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This study aims to assess the quality of care among adult oncology patients in tertiary care hospitals in Karachi by using an international standard of quality of care and to identify domains where improvement is needed.

This is a cross-sectional study carried out at two tertiary care hospitals of Karachi, Pakistan, belonging to private and public sector, respectively, between February and April 2018. Face-to-face interviews were conducted using a modified questionnaire having five-point Likert scale questions regarding satisfaction of patients with doctors, nursing staff, information provided and the hospital standards. SPSS 20 was used for statistical analysis, and the results were expressed using mean, frequencies, percentages and p-values.

The authors approached 415 patients, out of which 389 patients agreed to participate in the study. For both hospitals, the lowest mean scores were for sections pertaining to satisfaction with psychosocial support and information provided. The mean satisfaction score of patients from the private hospital were found to be significantly higher as compared to patients from the public hospital for all domains of patient care (p-value < 0.01 using t-test for two independent samples). The data showed an increasing trend of “satisfied” responses as the household income increased.

A comparative study should be conducted with the aim of pinpointing the differences in areas in which there is a significant difference in positive satisfaction levels between private and public sectors. Similar research could also be expanded adding other variables that affect quality of care such as doctor's approach to their patients, time given during each consultation and patient's understanding of doctor's knowledge. Further studies can be done to bridge the gaps between what a doctor views as standard care and what the patient knows will help them receive a more holistic approach to care.

Assessing the quality of care helps determine gaps in care and allocating health resources accordingly. In clinical practice, emphasis needs to be given on increased duration and improved quality of patient counselling to improve the low satisfaction levels of patients regarding the psychosocial support. Addressing patients' concerns should be made part of clinical teaching from an undergraduate level. As far as patient access to doctors of the specific speciality is concerned, hospital managements should adopt systems to ensure continuum of care and come up with mechanisms to bridge the discrepancy between a patient's needs and doctor availability.

After being identified as a major deficiency, training doctors in the sensitivities of the population and demographics, especially with respect to socio-economic statuses, can aid in enhancing patient satisfaction to the treatment. Implementation of patient-centred care leads to greater satisfaction with care, which, in turn, increases a patient's self efficacy in managing important aspects of their care and improves health care-related quality of life.

Cancer patients have long-term exposure to the hospital environment. A patient's satisfaction with the quality of care is an important determinant in patient compliance to the treatment protocol and required hospital visits. There is a dearth of research on the outpatient quality of care in the oncology departments in Karachi. This study provides an overview of the quality of care available to cancer patients in Karachi both in public and private sectors. The results of our study identify the gaps in the quality of care being provided to the patients in a developing country like Pakistan, which can be used to improve the quality of care, leading to better patient outcomes.

The purpose of this paper is to describe the case of Buurtzorg Nederland as a good practice example of integrated care, focussing in particular on the organizational aspects of its innovation. As the field of integrated care is still in many ways in its infancy, it is hoped that lessons learned could help other agencies and other systems seeking to reform community-based care.

Drawing on a grounded approach, this case study is based on individual interviews with 38 respondents comprising staff, founder, co-founders, coaches, nurses, clients and a trainer and analysis of internal company reports.

Based on the case study the authors suggest an integrated approach as the main explanation of the good practice at Buurtzorg rather than a focus on one single concept such as management structure, information and communication technology, community-based care or a patient focus. Next to the multi-level approach it furthermore shows a multi-dimensional approach as explanation for its success. In this perspective the primary process is the leading process but fully supported by the secondary process containing support facilities from a head office of the organization.

Buurtzorg Nederland has been awarded with several prizes for its good management practice in integrated care and attention internationally is growing.

This paper provides the first case study write-up of the Buurtzorg model for an international audience, based on extensive research to be published in an international book.

The purpose of this paper is to consider the nature of leadership in the current context where the crisis in global capitalism seems to be encouraging a mechanistic approach to the management of healthcare. The paper urges an holistic leadership ethos to encourage an holistic approach to care and treatment.

The paper utilises an extensive overview of the leadership literature, and also used practical examples of care and leadership practice.

Care and capability need to be partners, but concern has been expressed at all levels of society that a reductionist model is being implemented in many caring professions.

The implications for leadership are that one of the most vital current requirements is to encourage a spirit-filled leadership at all levels in the organisations that provide care.

The paper addresses the issue that leadership can never be a purely intellectual or emotional activity, it must combine all aspects of the person in an holistic approach.

Considering the increasing conceptualization of value creation, this paper aims to empirically examine the influence of pre-encounter value needs of patients on the clinical encounter process and how this impacts on their perceived experiential value, and contributes to the patient’s role in value creation in healthcare service delivery.

A model is proposed to suggest the antecedent and consequences of key elements of the patient–doctor encounter process. Following survey design approach, data collected from 332 outpatients from two clinics in Accra, Ghana, are examined through structural equation modeling using AMOS 23.0.

The findings reveal that patient pre-encounter value needs significantly influence key elements of the patient–doctor encounter process (care delivery approach, level of trust and shared-decision making approach). This in turn affects patient’s perceived experiential value and satisfaction evaluation. The results also suggest that patient characteristics (e.g. educational background and frequency of visit) had no significant effect on the encounter process leading to perceived experiential value; however, patient’s age had significant influence on the encounter process.

This study empirically establishes a need to understand patient’s pre-encounter value needs, which fundamentally influence the patient-doctor encounter process and their perceived experiential value. However, the research only focused on the patient, which could limit the findings considering the multi-actors involved in the service delivery.

Creating value with patients suggests a need for providers to understand patient value needs or goals and adopt an approach to engage in a holistic manner that would result in positive experiences. This would empower and increase confidence of patients in consultations.

Using a quantitative research approach, this research engages in a highly focused investigation of the influence of patient’s pre-encounter value needs on key elements of the patient–doctor encounter process, which has received limited attention in the extant literature. The study also furthers our understanding of the effects of fundamental patient characteristics on encounter process and how this influence actor perceived experiential value.

The purpose of this paper is to explore the “active ingredients” of integrated behavioral health care (IBHC) from the perspective of Karen refugee participants in an IBHC intervention.

This paper is based on in-depth, semi-structured interviews with participants (n=40) who have received an IBHC intervention for one year. These qualitative data are supplemented by descriptive quantitative data from those same participants.

This research suggested that IBHC increased awareness and access to behavioral health services, and that IBHC may be especially amenable to treating complex health conditions. The research also found that IBHC provided a point of regular contact for patients who had limited time with their primary care providers, which helped to enhance access to and engagement with health care.

IBHC has the potential to meet the complex needs of Karen resettled refugees living in an urban setting in the USA.

IBHC is a promising approach to help meet the mental health needs of refugees in the USA. There are, however, gaps in knowledge about the “active ingredients” of IBHC. This paper helps fill these gaps by studying how IBHC works from the perspective of a group of Karen refugees; these are critical perspectives, missing in the literature, which must be heard in order to better address the complex conditions and needs of resettled refugees.

This integrated care study seeks to highlight how voluntary sector “wellbeing co-ordinators” co-located in a horizontally and vertically integrated, multidisciplinary community hub within one locality of an Integrated Care Organisation contribute to complex, person-centred, co-ordinated care.

This is a naturalistic, mixed method and mixed data study. It is complementing a before-and-after study with a sub-group analysis of people receiving input from the wider hub (including Wellbeing Co-ordination and Enhanced Intermediate Care), qualitative case studies, interviews, and observations co-produced with embedded researchers-in-residence.

The cross-case analysis uses trajectories and outcome patterns across six client groups to illustrate the bio-psycho-social complexity of each group across the life course, corresponding with the range of inputs offered by the hub.

To consider the effectiveness and mechanisms of complex system-wide interventions operating at horizontal and vertical interfaces and researching this applying co-produced, embedded, naturalistic and mixed methods approaches.

How a bio-psycho-social approach by a wellbeing co-ordinator can contribute to improved person reported outcomes from a range of preventive, rehabilitation, palliative care and bereavement services in the community.

To combine knowledge about individuals held in the community to align the respective inputs, and expectations about outcomes while considering networked pathways based on functional status, above diagnostic pathways, and along a life-continuum.

The hub as a whole seems to (1) Enhance engagement through relationship, trust and activation, (2) Exchanging knowledge to co-create a shared bio-psycho-social understanding of each individual’s situation and goals, (3) Personalising care planning by utilising the range of available resources to ensure needs are met, and (4) Enhancing co-ordination and ongoing care through multi-disciplinary working between practitioners, across teams and sectors.

Quality and value are currently convergent concepts in healthcare. The importance of patients as customers has increased the focus on quality management and value delivery. The Queen Elizabeth Hospital in Rotorua is a specialist hospital for rheumatic disease and rehabilitation. It has a clear mission for the delivery of customer quality and in fulfilling this mission uses a holistic approach (a value chain approach) to customer care. The value chain study of QEH’s product/service delivery has enabled medical, medical support staff and management to review both value delivery quality and delivery methods. The study explored the QEH value chain organisation and process structures and has identified questions concerning healthcare delivery and alternative methods for achieving current results and the future direction of the organisation. Value chain analysis encourages an intra‐ and inter‐organisational review of resource application and identifies alternative methods and structures for meeting objectives.

There are intense current debates about the place of belief systems in a secular society, and also whether the mechanistic approach to mental health care is sufficient for human beings. This paper aims to describe the Birmingham and Solihull Mental Health Foundation NHS Trust (BSMHFT) spirituality and mental health research programme within that context.

The research studies are placed within a discourse of current debates, but also within the specific context of the city of Birmingham. Birmingham is England's second city to London, and is an increasingly multi‐ethnic and multi‐cultural environment.

Those who use mental health services increasingly state that they wish to have the spiritual dimension of their lives attended to by professionals. The BSMHFT project reinforces this message and demonstrates the merits of close working with faith communities and engaging with staff in their understanding of spirituality.

The research by Professor Koenig et al. in the USA has demonstrated the physical and mental health benefits of belonging to a supportive faith community. The BSMHFT project is a rare UK example of research in this area and comes at a time of intense debate in England over the nature of society.

The purpose of this paper is to explore the relationship between general practitioners (GPs) and social care professionals by reflecting on a project (the Home Truths project) which sought to improve joint working between general practice and social care though an action-research process.

iMPOWER's Home Truths project involved gathering local data regarding joint working in local areas and using this data as a catalyst for change. The Institute of Local Government Studies and the Health Services Management Centre at the University of Birmingham were asked to act as a critical friend to the project. This involved supporting the design of the data collection, offering advice on the process and to carrying out a short evaluation of the impact of the first wave. The paper reflects on the collected data from the sites and information from the impact evaluation.

The paper highlights the poor quality of the relationship between GPs and social workers. Findings that illustrate this include GPs’ poor knowledge of social care services; a perception that social care services were of poor quality and rating the quality of their relationships with social workers as poor. However GPs felt that knowing more about social care could help prevent their patients going into residential care earlier than necessary and wanted to work more closely with social care to exploit the benefits and opportunities. The interventions that have been put in place to try and improve relationships focus on the day-to-day working lives of the professionals rather than attempting to introduce new initiatives.

The response rate from GPs in the areas was low (average response rate was 10 per cent in each area) and it may be that only those GPs who are interested in working with social care responded. The initiatives that have been developed appear to be reasonable responses to the issues identified. However, a lack of discrete outcomes through which to measure improvement will make it difficult to demonstrate the impact of the interventions.

This paper underlines that despite many years of policy makers promoting better integration, the relationship between the key gate-keepers within the health and social care systems is still poor. The findings from the Home Truths surveys and action plans has gone some way to address the gap identified in the evidence base about the relationships between GPs and social workers.