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Article
Publication date: 21 March 2008

Abstract

Details

International Journal of Health Care Quality Assurance, vol. 21 no. 2
Type: Research Article
ISSN: 0952-6862

Keywords

Content available
Article
Publication date: 8 February 2011

Abstract

Details

International Journal of Health Care Quality Assurance, vol. 24 no. 2
Type: Research Article
ISSN: 0952-6862

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Book part
Publication date: 22 October 2019

Fanny Vincent

Adopting an intra-organizational viewpoint is essential to grasp legal intermediation. To deepen our understanding of such phenomena, this chapter proposes a qualitative…

Abstract

Adopting an intra-organizational viewpoint is essential to grasp legal intermediation. To deepen our understanding of such phenomena, this chapter proposes a qualitative and “multi-level” approach drawing on insights from the neo-institutional literature, policy ethnography analysis and the research on legal intermediaries. Such a perspective is particularly suited to capture the complexity and the depth of institutional change. Using the 12-hour work legal mechanism of derogation in the context of French public hospitals as an example, this chapter highlights how both macro-level actors (actors of a “reform network”), and micro-level ones (hospital directors) contribute to the shaping and framing of legality in French public hospitals. Results show that variation in how those actors use law depends on the local configuration. Second, results demonstrate that the legal games they play are not merely based on symbolic and superficial compliance with the law, but also on outright manipulations and conscious rule-breaking.

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Article
Publication date: 27 March 2009

Sameer Kumar, Anne Henseler and David Haukaas

Health Insurance Portability and Accountability Act implementation in the USA caused waves in the medical world about documentation storage, flow and access. Protecting…

Abstract

Purpose

Health Insurance Portability and Accountability Act implementation in the USA caused waves in the medical world about documentation storage, flow and access. Protecting patients from information falling into the wrong hands is admirable, but the Act has influenced more than just documentation; it has slowed the research process and complicated basic US medical care. This article aims to discuss Health Insurance Portability and Accountability Act's effects on documentation and patient care and future US healthcare options.

Design/methodology/approach

A chronological approach is used to lay out the Act's effects. Using process flow maps, the pre‐ and post‐Act environment is analyzed to discover differences in the two processes. Then a critique of the new environment leads to future movement recommendations by the US government and the healthcare industry.

Findings

True to the US government's track record, by the time the Act was passed, it was already outdated in terms of IT management capabilities. In addition to trying to comply with these outdated practices, the Act's wording is so vague that hospital staff are not sure with what they are even complying. The Act could be improved with some simple changes to wording and updating.

Research limitations/implications

This article attempts to take a massive problem with far reaching implications, drill down to the key issues and make managerial recommendations based on findings. This provides a more detailed problem view that can only be understood at a high level owing to its complexity. Importantly, the key issues developed in the article support US government reform for legislation, which is not an easy task. There were studies available on the Act's cost to patients, hospitals, clinics and general costs in the USA. However, all the research was site specific and easily contradicted by other sources. Additionally, source reliability was questionable at best, as publications came from specific hospitals and clinics.

Practical implications

Throughout the study two themes were clear – the Act's outdated nature and vague wording. The more research that was done, the more confusing the information began to get, it seems even experts have a hard time understating and complying with the Act. One thing is clear. The Act is confusing and outdated. Because the problem is so large and fragmented, people are not sure where to start fixing the predicament. Arming US hospitals, clinics and doctors with basic knowledge can give them a common springboard to start changing the current environment.

Originality/value

It is clear that the problem is large and confusing. Consolidating research results seems a valuable tool to help understand what is wrong with US healthcare. This article makes a case that updating and improving the directive's ambiguous nature helps create a less frustrating US healthcare system.

Details

International Journal of Health Care Quality Assurance, vol. 22 no. 2
Type: Research Article
ISSN: 0952-6862

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Book part
Publication date: 15 January 2021

Thespina J. Yamanis, Ana María del Río-González, Laura Rapoport, Christopher Norton, Cristiana Little, Suyanna Linhales Barker and India J. Ornelas

Purpose: Fear of deportation and its relationship to healthcare access has been less studied among immigrant Latinx men who have sex with men (MSM), a population at risk…

Abstract

Purpose: Fear of deportation and its relationship to healthcare access has been less studied among immigrant Latinx men who have sex with men (MSM), a population at risk for HIV and characterized by their multiple minority statuses. The first step is to accurately measure their fear of deportation.

Approach: We used an exploratory sequential mixed methods design. Eligibility criteria were that research participants be ages 18–34 years; Latinx; cisgender male; having had sex with another male; residing in the District of Columbia metro area; and not a US citizen or legal permanent resident. In Study 1, we used in-depth interviews and thematic analysis. Using participants' interview responses, we inductively generated 15 items for a fear of deportation scale. In Study 2, we used survey data to assess the scale's psychometric properties. We conducted independent samples t-test on the associations between scale scores and barriers to healthcare access.

Findings: For the 20 participants in Study 1, fear of deportation resulted in chronic anxiety. Participants managed their fear through vigilance, and behaviors restricting their movement and social network engagement. In Study 2, we used data from 86 mostly undocumented participants. The scale was internally consistent (α = 0.89) and had a single factor. Those with higher fear of deportation scores were significantly more likely to report avoiding healthcare because they were worried about their immigration status (p = 0.007).

Originality: We described how fear of deportation limits healthcare access for immigrant Latinx MSM.

Research implications: Future research should examine fear of deportation and HIV risk among immigrant Latinx MSM.

Details

Sexual and Gender Minority Health
Type: Book
ISBN: 978-1-83867-147-1

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Article
Publication date: 5 August 2014

Camilla M. Haw, Jean H. Stubbs and Geoffrey L. Dickens

Use of off-license medicines in forensic mental health settings is common and unlicensed drugs are sometimes prescribed. Despite their responsibility for administering…

Abstract

Purpose

Use of off-license medicines in forensic mental health settings is common and unlicensed drugs are sometimes prescribed. Despite their responsibility for administering medicines little is known about how mental health nurses view these practices. The paper aims to discuss these issues.

Design/methodology/approach

In total, 50 mental health nurses working in low and medium secure adolescent and adult mental health wards were presented with a clinical vignette about administration of unlicensed and off-license medicines. Semi-structured interviews about their likely clinical response to, and feelings about, this practice were conducted. Interview data were subject to a thematic analysis.

Findings

Analysis revealed six themes: status of unlicensed/off-label medicines; legality of administering unlicensed medicines; professional standards around administering unlicensed medicines; finding out more about unlicensed medicines; trusting medical colleagues; and decision making in uncertain cases.

Practical implications

Forensic mental health nurses take a pragmatic approach to the practice of administering unlicensed medicines and most are aware of their professional responsibilities.

Originality/value

This study provides the first evidence to inform the development of training for forensic mental health nurses about an issue that is common in forensic mental health practice.

Details

Journal of Forensic Practice, vol. 16 no. 3
Type: Research Article
ISSN: 2050-8794

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Article
Publication date: 5 August 2014

Dane M. Lee and Tommy Nichols

The purpose of this paper is to identify the challenges when recruiting and retaining rural physicians and to ascertain methods that make rural physician recruitment and…

Abstract

Purpose

The purpose of this paper is to identify the challenges when recruiting and retaining rural physicians and to ascertain methods that make rural physician recruitment and retention successful. There are studies that suggest rural roots is an important factor in recruiting rural physicians, while others look at rural health exposure in medical school curricula, self-actualization, community sense and spousal perspectives in the decision to practice rural medicine.

Design/methodology/approach

An extensive literature review was performed using Academic Search Complete, PubMed and The Cochrane Collaboration. Key words were rural, rural health, community hospital(s), healthcare, physicians, recruitment, recruiting, retention, retaining, physician(s) and primary care physician(s). Inclusion criteria were peer-reviewed full-text articles written in English, published from 1997 and those limited to USA and Canada. Articles from foreign countries were excluded owing to their unique healthcare systems.

Findings

While there are numerous articles that call for special measures to recruit and retain physicians in rural areas, there is an overall dearth. This review identifies several articles that suggest recruitment and retention techniques. There is a need for a research agenda that includes valid, reliable and rigorous analysis regarding formulating and implementing these strategies.

Originality/value

Rural Americans are under-represented when it comes to healthcare and what research there is to assist recruitment and retention is difficult to find. This paper identify the relevant research and highlights key strategies.

Details

International Journal of Health Care Quality Assurance, vol. 27 no. 7
Type: Research Article
ISSN: 0952-6862

Keywords

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Article
Publication date: 11 May 2021

Hisahiro Ishijima, Noriyuki Miyamoto, Fares Masaule and Raynold John

The purpose of this study is to see how the 5S-KAIZEN-TQM approach can contribute to improve the management of healthcare waste (HCW) in the regional level public…

Abstract

Purpose

The purpose of this study is to see how the 5S-KAIZEN-TQM approach can contribute to improve the management of healthcare waste (HCW) in the regional level public hospitals in Tanzania.

Design/methodology/approach

This study employed an explanatory case study framework and focused on improvement of HCW management by assessing the information obtained through the direct observation and systematic interviewing during the consultation visits and external hospital performance assessment (EHPA) and the self-administrated questionnaires as sources of evidence.

Findings

Based on the observations, 100% adoption of the 5S approach was observed in 25 of 28 regional referral hospitals (RRHs). At these RRHs, segregation of HCW management has been improved by applying color codes and symbols for establishing self-explanatory system on proper segregation. In addition, seven out of 28 RRHs applied the KAIZEN process and reduced occurrences of improper waste segregation.

Research limitations/implications

This study has the following limitations in terms of the information. The data were collected through the direct observation. Moreover, areas for the implementation of the KAIZEN vary from hospital to hospital, and only 25% of RRHs completed the KAIZEN processes for improvement of HCW management. Caveats are, therefore, needed in extrapolating the study results to other settings. Despite these caveats, the findings will provide important insights for implementing the 5S-KAIZEN approach in Tanzania and other African countries for improvement of HCW management.

Originality/value

This is an original study to provide evidence about the usefulness of the 5S-KAIZEN-TQM approach for improving HCW management in a low-income country in Africa.

Details

The TQM Journal, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 1754-2731

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Article
Publication date: 15 June 2012

Sarah Clark and Albert Weale

It is commonly recognized that the setting of health priorities requires value judgements and that these judgements are social. Justifying social value judgements is an…

Abstract

Purpose

It is commonly recognized that the setting of health priorities requires value judgements and that these judgements are social. Justifying social value judgements is an important element in any public justification of how priorities are set. The purpose of this paper is to review a number of social values relating both to the process and content of priority‐setting decisions.

Design/methodology/approach

A set of key process and content values basic to health priority setting is outlined, and normative analysis applied to those values to identify their key features, possible interpretations in different cultural and institutional contexts, and interactions with other values.

Findings

Process values are found to be closely linked, such that success in increasing, for example, transparency may depend on increasing participation or accountability, and “content” values are found often to be hidden in technical criteria. There is a complex interplay between value and technical components of priority setting, and between process and content values. Levels of economic development, culture and need will all play a part in determining how different systems balance the values in their decisions.

Originality/value

Technical analyses of health priority setting are commonplace, but approaching the issues from the perspective of social values is a more recent approach and one which this paper seeks to refine and develop.

Details

Journal of Health Organization and Management, vol. 26 no. 3
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 22 November 2011

Kurt Stanberry

This paper seeks to analyze attempts, in the USA and globally, to create new and improved methods used to manage patient health information: electronic medical records

Abstract

Purpose

This paper seeks to analyze attempts, in the USA and globally, to create new and improved methods used to manage patient health information: electronic medical records (EHRs). This new system of records management is to be examined to determine the possible benefits for patients, providers, insurers, employers, and others, as well as barriers to the use of EHRs, particularly in those embedded in US law.

Design/methodology/approach

In the USA, and in various other jurisdictions, new laws have been enacted to incentivize the use of EHRs, and the paper examines the regulations and provisions incentivizing the adoption of this type of integrated system for lifelong tracking of health‐related information. There are issues to be dealt with, such as cost, privacy, and legality, but each of these can and must be overcome to effectively manage and communicate health care information

Findings

The use of EHRs is increasing in the USA and globally, both in acute care hospitals and in primary care medical practices, largely accomplished through positive incentives, and penalties for non‐compliance. There are also various countries well on the way to wide‐spread use of electronic health records management.

Social implications

The use of EHRs creates a societal benefit, initially one on an individual level, but one which over time could rise to a level positively affecting health care on a national, even global level.

Originality/value

The paper is based on an analysis of relevant laws/regulations, best practices, and anecdotal/observational evidence. No empirical evidence survey or study was conducted, primarily because the process of implementation of EHRs is too new. It is of value to practitioners, policy makers, and interested public parties.

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