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Article
Publication date: 12 March 2018

Paul Clarkson, Rebecca Hays, Sue Tucker, Katie Paddock and David Challis

A growing ageing population with complex healthcare needs is a challenge to the organisation of healthcare support for older people residing in care homes. The lack of specialised…

Abstract

Purpose

A growing ageing population with complex healthcare needs is a challenge to the organisation of healthcare support for older people residing in care homes. The lack of specialised healthcare support for care home residents has resulted in poorer outcomes, compared with community-dwelling older people. However, little is known about the forms, staff mix, organisation and delivery of such services for residents’ physical healthcare needs. The paper aims to discuss these issues.

Design/methodology/approach

This systematic review, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, aimed to provide an overview of the range of healthcare services delivered to care homes and to identify core features of variation in their organisation, activities and responsibilities. The eligibility criteria for studies were services designed to address the physical healthcare needs of older people, permanently residing in care homes, with or without nursing. To search the literature, terms relating to care homes, healthcare and older people, across ten electronic databases were used. The quality of service descriptions was appraised using a rating tool designed for the study. The evidence was synthesised, by means of a narrative summary, according to key areas of variation, into models of healthcare support with examples of their relative effectiveness.

Findings

In total, 84 studies, covering 74 interventions, identified a diverse range of specialist healthcare support services, suggesting a wide variety of ways of delivering healthcare support to care homes. These fell within five models: assessment – no consultant; assessment with consultant; assessment/management – no consultant; assessment/management with consultant; and training and support. The predominant model offered a combination of assessment and management. Overall, there was a lack of detail in the data, making judgements of relative effectiveness difficult. Recommendations for future research include the need for clearer descriptions of interventions and particularly of data on resident-level costs and effectiveness, as well as better explanations of how services are implemented (review registration: PROSPERO CRD42017081161).

Originality/value

There is considerable debate about the best means of providing healthcare to older people in care homes. A number of specialist initiatives have developed and this review seeks to bring these together in a comparative approach deriving models of care of value to policy makers and commissioners.

Details

Quality in Ageing and Older Adults, vol. 19 no. 1
Type: Research Article
ISSN: 1471-7794

Keywords

Article
Publication date: 19 December 2017

Mette Kollerup, Tine Curtis and Birgitte Schantz Laursen

Employing a participatory approach, the purpose of this paper is to identify possible areas for improvement in visiting nurses’ post-hospital medication management and to…

Abstract

Purpose

Employing a participatory approach, the purpose of this paper is to identify possible areas for improvement in visiting nurses’ post-hospital medication management and to facilitate suggestions for changes in future practices.

Design/methodology/approach

Based on a previous study on visiting nurses’ post-hospital medication management, two workshops were conducted in a visiting nurse department in a Danish municipality.

Findings

The visiting nurses emphasised knowledge of patients’ basic needs and prioritised their performance of context-specific nursing assessments, with a preventive focus as a prerequisite for improved patient safety in post-hospital medication management.

Research limitations/implications

The participatory approach can increase the acceptability and feasibility of changes regarding future practices and thereby reduce the gap between official documents and daily practice. Although the local development of suggestions for changes in practices does not provide general knowledge, a subsequent detailed description of the changes in practices can promote transferability to other healthcare settings after local adjustments are made.

Practical implications

Flexible home healthcare, with stable relationships enabling the continuous assessment of the patient’s needs and symptoms, along with subsequent adjustments being made in care and medical treatment, might enhance patient safety in post-hospital medication management.

Originality/value

This paper adds to the knowledge of the need for integrated care in medication management in patients’ homes. It argues for primary healthcare professionals as “experts in complexity” and suggests a reconsideration of the purchaser-provider division of care to patients with unstable health conditions and complex care needs during the first days following hospital discharge.

Article
Publication date: 6 June 2022

Ankit Singh, Ajeya Jha, Shankar Purbey and Priya Ravi

Elderly patients suffering from non-communicable disease face a dilemma in the selection of healthcare providers. This study attempts to identify the key variables playing a…

Abstract

Purpose

Elderly patients suffering from non-communicable disease face a dilemma in the selection of healthcare providers. This study attempts to identify the key variables playing a crucial role and identify the appropriate healthcare destination with the help of a combination of Decision-making Trial and Evaluation Laboratory (DEMATEL) and analytic hierarchy process (AHP) techniques. The primary objective is to introduce the DEMATEL and AHP as efficient decision-making methods to choose the right healthcare provider for elderly patients suffering from non-communicable diseases.

Design/methodology/approach

An integrative approach utilizing DEMATEL and AHP is used to reach the ideal solution for healthcare provider selection decisions. The DEMATEL approach is used to segregate the cause and effect variables. Similarly, the AHP is used to identify the weights of the top five cause-inducing variables, and the paired comparison method is used to select the healthcare provider.

Findings

The variables such as dependency on family members, easily accessible services, and patient autonomy play a vital role in the selection decision of healthcare providers in elderly patients suffering from non-communicable diseases.

Practical implications

In terms of priority, home healthcare should be considered the preferred provider for elderly patients suffering from non-communicable diseases followed by neighbourhood registered medical practitioners and hospitals.

Originality/value

This is the first of its kind study which has attempted to solve the healthcare provider selection decision with the combined approach of DEMATEL and AHP.

Details

Journal of Integrated Care, vol. 31 no. 1
Type: Research Article
ISSN: 1476-9018

Keywords

Article
Publication date: 1 July 2014

Mélanie Levasseur, Nadine Larivière, Noémie Royer, Johanne Desrosiers, Philippe Landreville, Philippe Voyer, Nathalie Champoux, Hélène Carbonneau and Andrée Sévigny

– This paper aims to explore the match between needs and services related to participation for frail older adults receiving home care.

Abstract

Purpose

This paper aims to explore the match between needs and services related to participation for frail older adults receiving home care.

Design/methodology/approach

A qualitative multiple case study was conducted with 11 triads each involving an elder, a caregiver and a healthcare provider working in a Health and Social Services Centers (HSSCs).

Findings

Although HSSCs in Québec are supposed to promote social integration and participation of older adults, services provided to the older adults in this study focused mainly on safety and independence in personal care, dressing, mobility and nutrition, without fully meeting older adults’ needs in these areas. Discrepancies between needs and services may be attributable to the assessment not covering all the dimensions of social participation or accurately identifying older adults’ complex needs; older adults’ and their caregivers’ difficulties identifying their needs and accepting their limitations and the assistance offered; healthcare providers’ limited knowledge and time to comprehensively assess needs and provide services; guidelines restricting the types and quantity of services to be supplied; and limited knowledge of older adults, caregivers and healthcare providers about services and resources available in the community.

Originality/value

To improve and maintain older adults’ participation, a more thorough assessment of their participation, especially in social activities, is required, as is greater support for older adults and their families in using available community resources. It is also important to review the services provided by HSSCs and to optimize partnerships with community organizations.

Details

Leadership in Health Services, vol. 27 no. 3
Type: Research Article
ISSN: 1751-1879

Keywords

Article
Publication date: 30 October 2020

Leonard L. Berry

The purpose of this article is to highlight the importance of the foundational construct of “connection” in linking design and service in performing vital functions in the…

Abstract

Purpose

The purpose of this article is to highlight the importance of the foundational construct of “connection” in linking design and service in performing vital functions in the healthcare sector. “Connection” facilitates patients receiving life-saving and life-improving care at the right time, in the right place, in the right way.

Design/methodology/approach

This article discusses various design-improvement initiatives making clear that healthcare, like any labor-intensive service delivered to people, is a human endeavor whose systems and features can be materially and cleverly enhanced once their intricacies are analyzed, understood and then redesigned to move closer to excellence.

Findings

By designing connection into healthcare and thinking holistically about the needs and preferences of users (patients), the functionality and the appeal of healthcare services can be enhanced.

Originality/value

The gap between the service that healthcare aims to deliver – and what it actually delivers – is unacceptably large. This article calls for incorporating connection through design into healthcare as a way to bridge this gap.

Details

Journal of Service Management, vol. 31 no. 5
Type: Research Article
ISSN: 1757-5818

Keywords

Article
Publication date: 3 April 2018

Dimitra Dritsa and Nimish Biloria

The purpose of this paper is to investigate the role of emerging technologies in the promotion of health and well-being at the urban, domestic and bodily scale, through the…

Abstract

Purpose

The purpose of this paper is to investigate the role of emerging technologies in the promotion of health and well-being at the urban, domestic and bodily scale, through the systematic examination of technologies such as physical sensing systems and physiological data monitoring, that are currently explored as drivers for achieving sustainable healthcare within a multi-scalar approach.

Design/methodology/approach

A comprehensive study of the various technologies associated with smart healthcare is provided, first investigating smart cities, physical sensing systems and geospatial data as potential enablers of public health. Then the discourse shifts towards exploring Smart Home technologies for healthcare, first reviewing strategies of enhancing the home environment with multisensory components, and then discussing the emergence of physiological monitoring devices and their interconnection with the domestic and urban environment.

Findings

While the implementation of Internet of Things, physical sensing systems and geospatial analytics in extracting and analyzing the multiple information layers of the urban, the domestic and the bodily environment, has been widely explored, there is little consideration on the transition from the domestic to the urban level, and while within each of the different scales, the need for a multi-componential approach is addressed, there is minimal effort towards its materialization.

Originality/value

The major contribution of this study therefore lies in laying the ground for further research towards a multi-scalar relational approach that views smart healthcare as a trajectory, binding the bodily, to the domestic and the urban fabric.

Details

Smart and Sustainable Built Environment, vol. 7 no. 1
Type: Research Article
ISSN: 2046-6099

Keywords

Article
Publication date: 1 February 1997

Wendy Young and Peter C. Coyte

Posits that Canadian home care services compete with hospitals and other community and public health agencies for scarce financial resources but as yet regional authorities are…

1476

Abstract

Posits that Canadian home care services compete with hospitals and other community and public health agencies for scarce financial resources but as yet regional authorities are not responsible for paying physicians. Investigates all the various facets of home care services and concludes that by using joint ventures, there may be the possibility of making informed decisions for the Canadian healthcare system.

Details

Leadership in Health Services, vol. 10 no. 1
Type: Research Article
ISSN: 1366-0756

Keywords

Article
Publication date: 19 February 2019

James Chowhan, Margaret Denton, Catherine Brookman, Sharon Davies, Firat K. Sayin and Isik Zeytinoglu

The purpose of this paper is to examine the mediating role of stress between work intensification and musculoskeletal disorders (MSDs) focusing on personal support workers (PSWs…

Abstract

Purpose

The purpose of this paper is to examine the mediating role of stress between work intensification and musculoskeletal disorders (MSDs) focusing on personal support workers (PSWs) in home and community care.

Design/methodology/approach

The analysis sample of 922 comes from the 2015 survey of PSWs employed in Ontario, Canada. The endogenous variable is self-reported MSDs, and the exogenous variable is work intensification. Stress, measured as symptoms of stress, is the mediating variable. Other factors shown in the literature as associated with stress and/or MSDs are included as control variables. Structural equation model regression analyses are presented.

Findings

The results show that stress mediates the effect of work intensification on PSW’s MSDs. Other significant factors included being injured in the past year, facing hazards at work and preferring less hours – all had positive and significant substantive effects on MSDs.

Research limitations/implications

The survey is cross-sectional and not longitudinal or experimental in design, and it focuses on a single occupation in a single sector in Ontario, Canada and, as such, this can limit the generalizability of the results to other occupations and sectors.

Practical implications

For PSW employers including their human resource managers, supervisors, schedulers and policy-makers, the study recommends reducing work intensification to lower stress levels and MSDs.

Originality/value

The findings of this study contribute to the theory and knowledge by providing evidence on how work intensification can affect workers’ health and assist decision makers in taking actions to create healthy work environments.

Details

Personnel Review, vol. 48 no. 2
Type: Research Article
ISSN: 0048-3486

Keywords

Open Access
Article
Publication date: 7 May 2021

Malin Knutsen Glette and Siri Wiig

The purpose of this paper is to increase knowledge of the role organizational factors have in how health personnel make efficiency-thoroughness trade-offs, and how these…

2776

Abstract

Purpose

The purpose of this paper is to increase knowledge of the role organizational factors have in how health personnel make efficiency-thoroughness trade-offs, and how these trade-offs potentially affect clinical quality dimensions.

Design/methodology/approach

The paper is a thematic synthesis of the literature concerning health personnel working in clinical, somatic healthcare services, organizational factors and clinical quality.

Findings

Identified organizational factors imposing trade-offs were high workload, time limits, inappropriate staffing and limited resources. The trade-offs done by health personnel were often trade-offs weighing thoroughness (e.g. providing extra handovers or working additional hours) in an environment weighing efficiency (e.g. ward routines of having one single handover and work-hour regulations limiting physicians' work hours). In this context, the health personnel functioned as regulators, balancing efficiency and thoroughness and ensuring patient safety and patient centeredness. However, sometimes organizational factors limited health personnel's flexibility in weighing these aspects, leading to breached medication rules, skipped opportunities for safety debriefings and patients being excluded from medication reviews.

Originality/value

Balancing resources and healthcare demands while maintaining healthcare quality is a large part of health personnel's daily work, and organizational factors are suspected to affect this balancing act. Yet, there is limited research on this subject. With the expected aging of the population and the subsequent pressure on healthcare services' resources, the balancing between efficiency and thoroughness will become crucial in handling increased healthcare demands, while maintaining high-quality care.

Details

International Journal of Health Governance, vol. 26 no. 3
Type: Research Article
ISSN: 2059-4631

Keywords

Open Access
Article
Publication date: 12 October 2023

Jens Hemphälä and Magnus Eneberg

The increasing size of the elderly population is emerging as a primary catalyst for the escalation of healthcare expenditure, and a sense of urgency is manifest. However, the…

Abstract

Purpose

The increasing size of the elderly population is emerging as a primary catalyst for the escalation of healthcare expenditure, and a sense of urgency is manifest. However, the complexity of the health- and elderly care systems provides challenges in improving system efficiency. Hence, the system-level understanding of the main obstacles to integration care needs further exploration. In order to better integrate health- and elderly care, the study needs to identify the actual misalignments underpinning the issue. This study provides the theoretical foundations for resource misalignments and provides empirical examples of these.

Design/methodology/approach

Semi-structured interviews with multiple stakeholders on various hierarchical levels were carried out to create a more complete view of the system and resources deployed in health- and elderly care. The application of user-centered design methods and co-creation with employees have also been crucial to the outcomes of the study.

Findings

Results show that health- and elderly care is a large-scale complex system. The overlapping and mutually reinforcing misalignments are: (1) regulation and policy differences, (2) stakeholder quantity and variation, (3) external control of health- and elderly care, (3) decreasing collaboration and (4) communication channels and IT development.

Originality/value

This qualitative study builds on institutional theory and resource integration theory and contributes with empirical descriptions of misalignments in the health- and elderly care system. These descriptions will serve as points of departure for systems design to improve the efficiency and effectiveness of health- and elderly care.

Details

Journal of Integrated Care, vol. 31 no. 5
Type: Research Article
ISSN: 1476-9018

Keywords

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