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Open Access
Article
Publication date: 10 April 2017

Sara Korlén, Anna Essén, Peter Lindgren, Isis Amer-Wahlin and Ulrica von Thiele Schwarz

Policy makers are applying market-inspired competition and financial incentives to drive efficiency in healthcare. However, a lack of knowledge exists about the process whereby…

9866

Abstract

Purpose

Policy makers are applying market-inspired competition and financial incentives to drive efficiency in healthcare. However, a lack of knowledge exists about the process whereby incentives are filtered through organizations to influence staff motivation, and the key role of managers is often overlooked. The purpose of this paper is to explore the strategies managers use as intermediaries between financial incentives and the individual motivation of staff. The authors use empirical data from a local case in Swedish specialized care.

Design/methodology/approach

The authors conducted an exploratory qualitative case study of a patient-choice reform, including financial incentives, in specialized orthopedics in Sweden. In total, 17 interviews were conducted with professionals in managerial positions, representing six healthcare providers. A hypo-deductive, thematic approach was used to analyze the data.

Findings

The results show that managers applied alignment strategies to make the incentive model motivating for staff. The managers’ strategies are characterized by attempts to align external rewards with professional values based on their contextual and practical knowledge. Managers occasionally overruled the financial logic of the model to safeguard patient needs and expressed an interest in having a closer dialogue with policy makers about improvements.

Originality/value

Externally imposed incentives do not automatically motivate healthcare staff. Managers in healthcare play key roles as intermediaries by aligning external rewards with professional values. Managers’ multiple perspectives on healthcare practices and professional culture can also be utilized to improve policy and as a source of knowledge in partnership with policy makers.

Details

Journal of Health Organization and Management, vol. 31 no. 2
Type: Research Article
ISSN: 1477-7266

Keywords

Open Access
Article
Publication date: 29 April 2021

Sanjeev Singh, Damodar Sahu, Ashish Agrawal and Meeta Dhaval Vashi

A qualitative study can help in understanding the unpolluted perspectives of key stakeholders involved in the vaccination practices and can explore vital factors that could…

1509

Abstract

Purpose

A qualitative study can help in understanding the unpolluted perspectives of key stakeholders involved in the vaccination practices and can explore vital factors that could influence vaccination-related behaviors and their utilization. This study aims to document the perceptions of caretakers, community members and healthcare service providers related to childhood vaccination practices in slums under the national immunization program (NIP) of India.

Design/methodology/approach

This was a qualitative community-based cross-sectional study. Focus group discussions with caretakers, community members and healthcare service providers were used to build a holistic, detailed description and analysis of the factors associated with childhood vaccination practices within its real-world context.

Findings

Lack of awareness, fear of adverse events following immunization, inappropriate timing of vaccination sessions, loss of daily earnings, migration, lack of good behavior of health staffs, shortage of logistics and vaccines, limited resources and infrastructures and high expectations of beneficiaries were some of the vital barriers impacting vaccination practices in slums.

Research limitations/implications

Though this study provides significant good information on the indicators that can be considered to improve the vaccination practices in any slum settings, it has is also a limitations too due to its setting. Therefore, one needs to be cautious while generalizing these results to other settings like rural. In addition, Though we believe that these strategies could be useful in any setting, it is also important to tailor these observations them as per the need of the society and the population. Also, this is a self-reported qualitative study and therefore the perspectives reported in this study need to be taken with caution. Further, low vaccination, poor awareness, compromised healthcare services, high expectations could be considered as a stigma/fear among the responders and therefore there is always a chance of underreporting. Thus, it would be important in future to conduct a study involving a broader group of people in society and to establish factors associated with the vaccination coverage. that can help in improvement of vaccination.

Originality/value

Initiatives such as regular interactions at different levels, effective communication including reminders, behavior interventions, the continued supply of vaccines and logistics, additional resources for the vaccination program, incentives and recognition, extended sessions and people-friendly healthcare delivery system could be helpful to strengthen the routine vaccination practices in slums.

Details

Journal of Health Research, vol. 36 no. 4
Type: Research Article
ISSN: 0857-4421

Keywords

Open Access
Article
Publication date: 11 March 2021

Niharika Mahajan and Baljit Kaur

This study aimed to analyze the role of community health workers (CHWs) called accredited social health activists (ASHAs) in improving maternal health outcomes in the rural…

1352

Abstract

Purpose

This study aimed to analyze the role of community health workers (CHWs) called accredited social health activists (ASHAs) in improving maternal health outcomes in the rural community of Punjab, India. The study also examined the expectations of these workers from the community and identified the problems faced by them in carrying out their roles.

Design/methodology/approach

Using multistage sampling, a total of 28 villages were selected from seven districts of Punjab, and from these selected villages, a total of 57 ASHAs working as the interface between the rural community and the public health system and 420 women who had delivered a baby were interviewed.

Findings

Desire to earn money was the most prominent reason for joining the community work program, but ASHAs felt overburdened and underpaid compared to their work commitments. Not only was the incentive paid to these workers was insufficient and irregular but they also suffered at the hands of medical staff at public hospitals.

Originality/value

While exploring the problems experienced by the CHWs, this study recommends opting for a mix of monetary and nonmonetary incentives for acknowledging the work of CHWs. The study is the first of its kind for the state of Punjab battling with a worsening maternal mortality rate (MMR).

Details

Journal of Health Research, vol. 36 no. 2
Type: Research Article
ISSN: 0857-4421

Keywords

Open Access
Book part
Publication date: 6 May 2019

Paul Kocken, Eline Vlasblom, Gaby de Lijster, Helen Wells, Nicole van Kesteren, Renate van Zoonen, Kinga Zdunek, Sijmen A. Reijneveld, Mitch Blair and Denise Alexander

There is considerable heterogeneity between primary care systems that have evolved in individual national cultural environments. Models of Child Health Appraised (MOCHA) studied…

Abstract

There is considerable heterogeneity between primary care systems that have evolved in individual national cultural environments. Models of Child Health Appraised (MOCHA) studied how the transfer of models or their individual components can be achieved across nations, using examples of combinations of settings, functions, target groups and tracer conditions. There are many factors that determine the feasibility of successful transfer of these from one setting to another, which must be recognised and taken into account. These include the environment of the care system, national policy-making and contextual means of directing population behaviour – in the form of penalties and incentives, which cannot be assessed or expected to work by means of rational actions alone. MOCHA developed a list of criteria to assess transferability, summarised in a population characteristics, intervention content, environment and transfer (PIET-T) process. To explore the process and means of transferability, we obtained consensus statements from the researchers on optimum model scenarios and conducted a survey of stakeholders, professionals and users of children’s primary care services that involved three specific health topics: vaccination coverage in infants, monitoring of a chronic or complex condition and early recognition of mental health problems. The results give insight into features of transferability – such as the availability and the use of guidelines and formal procedures; the barriers and facilitators of implementation and similarities and differences between model practices and the existing model of child primary care in the country. We found that successful transfer of an optimal model is impossible without tailoring the model to a specific country setting. It is vital to be aware of the sensitivity of the population and environmental characteristics of a country before starting to change the system of primary care.

Details

Issues and Opportunities in Primary Health Care for Children in Europe
Type: Book
ISBN: 978-1-78973-354-9

Keywords

Open Access
Article
Publication date: 14 February 2020

Rod Sheaff, Verdiana Morando, Naomi Chambers, Mark Exworthy, Ann Mahon, Richard Byng and Russell Mannion

Attempts to transform health systems have in many countries involved starting to pay healthcare providers through a DRG system, but that has involved managerial workarounds…

2323

Abstract

Purpose

Attempts to transform health systems have in many countries involved starting to pay healthcare providers through a DRG system, but that has involved managerial workarounds. Managerial workarounds have seldom been analysed. This paper does so by extending and modifying existing knowledge of the causes and character of clinical and IT workarounds, to produce a conceptualisation of the managerial workaround. It further develops and revises this conceptualisation by comparing the practical management, at both provider and purchaser levels, of hospital DRG payment systems in England, Germany and Italy.

Design/methodology/approach

We make a qualitative test of our initial assumptions about the antecedents, character and consequences of managerial workarounds by comparing them with a systematic comparison of case studies of the DRG hospital payment systems in England, Germany and Italy. The data collection through key informant interviews (N = 154), analysis of policy documents (N = 111) and an action learning set, began in 2010–12, with additional data collection from key informants and administrative documents continuing in 2018–19 to supplement and update our findings.

Findings

Managers in all three countries developed very similar workarounds to contain healthcare costs to payers. To weaken DRG incentives to increase hospital activity, managers agreed to lower DRG payments for episodes of care above an agreed case-load ‘ceiling' and reduced payments by less than the full DRG amounts when activity fell below an agreed ‘floor' volume.

Research limitations/implications

Empirically this study is limited to three OECD health systems, but since our findings come from both Bismarckian (social-insurance) and Beveridge (tax-financed) systems, they are likely to be more widely applicable. In many countries, DRGs coexist with non-DRG or pre-DRG systems, so these findings may also reflect a specific, perhaps transient, stage in DRG-system development. Probably there are also other kinds of managerial workaround, yet to be researched. Doing so would doubtlessly refine and nuance the conceptualisation of the ‘managerial workaround’ still further.

Practical implications

In the case of DRGs, the managerial workarounds were instances of ‘constructive deviance' which enabled payers to reduce the adverse financial consequences, for them, arising from DRG incentives. The understanding of apparent failures or part-failures to transform a health system can be made more nuanced, balanced and diagnostic by using the concept of the ‘managerial workaround'.

Social implications

Managerial workarounds also appear outside the health sector, so the present analysis of managerial workarounds may also have application to understanding attempts to transform such sectors as education, social care and environmental protection.

Originality/value

So far as we are aware, no other study presents and tests the concept of a ‘managerial workaround'. Pervasive, non-trivial managerial workarounds may be symptoms of mismatched policy objectives, or that existing health system structures cannot realise current policy objectives; but the workarounds themselves may also contain solutions to these problems.

Details

Journal of Health Organization and Management, vol. 34 no. 3
Type: Research Article
ISSN: 1477-7266

Keywords

Open Access
Article
Publication date: 1 December 2020

Richard Colbran, Robyn Ramsden, Michael Edwards, Emer O'Callaghan and Dave Karlson

While Australia has continued to invest in polices and strategies aimed at improving rural health service provision, many communities still confront a disproportionate share of…

1319

Abstract

Purpose

While Australia has continued to invest in polices and strategies aimed at improving rural health service provision, many communities still confront a disproportionate share of the rural workforce shortage. The NSW Rural Doctors Network (RDN) contributes its perspectives about the importance of a whole of life career and the meandering stream concept to support the retention of health professionals rurally. We unpack these concepts and examine how they bring to light a new and useful approach to addressing rural workforce challenges and potentially contribute to building a stronger integrated care approach.

Design/methodology/approach

The approach used involved tapping into RDN's 30-years of experience in recruitment and retention of remote and rural health professionals, combined with insights from relevant existing and emerging evidence.

Findings

We suggest that reframing retention to consider a life stage approach to career will guide more effective targeting of rural health policies, workforce planning, collaborative approaches and allocation of incentives. We posit that an understanding and acceptance of modern lifestyles and career pathways, and a celebration of career commitment to serving rural communities, is necessary for successful recruitment and retention of Australia's future rural health workforce beyond the training pipeline.

Originality/value

We outline and visually represent RDN's meandering stream approach to building and retaining a capable rural health workforce through addressing life cycle and workforce level needs. This perspective paper draws on RDN's direct experience in the field.

Details

Journal of Integrated Care, vol. 30 no. 5
Type: Research Article
ISSN: 1476-9018

Keywords

Open Access
Article
Publication date: 8 October 2020

Craig Marshall

This research study included an examination into the extent that a comprehensive wellness program affects employees' job satisfaction levels. As the leaders of more hospitality…

14027

Abstract

Purpose

This research study included an examination into the extent that a comprehensive wellness program affects employees' job satisfaction levels. As the leaders of more hospitality organizations implement wellness programs in the workplace, they will want to understand what factors, besides the employees' health, the wellness programs can impact. Survey participants were self-identified employees of the hospitality organization who did or did not participate in the wellness program. Research findings indicated there was a significant difference in extrinsic and intrinsic job satisfaction levels between employees who participated and employees who were nonparticipating in the wellness program.

Design/methodology/approach

The population for this study was from a contract foodservice organization that provides facility services to higher education organizations, from their northeast regional location that consisted of approximately 200 employees. The employees of the organization ranged from entry-level positions, up to and including senior-level management. The researcher solicited employees in all departments in the organization to participate in the survey. The company offers a comprehensive wellness program, and all employees in the organization had a choice to participate in the wellness program.

Findings

The intent of the study was to determine if participating in a wellness program affected the employee's job satisfaction levels. Securing a hospitality organization to survey was a challenge, possibly because the survey included questions about job satisfaction. The purpose of the study was to identify whether participation in the wellness program affected employees' extrinsic and intrinsic job satisfaction levels. Hospitality organizations continue to allocate resources to implement and improve existing wellness programs in the workplace. Researchers had not specifically focused on the potential impact a wellness program might have on employee job satisfaction levels. Cyboran and Goldsmith (2012) concluded organization leaders should take steps to create an effective workplace. The study showed that even though hospitality organization leaders are dedicating resources to the development and implementation of wellness programs, participating in the wellness program has an effect on increasing or maintaining current employees' extrinsic and intrinsic job satisfaction levels throughout the organization.

Originality/value

This is the author’s research that was conducted for a dissertation that has been turned into a research article for publication.

Details

International Hospitality Review, vol. 34 no. 2
Type: Research Article
ISSN: 2516-8142

Keywords

Open Access
Article
Publication date: 26 January 2018

Samlee Plianbangchang

The purpose of this paper is to disseminate among concerned professionals its certain operational aspects, including some possible implications on health and medical care…

4661

Abstract

Purpose

The purpose of this paper is to disseminate among concerned professionals its certain operational aspects, including some possible implications on health and medical care practices.

Design/methodology/approach

It is written on the basis of the author’s special study of a diverse source of information, as well as on author’s practical experience and observation in this particular area.

Findings

Special attention is paid to possible public health impacts within a broad social and economic framework, as well as to its impacts on the existing national health care systems in countries, that would possibly lead to certain degree of inequity in health at national level as an important consequence of health development progress.

Originality/value

Knowledge and understanding gained from this paper might be useful in the efforts to develop and manage national health care systems to ensure a reasonable balance in health status of people of all groups.

Details

Journal of Health Research, vol. 32 no. 1
Type: Research Article
ISSN: 2586-940X

Keywords

Open Access
Book part
Publication date: 6 May 2019

Mitch Blair, Mariana Miranda Autran Sampaio, Michael Rigby and Denise Alexander

The Models of Child Health Appraised (MOCHA) project identified the different models of primary care that exist for children, examined the particular attributes that might be…

Abstract

The Models of Child Health Appraised (MOCHA) project identified the different models of primary care that exist for children, examined the particular attributes that might be different from those directed at adults and considered how these models might be appraised. The project took the multiple and interrelated dimensions of primary care and simplified them into a conceptual framework for appraisal. A general description of the models in existence in all 30 countries of the EU and EEA countries, focusing on lead practitioner, financial and regulatory and service provision classifications, was created. We then used the WHO ‘building blocks’ for high-performing health systems as a starting point for identifying a good system for children. The building blocks encompass safe and good quality services from an educated and empowered workforce, providing good data systems, access to all necessary medical products, prevention and treatments, and a service that is adequately financed and well led. An extensive search of the literature failed to identify a suitable appraisal framework for MOCHA, because none of the frameworks focused on child primary care in its own right. This led the research team to devise an alternative conceptualisation, at the heart of which is the core theme of child centricity and ecology, and the need to focus on delivery to the child through the life course. The MOCHA model also focuses on the primary care team and the societal and environmental context of the primary care system.

Details

Issues and Opportunities in Primary Health Care for Children in Europe
Type: Book
ISBN: 978-1-78973-354-9

Keywords

Open Access
Book part
Publication date: 22 March 2021

Sophie Guthmuller, Paolo Paruolo and Stefano Verzillo

This chapter summarises the role of EU actions in supporting healthcare policies in the EU Member States, both looking at implemented actions and describing current priorities for…

Abstract

This chapter summarises the role of EU actions in supporting healthcare policies in the EU Member States, both looking at implemented actions and describing current priorities for the future. It argues that these coordinated actions can be beneficial for EU Member States by helping them to avoid duplication of effort and to attain economies of scale. Moreover, data sharing with proper safeguards can unleash vast amount of ‘learning what works’ both for medical treatments and for healthcare sustainability measures. The need for this common learning appears ever more urgent while facing the health and economic consequences of the present pandemic.

Details

The Sustainability of Health Care Systems in Europe
Type: Book
ISBN: 978-1-83909-499-6

Keywords

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