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Exploding expenditure in health care has led to new reimbursement regulations forcing health care providers to conduct their organisations as business concerns. In order to be competitive providers have started to build networks that allow the delivery of interrelated health services in a well‐adjusted and uniform manner. However, besides strategic agreement, successful networking requires the support of information systems for efficient cooperation and process management in order to deliver efficient day to day service. With serviceflow management we provide a general concept that answers these needs. Based on modelling process patterns and the exchange of XML‐representations of process knowledge and data between service providers, serviceflow management supports organisations in jointly delivering services that cross provider boundaries. Furthermore, it enables flexible handling of processes, which is indispensable in health care. Based on a health care example, we explore the possibilities of serviceflow management and present a Web‐based prototype on the basis of our generic, four‐layered architecture.

Existing descriptions of trust in health care largely assume a straightforward association between a patient’s relationship with a regular provider and his or her trust in health care. I extend status characteristics theory (SCT) and social identity theory (SIT) to suggest greater variability in this association by investigating the role of social differences between patients and their regular providers. Whereas the SIT extension predicts lower trust in dissimilar than similar dyads, the predictions from the SCT extension depend on status in dissimilar dyads. Further, research examining how social differences in patient–provider dyads shape trust largely emphasizes racial differences, but the theories implicate gender differences too.

I analyze a longitudinal dataset of patient–provider dyads offering a conservative test of the extensions.

Results generally support predictions from the SCT extension. Specifically, patients’ status based on differences in either race or gender: (1) is inversely related to their trust in health care and (2) influences the resiliency of their trust, whereby the degree health care met prior expectations matters less (more) for the trust of low (high) status patients than equal status patients.

When patients and providers differ on both race and gender, findings sometimes depart from predictions. This indicates differences in two social categories is a unique situation where the contributions of each category are distinct from that of the other.

This research extends SCT to explain greater variability in the connection between patient–provider dyads and trust in health care, while also showing how gender compares to race.

This paper considers some implications of recent developments relating to patient safety for understandings of trust in health care contexts.

Conceptual analysis focusing on patients' trust in health care providers and health care providers' trust in patients.

Growing awareness of the scale of the problem of iatrogenic harm has prompted concerns that patients' trust in health care providers may be threatened and/or become inappropriate or dysfunctional. In principle, however, patients' trust may be both well placed and compatible with current understandings of safety problems and efforts to address these. Contemporary understandings of patient safety suggest that, to be deemed trustworthy, health care providers should make vigorous efforts to improve patient safety, be honest about safety issues, enable patients to contribute effectively to their own safety, and provide appropriate care and support after safety incidents. Patients who trust health care providers need not be ignorant of patient safety problems and may be vigilant in the course of their care. Iatrogenic harms do not necessarily reflect breeches of trust (not all such harms are yet preventable), and patients who are harmed might in some circumstances appropriately forgive and resume trusting. Health care providers may feel vulnerable to patients in several respects. From their perspective, trustworthy patients will act competently to optimise the outcomes of their health care efforts and to preserve health care providers' good reputations where those are justified. Providers' trust in patients may strengthen patients' trust in them and facilitate safety improvement work.

Shows how, in principle, trust can be compatible with current understandings of patient safety issues and may enhance efforts to improve patient safety.

In 2017, the WHO presented a framework of priorities and guiding principles to promote the health of refugees and migrants (WHO, 2017). The purpose of this paper is to analyze a crucial but understudied aspect for the implementation of this framework, namely, healthcare providers’ images of refugees and their use of health services.

A preliminary study first addresses images of refugees and their use of health services derived from the literature. This is followed by an empirical case study of antenatal and delivery service to Eritrean refugee women in Israel. The case study explores providers’ (n=8) images of Eritrean women and their use of services as well as Eritrean women’s (n=10) reflections on their own use of these services, examining the degree to which providers’ images correspond with Eritrean women’s realities.

The preliminary study shows how the literature largely tends to picture refugees as medicalized and disempowered. The case study illustrates that providers of Israeli antenatal and delivery services embrace similar images, although they are more nuanced. The reflections of Eritrean women show that providers’ images partially reflect their realities. However, Eritrean women attribute these images to external constraints, whereas providers attribute these images to innate characteristics of Eritrean women. Together, these findings suggest that implementation of the recently introduced WHO framework is at stake.

This study raises awareness of a crucial but understudied aspect regarding implementation of a recently introduced universal framework for promoting the health of refugees and migrants.

Karen people from Burma are a new population in resettlement countries. While research increasingly documents their health needs, few studies describe how health-care providers adapt their practices to serve this group. The purpose of this study was to explore the experiences of providers who work with Karen patients/clients in health settings, documenting the challenges they face, how they adapt their practice and recommendations.

This study used a qualitative survey and one phone interview with a total of 20 providers who had first-hand experience caring for Karen people in health settings. Data were analyzed using qualitative content analysis.

Two main categories described challenges providers faced in working with Karen people in health settings: system-level challenges and interpersonal communication challenges. Five main categories described specific strategies and support needed to adapt practice for Karen patients in health settings: strategies for improving communication and mutual understanding; partnering with Karen staff, interpreters and cultural brokers; strategies for building trust and rapport; addressing needs related to case management, care coordination and social determinants of health; recommendations for provider training.

This paper contributes suggestions for adapting practice to meet the health needs of Karen people from the perspective of health-care providers in a location that is nationally recognized for its excellence in refugee health.

One of the most affected groups during the COVID-19 pandemic was health-care providers due to the direct and continuous exposure to the virus and a lack of sufficient medical equipment. Palestinian health-care providers were exposed to several challenges related to their work environment as they worked in war-like conditions; therefore, this study aims to explore health-care providers’ perceptions, perspectives, challenges and human rights-related concerns during the COVID-19 Pandemic in Palestine.

The sample comprised 30 health-care providers 26–35 years, who were purposively selected from among health-care providers in two Palestinian cities, Nablus and Tulkarm, located in the north of the West Bank. Thematic content analysis was applied to transcripts of interviews with the practitioners to identify key themes.

The thematic content analysis showed that the pandemic and quarantine negatively affect the mental health outcomes, daily routine and social relations of health-care providers. The main challenges related to human rights violations and faced by the health-care providers include a lack of sufficient infrastructure, lack of medical equipment’s and protective gear, military occupation and a shortage of health-care providers in general, especially those who practice in speciality fields such as neurology, oncology, pediatric surgery and clinical psychology.

Further investigations are recommended to test different variables related to health-care providers’ work during the COVID-19 pandemic. This paper also recommends conducting studies targeting Palestinian health-care providers’ training and supervision services to improve their skills and resiliency in dealing with future crises.

The present work is the first to examine health-care providers’ perceptions, perspectives, challenges and human rights concerns during the COVID-19 pandemic in Palestine. This novel sample resides in a political and social environment characterized by high environmental stressors due to decades of military and political violence (e.g. militarization, poverty, lack of employment opportunities, cultural pressures, human rights violations, etc.)

To investigate the effects of payor–provider integration on the operational performance of health service provision. The research explores whether integration governs agency problems and tilts the incentives of diverse actors toward more systematic outcomes.

A two stage multimethod case study of occupational health services. A qualitative stage aimed to understand the reasons, mechanisms, and outcomes of payor–provider integration. A quantitative stage evaluated the performance of the integrated hospital against fee-for-service partner hospitals with a sample of 2,726 patients.

Payor–provider integration mitigates agency problems on multiple levels of the service system by complementing formal governance mechanisms with informal mechanisms. Compared to partner hospitals, the integrated hospital yielded 9% lower the total costs of occupational injuries achieved primarily by emphasizing conservative care and faster recovery.

Focuses on occupational health services in Finland. Provides initial evidence of the effects of payor–provider integration on the operational performance.

Vertical integration may provide systematic outcomes but requires mindful implementation of multiple mechanisms. Rigorous change management initiative is advised.

For patients, the research shows payor–provider integration of health services can be implemented in a manner that it reduces care costs while not compromising care quality and customer satisfaction.

This study provides a rare longitudinal analysis of payor–provider integration in health-care operations management. The study adds to the knowledge of operational performance improvement of health services.

Recent evidence on consumer decision-making suggests that highly complex choice scenarios lead consumers to use simplistic decision heuristics, often resulting in suboptimal decision-making. This study aims to investigate the relationships among consumers’ primary information source, patient satisfaction and patient well-being, specifically focused on the search for mental health professionals. The selection of a mental health provider is of interest, because practitioners work from a highly diverse set of theoretical bases, may hold a wide range of different credentials and provide drastically different therapeutic approaches, therefore making the selection complex and difficult for consumers to self-navigate.

Three studies were undertaken, with data sampling from both patients of mental health services and practitioners.

Consumers selecting a provider based on self-performed searches, rather than receiving external input (referrals from physicians, relatives or friends), report lower satisfaction with their mental health provider. In turn, patient satisfaction positively impacts patient well-being. Practitioner data corroborate these findings, revealing that a large percentage of patients stem from a self-performed internet search, though mental health providers recognize that external referrals are likely to lead to better outcomes.

The results reveal the importance of understanding the consumer search and, particularly, the use of the internet as a search tool. The results present several implications for service providers, including the need to identify patients’ primary source utilized within an information search, as it can adversely impact patient satisfaction.

Based on a case study in Hamilton, Ontario, Canada, the purpose of this paper is to explore the difficulties faced by local health care providers in the face of constantly evolving refugee policies, programs, and arrivals. In doing so, it illustrates the complications faced by service providers in providing care to refugee arrivals and how the diversity of arrivals challenges health care provision and ultimately the health and well-being of refugees.

A series of semi-structured, in-depth interviews with key service professionals in both the social service and health fields in Hamilton, Ontario, Canada, examined both health and health care issues.

Beyond challenges for service providers that have been previously flagged in the literature, including language barriers and the limited time that they have with their clients, analysis revealed that health care providers faced other challenges in providing care, with one challenge reflecting the difficulty of providing care and services to a diverse refugee population. A second challenge reflected the lack of knowledge associated with constantly evolving policies and programs. Both challenges potentially limit the abilities of care providers.

On-going changes to refugee and health care policy, along with the diversity of refugee arrivals, will continue to challenge providers. The challenge, therefore, for health care providers and policy makers alike is how to ensure adequate service provision for new arrivals.

The Federal government should do a better job in disseminating the impact of policy changes and should streamline programs. This is particularly relevant given limited budgets and resources, tri-partite government funding, short time-frames to prepare for new arrivals, inadequate background information, barriers/challenges or inequitable criteria for access to health and social services, while addressing an increasingly diverse and complex population.

The research reinforces the complexity of the needs and challenges faced by refugees when health is considered, and the difficulty in providing care to this group.

While there is a large refugee health literature, there is relatively little attention to the challenges and difficulties faced by service providers in addressing the health needs of the diverse refugee population, a topic that is particularly important given limited funding envelopes, shifting policies and programs, and a focus on clients (refugees). It is this latter piece – the challenges faced by providers in providing care to refugees – which this paper explores.

In an effort to address health care disparities, U.S. laws mandate that health care organizations provide free language interpreting and translation anytime a patient and health care provider cannot communicate in the same language. The heretofore absence of legislative and professional oversight in health care interpreting allows for anyone to interpret. A qualitative study was conducted to understand the conditions and practices of bilingual staff who interpret as a secondary part of their job in community health clinics.

Four focus groups were conducted as part of a study on shared decision-making during interpreted medical visits in a busy, urban clinic serving a large number of limited English proficient (LEP) patients. The focus groups were designed to understand the process of interpreting and how interpreters influence medical decisions between LEP patients and their health care providers. To understand the interpreting process from multiple perspectives, one focus group was conducted with users of interpreters – monolingual health care providers (N=6), two with Spanish speaking men (N=10) who were experienced with interpreted health visits, and one with bilingual staff (N=5) who interpret as an ad hoc feature of their job, also known as dual-role medical interpreters.

Dual-role interpreters use different styles while interpreting what is communicated between health care providers and patients. In some cases, they provide near word-for-word interpretation of what is said. In other cases, they summarize and or paraphrase multiple sentences, seek clarity through questions, and deconstruct culturally laden and technical terms. In still other cases, dual-role interpreters combine interpretation styles within a single interactional exchange. Each of the three major styles of interpreting has advantages in medical settings. Specific style is influenced by health care provider preference, interpreter–health care provider trust and familiarity, and interpreter medical knowledge. Interpreters are challenged by the patients’ dialects, educational level, provider personalities, gender issues, and out of clinic relationships with the patients. Contextual conditions and contingencies of reinforcement contributed to varying methods of interpretation. These conditions included organizational policies, language and bilingual communication, and social relations with both the health care providers and the patients.

These findings demonstrate the complexity of medical interpretation and the critical involvement of health care providers and bilingual staff in facilitating interpreted encounters. Findings suggest the need for training both health care providers and interpreters and possible change in reimbursement for services.