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1 – 10 of 475Decentralization has profound implications for many health systems. This study investigates the effect of health system decentralization in Organization for Economic Co-operation…
Abstract
Purpose
Decentralization has profound implications for many health systems. This study investigates the effect of health system decentralization in Organization for Economic Co-operation and Development (OECD) countries on public health security capacity and health service satisfaction.
Design/methodology/approach
Multiple linear regression analyses were employed for variables related to the level of health security capacity and satisfaction with the healthcare system while controlling for all socio-demographic variables from the European Social Survey, including over 44,000 respondents from 25 OECD countries. The Health Systems in Transition series of countries were used for assessing the decentralization level.
Findings
The result of multiple linear regression analyses showed that the level of decentralization in health systems was significantly associated with higher health security capacity (ß-coefficient 3.722, 95% confidence interval (CI) [3.536 3.908]; p=<0.001) and health service satisfaction (ß-coefficient 1.463, 95% CI [1.389 1.536]; p=<0.001) in the study. Countries with a higher level of decentralization in health policy tasks and areas were significantly likely to have higher health services satisfaction, whereas this satisfaction had a significant negative relation with the lower level of decentralization status of secondary/tertiary care services in OECD countries (ß-coefficient −5.250, 95% CI [−5.757–4.743]; p = 0.001).
Originality/value
This study contributes to a better understanding of the extent to which decentralization of health services affects public health safety capacity and satisfaction with health services, whereas the level of decentralization in OECD countries varies considerably. Overall, the findings highlight the importance of public health security and satisfaction with health care delivery in assessing the effects of decentralization in health services.
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Victor Pimentel and Carlo A. Mora-Monge
This study aims to benchmark the operational efficiency of fifty-eight public hospitals across Mexico between 2015 and 2018 and identifies the most critical inputs affecting their…
Abstract
Purpose
This study aims to benchmark the operational efficiency of fifty-eight public hospitals across Mexico between 2015 and 2018 and identifies the most critical inputs affecting their efficiency. In doing so, the study analyzes the impact of policy changes in the Mexican healthcare system introduced in recent years.
Design/methodology/approach
To measure the operational efficiency of Mexican public hospitals, data envelopment analysis (DEA) window analysis variable returns to scale (VRS) methodology using longitudinal data collected from the National Institute for Transparency and Access to Information (IFAI). Hospital groups are developed and compared using a categorization approach according to their average and most recent efficiency.
Findings
Results show that most of the hospitals in the study fall in the moving ahead category. The hospitals in the losing momentum or falling behind categories are mostly large units. Hospitals with initially low efficiency scores have either increased their efficiency or at least maintained a steady improvement. Finally, the findings indicate that most hospitals classified as moving ahead focused on a single care area (cancer, orthopedic care, child care and trauma).
Research limitations/implications
This study examined the technical efficiency of the Mexican healthcare system over a four-year period. Contrary to conventional belief, results indicate that most public Mexican hospitals are managed efficiently. However, recent changes in public and economic policies that came into effect in the current administration (2018) will likely have long-lasting effects on the hospitals' operational efficiency, which could impact the results of this study.
Originality/value
To the best of authors’ knowledge, this is the first study that examines the efficiency of the complex Mexican healthcare system using longitudinal data.
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A large number of studies indicate that coercive forms of organizational control and performance management in health care services often backfire and initiate dysfunctional…
Abstract
Purpose
A large number of studies indicate that coercive forms of organizational control and performance management in health care services often backfire and initiate dysfunctional consequences. The purpose of this article is to discuss new approaches to performance management in health care services when the purpose is to support innovative changes in the delivery of services.
Design/methodology/approach
The article represents cross-boundary work as the theoretical and empirical material used to discuss and reconsider performance management comes from several relevant research disciplines, including systematic reviews of audit and feedback interventions in health care and extant theories of human motivation and organizational control.
Findings
An enabling approach to performance management in health care services can potentially contribute to innovative changes. Key design elements to operationalize such an approach are a formative and learning-oriented use of performance measures, an appeal to self- and social-approval mechanisms when providing feedback and support for local goals and action plans that fit specific conditions and challenges.
Originality/value
The article suggests how to operationalize an enabling approach to performance management in health care services. The framework is consistent with new governance and managerial approaches emerging in public sector organizations more generally, supporting a higher degree of professional autonomy and the use of nonfinancial incentives.
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Atsushi Katsuda, Yoshiyuki Naito and Toshihiko Ishihara
In Japan, health-care systems have long been supported by physicians' long working hours. To solve this problem, there is an urgent need to improve the working environment for…
Abstract
Purpose
In Japan, health-care systems have long been supported by physicians' long working hours. To solve this problem, there is an urgent need to improve the working environment for physicians while practicing patient-centered medicine and controlling health-care costs. This paper aims to examine the effect of task shifting to nurses and discuss its usefulness from the perspective of health-care value co-creation.
Design/methodology/approach
This paper analyzes task shifting to nurses in acute care hospitals in Japan as a solution for the shortage of anesthesiologists. The authors discuss how the value was created from the perspective of the health-care ecosystem, with conceptual consideration of the value co-creation mechanism through patient-centered practices.
Findings
The study showed that task shifting initiatives in Japan can improve the motivation of nurses through human resource development while maintaining high quality. The study also suggested that task shifting from physicians to nurses may contribute to improving net income and maintaining the health-care system.
Practical implications
The findings are highly reproducible and can be immediately applied to initiatives at other medical institutions in Japan. Furthermore, it is suggested that these findings might provide some perspective on the realignment of fragmented healthcare in the USA.
Originality/value
It was confirmed in practical terms that micro-level initiatives have an impact on the macro level as well. In addition, the academic presentation of the concept has contributed to the deepening of value research.
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As part of a national plan to govern professional and organizational development in Norwegian specialist healthcare, the country’s hospital clinics are tasked with constructing…
Abstract
Purpose
As part of a national plan to govern professional and organizational development in Norwegian specialist healthcare, the country’s hospital clinics are tasked with constructing development plans. Using the development plan as a case, the paper analyzes how managers navigate and legitimize the planning process among central actors and deals with the contingency of decisions in such strategy work.
Design/methodology/approach
This study applies a qualitative research design using a case study method. The material consists of public documents, observations and single interviews, covering the process of constructing a development plan at the clinical level.
Findings
The findings suggest that the development plan was shaped through a multilevel translation process consisting of different contending rationalities. At the clinical level, the management had difficulties in legitimizing the process. The underlying tension between top-down and bottom-up steering challenged involvement and made it difficult to manage the contingency of decisions.
Practical implications
The findings are relevant to public sector managers working on strategy documents and policymakers identifying challenges that might hinder the fulfillment of political intentions.
Originality/value
This paper draws on a case from Norway; however, the findings are of general interest. The study contributes to the academic discussion on how to consider both the health authorities’ perspective and the organizational perspective to understand the manager’s role in handling the contingency of decisions and managing paradoxes in the decision-making process.
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Mijeong Kim, Inseong Jeong and Johngseok Bae
Research has suggested that employees interpret high-performance work systems (HPWSs) as targeting two distinct organizational objectives: enhancing performance and promoting…
Abstract
Purpose
Research has suggested that employees interpret high-performance work systems (HPWSs) as targeting two distinct organizational objectives: enhancing performance and promoting employee well-being. These attributions often exert divergent effects on employee attitudes. Thus, this study aims to investigate this dynamic within the context of the Korean nursing occupation, clarifying how the HPWS can simultaneously evoke dual attributions: human resource (HR) well-being and HR performance attributions. Additionally, the authors examine the contrasting effects of these attributions and identify a moderating variable that could reconcile them. Drawing on the psychological experience of status theory, the authors conceptualize and test the moderating effect of employees' self-perceived status on the relationship between HR performance attribution and affective commitment.
Design/methodology/approach
Data were collected from 475 nurses in 82 work units in Korean hospitals. Hypotheses were tested in a multilevel moderated mediation model.
Findings
The findings revealed that an HPWS elicits HR well-being and HR performance attributions. While HR well-being attribution was positively associated with affective commitment, HR performance attribution was positively related to affective commitment when employees' self-perceived status was high. Moreover, the HPWS demonstrated an indirect relationship with affective commitment via increasing HR performance attribution when self-perceived status was high.
Originality/value
Although the personal meaning of HR attributions differs depending on the perceiver’s situation, this aspect has received little attention in the field of research. This study advances the understanding of HR attributions derived from the HPWS within the specific context of Korean nursing. Furthermore, the authors suggest that the two attributions may not conflict with each other, indicating that the impact of HR performance attribution is conditional on an individual’s self-perceived status.
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Gabriella Karakas and Daniel R. du Plooy
Despite the substantial body of international research exploring the effects of forced migration on mental health and the obstacles faced by refugee cohorts in accessing mental…
Abstract
Purpose
Despite the substantial body of international research exploring the effects of forced migration on mental health and the obstacles faced by refugee cohorts in accessing mental health services, there is a lack of in-depth studies specifically focusing on Bosnian refugees in Australia – one of the largest ethnic groups of displaced peoples. This qualitative investigation seeks to convey the experiences of mental health services by five Bosnian refugees in Melbourne, highlighting perceived pathways and barriers to service utilisation. This study aims to address two primary research questions: firstly, what characterises the experiences of Bosnian refugees in Australia when accessing mental health services? Secondly, what are the main barriers encountered by this population when seeking mental health services?
Design/methodology/approach
This study used qualitative inquiry and in-depth interviews to investigate the experiences of Bosnian refugees with mental health services in Australia. Data was collected through face-to-face interviews with five Melbourne-based Bosnian refugees who had previously accessed mental health services. Participants were recruited from community groups or associations using purposive sampling. Thematic analysis was used.
Findings
Key themes were revealed, such as the crucial role of social and community services, preferences for individual vs group therapy, potential re-traumatisation from therapeutic engagement, distrust of government-run mental health services and concerns regarding psychopharmaceutical prescription practices. Addressing barriers to mental health service access necessitates a multifaceted approach, including flexible social and community service support, an increased number of co-ethnic professionals and a recognition of cultural variations for effective service provision. Implementing these strategies can enhance help-seeking behaviours, provide culturally appropriate mental health services and improve the experiences of Bosnian refugees in Australia.
Originality/value
To the best of the authors’ knowledge, this study is the first to qualitatively explore how Bosnian refugees in Melbourne perceived the adequacy and availability of mental health services upon arrival to Australia. They are a large and potentially vulnerable community, due to experiences of war trauma and dislocation from country of origin. A lack of understanding regarding how this cohort engage with mental health services can lead to persistent inequities and ineffective service provision. This study identifies unique experiences and perspectives of Bosnian refugee participants, including distrust of government-run mental health services, and concerns regarding psychopharmaceutical prescription practices. This research is expected to contribute positively to the discourse on mental health service provision for Bosnian refugees and wider refugee communities in Australia.
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Lorna de Witt, Kathryn A. Pfaff, Roger Reka and Noeman Ahmad Mirza
Current and predicted continued dramatic increases in international migration and ethnocultural diversity of older adult cohorts pose challenges for health care services. Review…
Abstract
Purpose
Current and predicted continued dramatic increases in international migration and ethnocultural diversity of older adult cohorts pose challenges for health care services. Review studies on ethnoculturally diverse older adults and health care show a lack of focus on their service use experiences. This study aims to report a meta-ethnography that addresses this knowledge gap through answering the review question: How do ethnoculturally diverse older adults who are immigrants experience health careservices?
Design/methodology/approach
The authors applied a seven-phase method of meta-ethnography to guide the review. The authors conducted two literature searches (April 2018 and June 2020) in MEDLINE, CINAHL, Embase, Sociological Abstracts and Abstracts in Social Gerontology that yielded 17 papers eligible for review.
Findings
“There’s always something positive and something negative” is the overarching metaphor for answering the review question. Findings highlight positive and negative tensions within ethnoculturally diverse older adults’ health care use experiences of understanding and being understood, having trust in providers and the health care system, having needs, preferences and resources met and desire for self-care over dependency. The majority of experiences were negative. Tipping points towards negative experiences included language, fear, provider attitudes and behaviours, service flexibility, attitudes towards Western and traditional health care and having knowledge and resources.
Originality/value
The authors propose concrete actions to mitigate the tipping points. The authors discuss policy recommendations for health care system changes at the micro, meso and macro service levels to promote positive experiences and address mainstream service policy inequities.
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Manzoor Ahmad Malik and Wondimagegnehu Alemu
Research has found a strong correlation between maternal healthcare and health insurance coverage. But, despite having one of the best health coverage systems in the developing…
Abstract
Purpose
Research has found a strong correlation between maternal healthcare and health insurance coverage. But, despite having one of the best health coverage systems in the developing world, Rwanda still faces formidable challenges in provision certain key maternal health services, leading to higher levels of maternal morbidity and mortality. To understand this paradox, this study will examine the association between maternal health services and insurance coverage, utilizing the latest data from the Rwanda Demographic Health Survey.
Design/methodology/approach
Using a sample of 6,167 childbearing women aged 15–49 years, a bivariate and multivariate analysis was conducted to examine the paradoxical relationship between health insurance and maternal health services, such as antenatal care, in Rwanda.
Findings
The results reveal significant differences in ANC4+ and the timing of the first ANC, which remain low in Rwanda. Despite significant improvements in delivery factors and skilled ANC providers, ANC4+ rates in the country remain the lowest. However, this study found a positive and significant association between ANC4+ and insurance coverage (AOR = 1.64, p < 0.001).
Originality/value
Rwanda has implemented an effective health insurance policy, but there has been minimal progress in the utilization of maternal health services. Therefore, there is a strong need for policy interventions to reduce barriers to healthcare utilization. Additionally, supply-side factors such as transportation, socio-cultural factors and other logistic barriers should be examined in greater detail. These factors may overshadow the impact of health insurance on the utilization of healthcare services in Rwanda.
Peer review
The peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-01-2023-0059
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Sundeep Sahay and Esther N. Landen
The purpose of this paper is to understand how digital interventions are mediating the identity work of community health workers (CHWs) in the context of two African countries.
Abstract
Purpose
The purpose of this paper is to understand how digital interventions are mediating the identity work of community health workers (CHWs) in the context of two African countries.
Design/methodology/approach
This paper analyzes the everyday work of CHWs in two low- and middle-income country (LMIC) contexts (Uganda and Malawi) and seeks to understand changes in collective identity and the role of Information and Communication Technologies (ICTs) in mediating this “identity work”. As CHWs conduct their everyday tasks of care giving, data reporting and maintaining social interactions, they play two primary roles. One is the care giving role oriented towards the community, and two, is reporting and administrative work by virtue of them being affiliated with the Ministry of Health, either in formal or voluntary capacity. The ambivalence which they experience as they move back and forth between these two worlds of work is significantly now mediated through ICTs. The paper analyzes these dynamics and identifies three key sets of ambivalence in identity work: (1) role embracing-institutional distancing; (2) conformist-resistant and (3) dramaturgical-transformative. The paper makes unique contributions to information systems (IS) and ICT for development (ICT4D) studies in that it focuses on a nonprofessional group, which plays a fundamental role in providing care to underserved populations and also conducts data work which provides the foundation of the national health information system. This contrasts with dominant research in the field which focuses on professional groups, largely based in Western business organizations.
Findings
The paper identifies identity related tensions that emerge with the mediation of digital technologies in the work world of CHWs. These include tensions of conformist-resistant; and (3) dramaturgical-transformative. These findings are relevant and unique to the field of IS and ICT4D studies in that it focuses on a nonprofessional group, which plays a fundamental role in providing care to underserved populations and also conducts data work which provides the foundation of the national health information system.
Research limitations/implications
While acknowledging identity construction and negotiation is a function of both work and social lives, in this paper we could only focus on the work lives.
Practical implications
As digital interventions in the health sector of low and middle income countries is becoming increasingly widespread, often the focus is more on the supply side (the supply of the technology) rather than on the demand side (users experiences and aspirations). Identity becomes a lens to understand these demand side dynamics, which helps provides practical guidance on implementation approaches to ensure that the technology adds value to user work processes and there is a seamless and not a disruptive transition.
Social implications
CHWs are the most neglected cadre in the health system of low and middle income countries, even though they provide the cutting edge in care provision work to the most marginalized populations, living in rural and underserved areas. By focusing on how technologies can be more effectively implemented to support these care processes, the paper provides important social implications both for practice and research.
Originality/value
Analysis of identity construction and negotiation of informal groups in the unorganized sector of low and middle income countries has not received adequate attention in IS research. The paper seeks to fill this important gap.
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