Search results

Older people living in nursing homes have complex care needs and frequently need specialists’ advice and support that can be challenging to deliver in a rural setting. The aim of this paper is to describe a model of integrated care in a rural area supported by a nurse case manager.

A real-world evidence study of people living in Ribes de Freser nursing home, was conducted between specific timeframes in 2019 and 2022, comparing the casemix and outcomes of a traditional care model with the integrated interdisciplinary model.

The integrated care model led to a significant reduction in transfers to the emergency department, hospitalisations, outpatient medical visits and a reduction in the number of medicines. In addition, the number of residents receiving end-of-life care at the nursing home showed a substantial increase.

This case study contributes valuable evidence supporting the implementation of an integrated model of nurse case manager support in nursing homes, particularly in the rural contexts, where access to specialist medical staff may be limited. The findings highlight the potential benefits of person-centred integrated care for older adults, addressing their complex needs and improving end-of-life care in nursing home settings.

The purpose of this paper is to describe how first-line managers (FLMs) in home care (HC) reason about the opportunities and obstacles to lead the work according to the individual’s needs and goals.

In this participatory appreciative action reflection project, eight managers within one Swedish municipality were interviewed. The data were analysed using a thematic analysis.

The results showed a polarization between two different systems that FLMs struggle to balance when attempting to lead HC that adapts to the needs and goals of individuals. One system was represented by the possibilities of a humane system, with human capital in the form of the individual, older persons and the co-workers in HC. The second system was represented by obstacles in the form of the economic needs of the organization in which the individual receiving HC often felt forgotten. In this system, the organization’s needs and goals governed, with FLMs needing to adapt to the cost-effectiveness principle and keep a balanced budget. The managers had to balance an ethical conflict of values between the human value and needs-solidarity principles, with that of the cost-effectiveness principle.

The FLMs lack the opportunity to lead HC according to the needs and goals of the individuals receiving HC. There is a need for consensus and a value-based leadership model based on ethical principles such as the principles of human value and needs-solidarity to lead the HC according to the individual’s needs and goals.

This study aims to build on the dynamic capability view by examining dynamic capabilities associated with public value in public procurement.

A qualitative case study approach is used in this study. The interview and secondary data consist of eight cases of value-creating procurement from four public organizations.

The findings connect dynamic capabilities and public value in terms of innovation generation and promotion, well-functioning supplier markets, public procurement process effectiveness, environmental and social sustainability and quality and availability of products or services.

Dynamic capabilities in public procurement are necessary to improve public procurement.

This study extends understanding of how sensing, seizing and transforming capabilities contribute to public value creation in both innovative and less innovative (i.e. ordinary) procurement scenarios.

To facilitate the reception and care of discharged patients, streamlining processes at the University Hospital and promoting a seamless transition to continuity of care services post-discharge.

Hospitalised patients undergo the Blaylock risk assessment screening score (BRASS), a screening tool identifying those at risk of complex discharge.

Pre-pandemic, patients with a medium-to-high risk of complex discharge were predominantly discharged to their residence or long-term care facilities. During the pandemic, coinciding with an overall reduction in hospitalisation rates, there was a decrease in patients being discharged to their residence.

The analysis of discharges, with the classification of patients into risk groups, revealed a coherence between the BRASS score and the characteristics of the studied sample. This tool aids physicians in decision-making by identifying the need for a planned discharge in a systematic and organised manner, preventing the loss of crucial information.

Meals on Wheels (MOW) support older people to live in their own homes and communities. The purpose of this paper is to explore MOW experiences from a multi-stakeholder level to inform and better equip this valuable service.

A qualitative approach was undertaken utilising semi-structured interviews and focus groups with current, former and potential MOW service users and MOW stakeholders.

Qualitative analysis explored MOW perspectives and experiences, highlighting a lack of MOW information and awareness, the importance of a client-centred approach the multiple roles of MOW and service transition.

This research explores MOW from the perspective of different groups directly involved in this community service, offering unique multi-stakeholder insights to understand and guide the future of this service.

Mental health recovery across cultures lacks understanding and suitable measures. The Questionnaire about the Process of Recovery (QPR) is a self-report instrument measuring personal recovery outcomes for consumers of mental health services. However, the extent of its relevance among culturally and linguistically diverse (CALD) communities is unclear. This pilot study aimed to examine the relevance and utility of the QPR among CALD consumers of primary mental health services in Australia.

Eleven individual, semi-structured interviews were conducted with two general practitioners (GPs) and nine consumers from two clinics, at locations with high Iranian and Burmese refugee or asylum seeker populations. Interviews were transcribed and analysed using a thematic framework approach.

Although almost all consumers had little or no understanding of the concept of personal recovery, they found the QPR culturally acceptable and understandable. Using the QPR during mental health consultations can help with needs identification and goal setting. Challenges in using the QPR included completion time, cross-cultural differences in concepts and norms for some items, and need for careful translation. Consumers suggested additional items regarding family reputation, sexuality, and spirituality.

The QPR is potentially a valuable tool to support mental health consultations with CALD consumers, from the perspectives of both GPs and consumers.

As supply chain excellence matters, designing an appropriate health-care supply chain is a great consideration to the health-care providers worldwide. Therefore, the purpose of this paper is to benchmark several potential health-care supply chains to design an efficient and effective one in the presence of mixed data.

To achieve this objective, this research illustrates a hybrid algorithm based on data envelopment analysis (DEA) and goal programming (GP) for designing real-world health-care supply chains with mixed data. A DEA model along with a data aggregation is suggested to evaluate the performance of several potential configurations of the health-care supply chains. As part of the proposed approach, a GP model is conducted for dimensioning the supply chains under assessment by finding the level of the original variables (inputs and outputs) that characterize these supply chains.

This paper presents an algorithm for modeling health-care supply chains exclusively designed to handle crisp and interval data simultaneously.

The outcome of this study will assist the health-care decision-makers in comparing their supply chains against peers and dimensioning their resources to achieve a given level of productions.

A real application to design a real-life pharmaceutical supply chain for the public ministry of health in Morocco is given to support the usefulness of the proposed algorithm.

The novelty of this paper comes from the development of a hybrid approach based on DEA and GP to design an appropriate real-life health-care supply chain in the presence of mixed data. This approach definitely contributes to assist health-care decision-makers design an efficient and effective supply chain in today’s competitive word.

Infection and cross-contamination have been massive concerns in the medical field. This study aims to investigate consumers’ awareness and their choices of endoscopes, which may deter them from the cross-contamination problem.

A discrete choice experiment survey was administered to 166 respondents in Penang, Malaysia. Participants were asked to make hypothetical choices and estimate their preference for endoscopes. The multinomial logit model was used to estimate the assumptions based on the stated preference data collected.

Only two-fifths of respondents are aware of their rights regarding endoscope selection. The findings are consistent with utility theory, where choices are made to maximise personal satisfaction. If given the choice, consumers preferred the single-use endoscope over the reusable or the doctor’s preferred endoscope. Price, insurance coverage and personal income are significant determinants of the consumer’s choice of endoscopes.

This study only investigates subjects living in Penang. Other possible important attributes to endoscope choices, such as environmental and device availability may be considered in future study.

The findings may create awareness among consumers about their rights when choosing medical devices. It may also improve health-care institutions’ (users’) and device manufacturers’ (industry players’) understanding of consumer needs and demands from socioeconomic perspectives.

The research offers insights into consumer rights and awareness of health-care services. Ultimately leading to better policy to protect consumers’ rights and safety.

This study contributes to the rare literature on consumer rights toward medical devices, in particular, the consumer’s awareness of the choice of endoscopes.

This paper aims to examine the interaction between gatekeeping and trust in a public sector organization, where employees at lower hierarchical levels are expected to autonomously translate and transform directives into public services. This requires them to have access to operational steering information, i.e. information about directives and how to interpret and apply them. This study focuses on how gatekeeping structures regulate flows of operational steering information and how the gatekeeping structures affect the development of trust.

The research design is qualitative. The data material consisted of semi-structured interviews with 26 employees in home care and schools and of eight complementary nonparticipant observations. Thematic analysis revealed the presence of static and dynamic gatekeeping structures, which are characterized by fixed and variable arrangements of information sources and channels, respectively.

In static gatekeeping structures, managers or domain experts typically act as gatekeepers, and employees also perform gatekeeping activities collectively. Gatekeeping structures allow employees to switch between acting as gatekeepers and being gated, depending on the situation. The results show that gatekeeping structures for intermediation of operational steering information may support or impede employees' work, thus affecting their trust in their peers and their work organization.

Although the present study included both interviews and observations, these primarily occurred within scheduled and prearranged activities rather than capturing the nuances of the typical daily work of teachers and home care employees. As a result, certain perspectives may have been unintentionally omitted.

The participants were recruited through the City of Oslo contact people, which may have impacted their status or perception in some way. Moreover, the study was conducted in the City of Oslo, a specific organization with its own unique set of values, norms and processes. The trust-based management in the City of Oslo is likely not representative of all public sector organizations.

This study contributes conceptually by introducing gatekeeping structures and operational steering information and empirically by providing evidence of their relationship to trust development in public service delivery. Thus, it contributes to the research fields of information management and public administration.

The purpose of this paper is to report on the dynamics of “identity leadership” with a quality improvement project undertaken by an International Medical Graduate (IMG) from Sri Lanka, on a two year Medical Training Initiative (MTI) placement in the National Health Service (NHS) [Academy of Medical Royal Colleges (AoMRC), 2017]. A combined MTI rotation with an integrated Fellowship in Quality Improvement (Subedi et al., 2019) provided the driver to implement the HEART score (HS) in an NHS Emergency Department (ED) in the UK. The project was undertaken across ED, Acute Medicine and Cardiology at the hospital, with stakeholders emphasizing different and conflicting priorities to improve the pathway for chest pain patients.

A social identity approach to leadership provided a framework to understand the insider/outsider approach to leadership which helped RH to negotiate and navigate the conflicting priorities from each departments’ perspective. A staff survey tool was undertaken to identify reasons for the lack of implementation of a clinical protocol for chest pain patients, specifically with reference to the use of the HS. A consensus was reached to develop and implement the pathway for multi-disciplinary use of the HS and a quality improvement methodology (with the use of plan do study act (PDSA) cycles) was used over a period of nine months.

The results demonstrated significant improvements in the reduction (60%) of waiting time by chronic chest pain patients in the ED. The use of the HS as a stratified risk assessment tool resulted in a more efficient and safe way to manage patients. There are specific leadership challenges faced by an MTI doctor when they arrive in the NHS, as the MTI doctor is considered an outsider to the NHS, with reduced influence. Drawing upon the Social Identity Theory of Leadership, NHS Trusts can introduce inclusion strategies to enable greater alignment in social identity with doctors from overseas.

More than one third of doctors (40%) in the English NHS are IMGs and identify as black and minority ethnic (GMC, 2019a) a trend that sees no sign of abating as the NHS continues its international medical workforce recruitment strategy for its survival (NHS England, 2019; Beech et al., 2019). IMGs can provide significant value to improving the NHS using skills developed from their own health-care system. This paper recommends a need for reciprocal learning from low to medium income countries by UK doctors to encourage the development of an inclusive global medical social identity.

This quality improvement research combined with identity leadership provides new insights into how overseas doctors can successfully lead sustainable improvement across different departments within one hospital in the NHS.