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Book part
Publication date: 7 February 2024

Tory H. Hogan, Larry R. Hearld, Ganisher Davlyatov, Akbar Ghiasi, Jeff Szychowski and Robert Weech-Maldonado

High-quality nursing home (NH) care has long been a challenge within the United States. For decades, policymakers at the state and federal levels have adopted and implemented…

Abstract

High-quality nursing home (NH) care has long been a challenge within the United States. For decades, policymakers at the state and federal levels have adopted and implemented regulations to target critical components of NH care outcomes. Simultaneously, our delivery system continues to change the role of NHs in patient care. For example, more acute patients are cared for in NHs, and the Center for Medicare and Medicaid Services (CMS) has implemented value payment programs targeting NH settings. As a part of these growing pressures from the broader healthcare delivery system, the culture-change movement has emerged among NHs over the past two decades, prompting NHs to embody more person-centered care as well as promote settings which resemble someone's home, as opposed to institutionalized healthcare settings.

Researchers have linked culture change to high-quality outcomes and the ability to adapt and respond to the ever-changing pressures brought on by changes in our regulatory and delivery system. Making enduring culture change within organizations has long been a challenge and focus in NHs. Despite research suggesting that culture-change initiatives that promote greater resident-centered care are associated with several desirable patient outcomes, their adoption and implementation by NHs are resource intensive, and research has shown that NHs with high percentages of low-income residents are especially challenged to adopt these initiatives.

This chapter takes a novel approach to examine factors that impact the adoption of culture-change initiatives by assessing knowledge management and the role of knowledge management activities in promoting the adoption of innovative care delivery models among under-resourced NHs throughout the United States. Using primary data from a survey of NH administrators, we conducted logistic regression models to assess the relationship between knowledge management and the adoption of a culture-change initiative as well as whether these relationships were moderated by leadership and staffing stability. Our study found that NHs were more likely to adopt a culture-change initiative when they had more robust knowledge management activities. Moreover, knowledge management activities were particularly effective at promoting adoption in NHs that struggle with leadership and nursing staff instability. Our findings support the notion that knowledge management activities can help NHs acquire and mobilize informational resources to support the adoption of care delivery innovations, thus highlighting opportunities to more effectively target efforts to stimulate the adoption and spread of these initiatives.

Article
Publication date: 6 February 2024

Radhika Gore

The institutional conditions of primary care provision remain understudied in low- and middle-income countries. This study analyzes how primary care doctors cope with medical…

Abstract

Purpose

The institutional conditions of primary care provision remain understudied in low- and middle-income countries. This study analyzes how primary care doctors cope with medical uncertainty in municipal clinics in urban India. As street-level bureaucrats, the municipal doctors occupy two roles simultaneously: medical professional and state agent. They operate under conditions that characterize health systems in low-resource contexts globally: inadequate state investment, weak regulation and low societal trust. The study investigates how, in these conditions, the doctors respond to clinical risk, specifically related to noncommunicable diseases (NCDs).

Design/methodology/approach

The analysis draws on year-long ethnographic fieldwork in Pune (2013–14), a city of three million, including 30 semi-structured interviews with municipal doctors.

Findings

Interpreting their municipal mandate to exclude NCDs and reasoning their medical expertise as insufficient to treat NCDs, the doctors routinely referred NCD cases. They expressed concerns about violence from patients, negative media attention and unsupportive municipal authorities should anything go wrong clinically.

Originality/value

The study contextualizes street-level service-delivery in weak institutional conditions. Whereas street-level workers may commonly standardize practices to reduce workload, here the doctors routinized NCD care to avoid the sociopolitical consequences of clinical uncertainty. Modalities of the welfare state and medical care in India – manifest in weak municipal capacity and healthcare regulation – appear to compel restraint in service-delivery. The analysis highlights how norms and social relations may shape primary care provision and quality.

Details

International Journal of Sociology and Social Policy, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 0144-333X

Keywords

Open Access
Article
Publication date: 17 May 2023

Abstract

Details

Public Administration and Policy, vol. 26 no. 1
Type: Research Article
ISSN: 1727-2645

Open Access
Article
Publication date: 9 March 2021

Linda Hantrais

The relative success of East Asian countries in controlling the spread of COVID-19 at its onset was widely attributed to their capacity to learn from previous experience of…

Abstract

The relative success of East Asian countries in controlling the spread of COVID-19 at its onset was widely attributed to their capacity to learn from previous experience of epidemics, their preparedness to deal with new threats to health, and public acceptance of the need to comply unquestioningly with stringent measures to contain the virus. The conditions were very different when Europe was recognised as the epicentre of the pandemic in March 2020. In a climate of uncertainty, intensified by inconsistent scientific advice and intractable political dilemmas, European governments embarked on a steep learning curve. They experimented with packages of measures based on limited and often conflicting evidence about their effectiveness in preventing transmission of the disease and high excess death rates, amid growing concern about the collateral damage being caused to public health, and to social and economic life.

Drawing on a wide range of multi-disciplinary published materials and official statistics, research articles, reports, briefings and academic debates, as well as media headlines and commentary, this briefing assesses policy learning during the first wave of the pandemic in Europe and asks:

What lessons did European countries, individually and collectively, draw from their own experiences and from the policy responses of neighbouring countries when Europe was the epicentre of the COVID-19 pandemic?

Were decision-takers better prepared to contain further waves of the disease and to improve outcomes?

Details

Emerald Open Research, vol. 1 no. 13
Type: Research Article
ISSN: 2631-3952

Keywords

Abstract

Details

World Healthcare Cooperatives: Challenges and Opportunities
Type: Book
ISBN: 978-1-80455-775-4

Article
Publication date: 13 March 2024

Rachael Elizabeth Sanders, Corina Modderman, Stacey Bracksley-O'Grady, Fiona Harley, Jacquelin Spencer and Jacinta Molloy

There is a growing recognition of the urgency to enhance health outcomes for children and young people residing in out-of-home care (OOHC). Research underscores the need to…

Abstract

Purpose

There is a growing recognition of the urgency to enhance health outcomes for children and young people residing in out-of-home care (OOHC). Research underscores the need to establish effective pathways to quality health care for children and young people who have been exposed to trauma. Child protection (CP) practitioners should play a vital role in proactively improving health outcomes and navigating the intricacies of healthcare systems. Their involvement in initiating and collaborating on healthcare interventions is pivotal for the well-being of these vulnerable children and young people. However, challenges associated with poor health literacy and the complexities of healthcare systems hinder collaborative service delivery in the Australian context. This review explores how CP practitioners support the health care of children and young people in their care.

Design/methodology/approach

A scoping review followed Arksey and O’Malley’s framework, employing a narrative synthesis to assess the selected studies.

Findings

Health outcomes for children and young people in OOHC remain under-researched and potentially under-resourced within the realm of CP practice. There is room for enhanced practices and system integration in CP service delivery to better address health needs and prevent further health and well-being disparities.

Originality/value

Through this scoping review and involving industry experts in the discussion of findings, this study contributes valuable insights to the existing knowledge base regarding the active participation of CP practitioners in addressing the healthcare needs of vulnerable children.

Details

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

Keywords

Book part
Publication date: 9 May 2023

Ferhat Devrim Zengul, Justin Lord, Ganisher Davlyatov, Akbar Ghiasi, Gregory Orewa and Robert Weech-Maldonado

Residents in under-resourced/high-Medicaid (85% or higher) nursing homes on average receive care from relatively lower quality providers and have worse health outcomes, which may…

Abstract

Residents in under-resourced/high-Medicaid (85% or higher) nursing homes on average receive care from relatively lower quality providers and have worse health outcomes, which may increase the risk of higher COVID-19 incidence. This study aims to evaluate if having a culture that encourages employee empowerment results in better quality (lower COVID-19 deaths) in times of crisis, such as the current pandemic. The study combined primary survey data from 391 Directors of Nursing (response rate of 37%), with Centers for Medicare and Medicaid Services’ (CMS) Nursing Home COVID-19 Public File, LTCFocus, Area Health Resource File, and Nursing Home Compare. The dependent variable consisted of the number of COVID-19 death as of November 25, 2021. The independent variables consisted of Likert scale for employee empowerment (Cronbach alpha= 0.82). Control variables consisted of organizational factors (e.g., size, location, and ownership), as well as community factors (e.g., poverty, unemployment, and competition). The results indicated that one unit increase in employee empowerment was associated with 6% lower likelihood of having COVID-19 deaths. Nursing homes, particularly those under-resourced, face difficulty improving the quality of care due to financial constraints. However, the results suggest that adopting a culture that fosters employee empowerment may give nursing homes an edge in improving quality outcomes in crises.

Details

Management and Organizational Studies on Blue- and Gray-collar Workers: Diversity of Collars
Type: Book
ISBN: 978-1-80455-754-9

Keywords

Article
Publication date: 3 January 2024

Sudhir Rama Murthy, Thayla Tavares Sousa-Zomer, Tim Minshall, Chander Velu, Nikolai Kazantsev and Duncan McFarlane

Advancements in responsive manufacturing have been supporting companies over the last few decades. However, manufacturers now operate in a context of continuous uncertainty. This…

Abstract

Purpose

Advancements in responsive manufacturing have been supporting companies over the last few decades. However, manufacturers now operate in a context of continuous uncertainty. This research paper explores a mechanism where companies can “elastically” provision and deprovision their production capacity, to enable them in coping with repeated disruptions. Such a mechanism is facilitated by the imitability and substitutability of production resources.

Design/methodology/approach

An inductive study was conducted using Gioia methodology for this theory generation research. Respondents from 20 UK manufacturing companies across multiple industrial sectors reflected on their experience during COVID-19. Resource-based view and resource dependence theory were employed to analyse the manufacturers' use of internal and external production resources.

Findings

The study identifies elastic responses at four operational levels: production-line, factory, company and supply chain. Elastic responses that imposed variable-costs were particularly well-suited for coping with unforeseen disruptions. Further, the imitability and substitutability of manufacturers helped others produce alternate goods during the crisis.

Originality/value

While uniqueness of production capability helps manufacturers sustain competitive advantage against competitors during stable operations, imitability and substitutability are beneficial during a crisis. Successful manufacturing companies need to combine these two approaches to respond effectively to repeated disruptions in a context of ongoing uncertainties. The theoretical contribution is in characterising responsive manufacturing in terms of resource heterogeneity and resource homogeneity, with elastic resourcing as the underlying mechanism.

Details

International Journal of Operations & Production Management, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 0144-3577

Keywords

Article
Publication date: 20 February 2024

Liisa Lee, Mira Hammarén and Outi Kanste

To explore Finnish experts' perceptions of the forms of digital healthcare that are anticipated to be the most utilised in healthcare in the medium-term future (year 2035) and…

Abstract

Purpose

To explore Finnish experts' perceptions of the forms of digital healthcare that are anticipated to be the most utilised in healthcare in the medium-term future (year 2035) and anticipated healthcare workforce impacts those forms will have.

Design/methodology/approach

A total of 17 experts representing relevant interest groups participated in a biphasic online Delphi study. The results for each round were analysed using descriptive statistical methods and inductive content analysis.

Findings

The forms of digital healthcare that the experts perceived as most likely to be utilised were those enabling patient participation, efficient organisation of services and automated data collection and analysis. The main impacts on the healthcare workforce were seen as being the redirection of workforce needs within the healthcare sector and need for new skills and new professions. The decrease in the need for a healthcare workforce was seen as less likely. The impacts were perceived as being constructed through three means: impacts within healthcare organisations, impacts on healthcare professions and impacts via patients.

Research limitations/implications

The results are not necessarily transferable to other contexts because the experts anticipated local futures. Patients' views were also excluded from the study.

Originality/value

Healthcare organisations function in complex systems where drivers, such as regional demographics, legislation and financial constraints, dictate how digital healthcare is utilised. Anticipating the workforce effects of digital healthcare utilisation has received limited attention; the study adds to this discussion.

Details

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

Keywords

Article
Publication date: 18 March 2022

Marie Claire Van Hout, Victor Mhango, Ruth Kaima, Charlotte Bigland and Triestino Mariniello

The first case of COVID-19 in the Malawi prison system was reported in July 2020. Human rights organisations raised concerns about the possibility of significant COVID-19…

Abstract

Purpose

The first case of COVID-19 in the Malawi prison system was reported in July 2020. Human rights organisations raised concerns about the possibility of significant COVID-19 outbreaks and deaths in the prison system, because of the poor infrastructure, lack of healthcare and adequate COVID-19 mitigation measures, existing co-morbidities (tuberculosis, HIV and hepatitis C), malnutrition and poor health of many prisoners.

Design/methodology/approach

The authors conducted a legal-realist assessment of the Malawian prison system response to COVID-19 during state disaster measures, with a specific focus on the right to health and standards of healthcare as mandated in international, African and domestic law.

Findings

The Malawi prison system was relatively successful in preventing serious COVID-19 outbreaks in its prisons, despite the lack of resources and the ad hoc reactive approach adopted. Whilst the Malawi national COVID plan was aligned to international and regional protocols, the combination of infrastructural deficits (clinical staff and medical provisions) and poor conditions of detention (congestion, lack of ventilation, hygiene and sanitation) were conducive to poor health and the spread of communicable disease. The state of disaster declared by the Malawi Government and visitation restrictions at prisons worsened prison conditions for those working and living there.

Originality/value

In sub-Saharan Africa, there is limited capacity of prisons to adequately respond to COVID-19. This is the first legal-realist assessment of the Malawian prison system approach to tackling COVID-19, and it contributes to a growing evidence of human rights-based investigations into COVID-19 responses in African prisons (Ethiopia, South Africa and Zimbabwe).

Details

International Journal of Prisoner Health, vol. 19 no. 3
Type: Research Article
ISSN: 1744-9200

Keywords

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