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This study aims to explore the influence of health-care service quality on customers’ perceived value, satisfaction, effectiveness and behavioural intention concerning district health centres (DHCs) in Hong Kong. This research also intends to assess customers’ perception of the subsidy scheme and its influence on the relationships amongst the aforementioned constructs.

The convenience and snowball sampling approaches were adopted, and the self-administered questionnaire was sent to 309 customers of DHCs.

Service quality attributes in terms of staffing and procedures positively increased customers’ perceived value and staffing, procedures and operations. Physical facilities positively promoted customers’ satisfaction, consequently improving DHCs’ effectiveness and behavioural intention. However, core treatments and services of DHCs did not impact customers’ perceived value and satisfaction. Furthermore, customers receiving subsidies exhibited a more positive perception than those without subsidies.

Health-care organisations are advised to strategically allocate resources (staffing, facilities and procedures and operations management) to optimise overall performance outcomes. DHC operators could reinforce the core services of DHCs and health-care voucher subsidies to local citizens so as to enhance the effectiveness of DHCs and behavioural intention of customers.

This study integrates the input–process–output approach in measuring the effectiveness of and customers’ behavioural intention towards newly established DHCs.

Contrary to want-based services, customer participation has got lesser attention in high-credence services like health care. Customer participation for patients with chronic illnesses could be life-threatening and goes beyond the service organization’s physical environment. Realizing the importance of transformative service research in health-care services, this study aims to propose and validate the conceptualization of customer participation for patients with chronic illnesses.

The study uses sequential exploratory research design with mixed method research. The first phase is a qualitative exploration of the nature and meaning of customer participation by synthesizing theory and insights from semi-structured interviews (N = 75) with doctors, patients and paramedical staff. Next, survey data (N = 690) of patients with chronic illnesses is used to validate the proposed conceptualization. Finally, nomological validity was also tested on an additional survey data set (N = 362) using SEM and FsQCA.

The findings reveal that health-care customer participation is a three-dimensional behavioral construct in which a customer can participate by sharing information, involving in decision-making and ensuring compliance. The study also demonstrates that customer participation is a critical driver of satisfaction with life and perceived control on illness.

The research provides policy guidelines for owners and operators of health-care organizations in developing frameworks for collecting participation data, which can be used in strategies for seeking customer participation.

The research conceptualizes and validates “customer participation” as a multidimensional higher-order construct for patients with chronic illnesses, rarely focused in services marketing and management research on health care.

Research has examined how new ventures strengthen local economic outcomes; however, limited research examines health-oriented ventures and their impact on social outcomes, including health outcomes. Increased VC investment in healthcare service start-ups signals more activity toward this end, and the need for further academic inquiry. We examine the relationship between these start-ups and county-level health outcomes, health factors, and hospital utilization.

Data on start-ups funded via institutional venture capital from PitchBook were merged with US county-level outcomes from the County Health Rankings and Area Health Resources Files for 2010 to 2019. We investigated how the number of VC-funded healthcare service start-ups, as well as a subset defined as innovative, were associated with county-level health measures. We used panel models with two-way fixed effects and Propensity Score Matched (PSM), controlling for demographics and socioeconomic factors.

Each additional VC-funded healthcare service start-up was related to a significant 0.01 percentage point decrease in diabetes prevalence (p < 0.01), a decrease of 1.54 HIV cases per 100,000 population (p < 0.1), a 0.02 percentage point decrease in obesity rates (p < 0.01), and a 0.03 percentage point decrease in binge drinking (p < 0.01). VC-funded healthcare service start-ups were not related to hospital utilization.

This work expands our understanding of how industry-specific start-ups, in this case healthcare start-ups, relate to positive social outcomes. The results underscore the importance of evidence-based evaluation, the need for expanded outcome measures for VC investment, and the possibilities for integration of healthcare services and entrepreneurship ecosystems.

This paper – the final paper of a series of three – aims to discuss the implications of the findings from a service user needs assessment of people experiencing homelessness in the Northwest of England. It will expand on the previous paper by offering a more detailed analysis and discussion of the identified key themes and issues. The service user needs assessment was completed as part of a review of local service provision in the Northwest of England against the backdrop of the COVID-19 pandemic.

Semi-structured questionnaires were administered and used by health-care professionals to collect data from individuals accessing the Homeless and Vulnerable Adults Service (HVAS) in Bolton. The questionnaires included a section exploring Adverse Childhood Experiences. Data from 100 completed questionnaires were analysed to better understand the needs of those accessing the HVAS.

Multiple deprivations including extensive health and social care needs were identified within the cohort. Meeting these complex needs was challenging for both service users and service providers. This paper will explore key themes identified by the needs assessment and draw upon further comments from those who participated in the data-gathering process. The paper discusses the practicalities of responding to the complex needs of those with lived experience of homelessness. It highlights how a coordinated partnership approach, using an integrated service delivery model can be both cost-effective and responsive to the needs of those often on the margins of our society.

Data collection during the COVID-19 pandemic presented a number of challenges. The collection period had to be extended whilst patient care was prioritised. Quantitative methods were used, however, this limited the opportunity for service user involvement and feedback. Future research could use qualitative methods to address this balance and use a more inclusive approach.

This study illustrates that the needs of the homeless population are broad and varied. Although the population themselves have developed different responses to their situations, their needs can only be fully met by a co-ordinated, multi-agency, partnership response. An integrated service model can help identify, understand, and meet the needs of the whole population and individuals within it to improve healthcare for a vulnerable population.

This study highlighted new and important findings around the resilience of the homeless population and the significance of building protective factors to help combat the multiplicity of social isolation with both physical and mental health problems.

The discussion provides an opportunity to reflect on established views in relation to the nature and scope of homelessness. The paper describes a contemporary approach to tackling current issues faced by those experiencing homelessness in the current context of the COVID-19 pandemic. Recommendations for service improvements will include highlighting established good practices including embedding a more inclusive/participatory approach.

The purpose of this paper is to investigate user satisfaction with digital health solutions by identifying and prioritizing different service attributes on the basis of their impact on improving user satisfaction.

Through a literature review and interviews with health professionals and patients, 20 attributes of digital health services provided in Italy have been identified. User satisfaction with these attributes has been evaluated by adopting the Kano model’s continuous and discrete analyses.

The findings reveal the essential attributes of digital health services that meet users' expectations, identify the attributes that users appreciate or dislike having and highlight unexpected attributes that lead to a significant boost in satisfaction when provided.

This study demonstrates the efficacy of the Kano model in assessing the nonlinear correlation between user satisfaction and the quality of digital health services, thus contributing to fill a gap in the literature in this area. The main limitation of this work is the use of a non-probabilistic sampling method.

This research suggests healthcare institutions and organizations consider user preferences when designing digital health solutions to increase their satisfaction. The results indicate different effects on user satisfaction and dissatisfaction for different categories of attributes in the Italian context.

Previous works studied customer satisfaction with digital health, assuming a linear relationship with service quality, or investigated consumer adoption intentions focusing on the technological factors. This work advances available knowledge by analyzing the nonlinear relationship between digital health attributes and users’ satisfaction and dissatisfaction.

Drawing upon the stimulus-organism-response model, this study aims to explore the impact of soft aspects of service quality on revisit intention through the mechanism of perceived empathy.

For the examination of the hypothesized relationships, the study adopts structural equation modelling to analyse the data of 562 respondents (i.e. 281 family members and 281 inpatients).

The empirical results suggest that service quality increased family member empathy perception, which, in turn, improved inpatients’ revisit intentions.

Past studies have focused on the roles of overall service quality. The authors have extended the literature by examining the specific but important aspect of service quality and its effects on emotional response. Importantly, the study explains that the affective reactions of a patient’s family, fastened with perceived empathy, have a central role in influencing the patients’ subsequent reactions. Moreover, the prior studies collected the data either from hospital employees or patients. However, in the present study, the authors used a unique sample (family members as well as patients) to have a deeper understanding. Thus, the study enhances the literature on the stimuli-response (i.e. service quality – revisit intentions) relationship in the context of service marketing in general and health care in specific. Important academic and managerial contributions and recommendations for future research are discussed.

This study aims to use the database of consumers referred to the dual diagnosis shared care service to examine those connections. The Eastern Dual Diagnosis Service, based in Melbourne, Australia, has established a database of consumers with co-occurring mental health disorders and problematic substance use. An examination of mental health and substance-use information obtained over a two-year period in the delivery of dual diagnosis shared care to consumers of mental health services is supporting an improved understanding of substance use and the connections to specific mental health diagnoses of schizophrenia, bipolar disorder and schizoaffective disorder.

This research uses a quantitative approach to review the prevalence of primary substance use and mental health diagnoses for consumers referred to as dual diagnosis shared care. Reviewed are referrals from adult mental health community and rehabilitation teams operating within a mental health and well-being program between January 2019 and December 2020 inclusive.

Of the 387 clients referred to the specialist dual diagnosis shared care, methamphetamine, alcohol and cannabis are associated with 89.4% of the primary mental health diagnosis (PMHD). The most common PMHDs are schizophrenia, schizoaffective disorder and bipolar disorder. The most common PMHD and substance-use connection was schizophrenia and methamphetamine. Nicotine was reported to be used by 84% of consumers and often occurred in addition to another problematic primary substance.

Improved dual diagnosis data collection from a community-based clinical mental health service is increasing understanding of the mental health and substance-use relationship. This is now providing clarity on routes of investigation into co-occurring mental health and problematic substance-use trends and guiding improved integrated treatments within a contemporary mental health setting.

The future increase of chronic diseases in the world requires new challenges in the health domain to improve patients' care from the point of view of the organizational processes, clinical pathways and technological solutions of digital health. For this reason, the present paper aims to focus on the study and application of well-known clinical practices and efficient organizational approaches through an innovative model (TALIsMAn) to support new care process redesign and digitalization for chronic patients.

In addition to specific clinical models employed to manage chronic conditions such as the Population Health Management and Chronic Care Model, we introduce a Business Process Management methodology implementation supported by a set of e-health technologies, in order to manage Care Pathways (CPs) digitalization and procedures improvement.

This study shows that telemedicine services with advanced devices and technologies are not enough to provide significant changes in the healthcare sector if other key aspects such as health processes, organizational systems, interactions between actors and responsibilities are not considered and improved. Therefore, new clinical models and organizational approaches are necessary together with a deep technological change, otherwise, theoretical benefits given by telemedicine services, which often employ advanced Information and Communication Technology (ICT) systems and devices, may not be translated into effective enhancements. They are obtained not only through the implementation of single telemedicine services, but integrating them in a wider digital ecosystem, where clinicians are supported in different clinical steps they have to perform.

The present work defines a novel methodological framework based on organizational, clinical and technological innovation, in order to redesign the territorial care for people with chronic diseases. This innovative ecosystem applied in the Italian research project TALIsMAn is based on the concept of a continuum of care and digitalization of CPs supported by Business Process Management System and telemedicine services. The main goal is to organize the different socio-medical activities in a unique and integrated IT system that should be sustainable, scalable and replicable.

Obesity and associated morbidity and mortality are major challenges for people with severe mental illness, particularly in secure (forensic) mental health care (patients who have committed a crime or have threatening behaviour). This study aims to explore experiences of weight management in secure mental health settings.

This study used a mixed-methods approach, involving thematic analysis. A survey was delivered to secure mental health-care staff in a National Health Service (NHS) mental health trust in Northern England. Focus groups were conducted with current and former patients, carers and staff in the same trust and semi-structured interviews were undertaken with staff in a second NHS mental health trust.

The survey received 79 responses and nine focus groups and 11 interviews were undertaken. Two overarching topics were identified: the contrasting perspectives expressed by different stakeholder groups, and the importance of a whole system approach. In addition, seven themes were highlighted, namely: medication, sedentary behaviour, patient motivation, catered food and alternatives, role of staff, and service delivery.

Secure care delivers a potentially “obesogenic environment", conducive to excessive weight gain. In future, complex interventions engaging wide-ranging stakeholders are likely to be needed, with linked longitudinal studies to evaluate feasibility and impact.

To the best of the authors’ knowledge, this is the first study to involve current patients, former patients, carers and multidisciplinary staff across two large NHS trusts, in a mixed-methods approach investigating weight management in secure mental health services. People with lived experience of secure services are under-represented in research and their contribution is therefore of particular importance.

Today, e-government (electronic government) applications have extended to the frontiers of health-care delivery. E-Nabız contains personal health records of health services received, whether public or private. The use of the application by patients and physicians has provided efficiency and cost advantages. The success of e-Nabız depends on the level of technology acceptance of health-care service providers and recipients. While there is a large research literature on the technology acceptance of service recipients in health-care services, there is a limited number of studies on physicians providing services. This study aims to determine the level of influence of trust and privacy variables in addition to performance expectancy, effort expectancy, social influence and facilitating factors in the unified theory of acceptance and use of technology (UTAUT) model on the intention and behavior of using e-Nabız application.

The population of the study consisted of general practitioners and specialist physicians actively working in any health facility in Turkey. Data were collected cross-sectionally from 236 physicians on a voluntary basis through a questionnaire. The response rate of data collection was calculated as 47.20%. Data were collected cross-sectionally from 236 physicians through a questionnaire. Descriptive statistics, correlation analysis and structural equation modeling were used to analyze the data.

The study found that performance expectancy, effort expectancy, trust and perceived privacy had a significant effect on physicians’ behavioral intentions to adopt the e-Nabız system. In addition, facilitating conditions and behavioral intention were determinants of usage behavior (p < 0.05). However, no significant relationship was found between social influence and behavioral intention (p > 0.05).

This study confirms that the UTAUT model provides an appropriate framework for predicting factors influencing physicians’ behaviors and intention to use e-Nabız. In addition, the empirical findings show that trust and perceived privacy, which are additionally considered in the model, are also influential.