. The article then goes on to consider some of the barriers to more inclusive ways of working and looks at the current discourse and practices around the ‘co‐production’ agenda. Finally, the article covers the practical operation of the Partnership Project looking at structure and learning points and concludes by looking to the final six months of the Project and beyond.

For decades, there has been a call for the public sector to be more innovative, and there is widespread agreement that managers play a crucial role in meeting this goal. Most studies of innovation management focus on top-level managers, despite the fact that most innovation activities take place on the frontlines, deeply embedded in professional practice. Meanwhile, micro-level studies of innovation tend to focus on the agency of employees, which leaves a knowledge gap regarding the mobilizing role of frontline managers. This is unfortunate because frontline managers are in a unique position to advance the state of the art of their professions, in scaling public innovation and in implementing public reform.

To explore how frontline managers approach innovation, a case study has been constructed based on in-depth interviews with 20 purposely selected frontline managers, all working within the Danish public childcare sector.

The article explores how frontline managers perceive their role in public innovation and finds three distinct approaches to innovation leadership: a responsive, a strategic and a facilitating approach.

This paper contributes to the research on public management by applying existing research on leadership styles in order to discuss the implications of how frontline managers perceive their role in relation to public innovation.

This paper employs implementation theory and the political literature on performance measurement to understand how frontline health workers know, participate and evaluate the Brazilian National Program for Improving Access and Quality of Primary Care (PMAQ, 2nd round).

This paper develops an implementation theory-driven qualitative analysis. The research is developed in the city of Goiania (Brazil): a challenging organizational context in primary care (PHC). Interviews were carried out with 25 frontliners – managers, doctors, nurses and community health workers. Data were thematically and hierarchically analysed according to theoretical concepts such as policy knowledge, policy adherence, forms of accountability, alternative logics, organizational capacity and policy feedback.

Results show the need to foster organizational capacity, knowledge, participation and policy feedback at the frontline. Successful implementation would require those adaptations to counteract policy challenges/failures or the emergence of alternative logics.

The study was conducted in only one setting, however, our sample includes different types of professionals working in units with different levels of organization capacity, located in distinct HDs, expressing well the implementation of PMAQ/P4P. Qualitative researches need to be developed for further exploring the same/other factors.

Findings can be used to improve discussions/planning and design of P4P programs in the city and State of Goias.

The majority of analysis of PMAQ are of a quantitative or results-based nature. This article focuses on politically significant and unanswered questions regarding the implementation of PMAQ.

This paper aims to investigate the effect of top management’s customer interactions (TMCI) on customer satisfaction. This study argues that TMCI’s overall relationship with customer satisfaction follows an inverted-U shape due to its positive and disruptive effects on the customer relationship efforts of frontline service/sales employees (FSEs). This paper further investigates the frontline competence of both FSEs and the top management team (TMT) as moderators of the impact of TMCI on customer satisfaction.

The conceptual model was tested empirically using data from managers, frontline employees and customers of microfinance firms. A multilevel structural equation modeling approach was used to test the hypothesized model.

The results show that TMCI has a curvilinear relationship with customer satisfaction. The results also show that frontline employees’ collective efficacy attenuates this relationship by shifting the turning point of the curvilinear effect to the right. Furthermore, TMT frontline competence amplifies both the positive and negative effects of TMCI on customer satisfaction.

This study advances knowledge on the effects of TMCI on customer satisfaction and highlights the nuanced relationship between top management involvement and indicators of firm performance.

The findings show the importance of considering the frontline competence of both top management and frontline employees when encouraging TMCI in organizations.

To the best of the author’s knowledge, this study is one of the first to examine TMCI’s direct impact on customer satisfaction and propose the frontline competence of both top management and frontline employees as boundary conditions on this relationship.