Search results

Providing high-quality and cost-efficient care of older people is an important development priority for many health and social care systems in the world. This paper suggests a shift from acute, episodic and reactive hospital-centered care toward longitudinal, person-centered and proactive home-centered care. The purpose of this paper is to contribute to the knowledge of a comprehensive development strategy for designing and providing home-centered care of older people.

The study design is based on qualitative research with an inductive approach. The authors study development initiatives at the national, regional and local levels of the Swedish health and social care system. The data collection methods included interviews (n = 54), meeting observations (n = 25) and document studies (n = 59).

The authors describe findings related to policy actions and system changes, attempts to achieve collaboration, integration and coordination, new forms of care offerings, characteristics of work settings at home and differences in patients' roles and participation at home and in the hospital.

The authors suggest home-centered care as a solution for providing person-centered and integrated care of older people and give examples of how this can be achieved.

The authors outline five propositions for research and development related to national policies, service modularity as a solution for customized and coordinated care, developing human resources and infrastructure for home settings, expanding services that enable older people living at home and patient co-creation.

This paper aims to explore challenges and opportunities associated with young carers' employment in Australia.

Using a multi-stakeholder approach, this study captures the reflections of stakeholders (n = 8) and young carers (n = 10) about opportunities for, and experiences of, paid employment for young carers.

Despite many organisations internationally increasingly pushing diversity agendas and suggesting a commitment to equal opportunity experiences, this study found that young carers' work opportunities are often disrupted by their caring role. For young carers to be successful in their careers, organisations need to provide further workplace flexibility, and other support is required to attract and retain young carers into organisations and harness their transferrable skills for meaningful careers.

The paper highlights important implications for human resource management practitioners given the need to maximise the participation of young carers as workers, with benefits for young carers themselves, employers and society.

The research adds to the human resource management and work–family conflict literature in examining young carers through drawing on Conservation of Resources theory to highlight resources invested in caring leads to loss of educational and work experience resources. This leads to loss cycles and spirals, which can potentially continue across a lifetime, further contributing to disadvantage and lack of workplace and societal inclusion for this group of young people.

A large number of studies indicate that coercive forms of organizational control and performance management in health care services often backfire and initiate dysfunctional consequences. The purpose of this article is to discuss new approaches to performance management in health care services when the purpose is to support innovative changes in the delivery of services.

The article represents cross-boundary work as the theoretical and empirical material used to discuss and reconsider performance management comes from several relevant research disciplines, including systematic reviews of audit and feedback interventions in health care and extant theories of human motivation and organizational control.

An enabling approach to performance management in health care services can potentially contribute to innovative changes. Key design elements to operationalize such an approach are a formative and learning-oriented use of performance measures, an appeal to self- and social-approval mechanisms when providing feedback and support for local goals and action plans that fit specific conditions and challenges.

The article suggests how to operationalize an enabling approach to performance management in health care services. The framework is consistent with new governance and managerial approaches emerging in public sector organizations more generally, supporting a higher degree of professional autonomy and the use of nonfinancial incentives.

The lack of progress toward equity in the U.S. is evident across many spheres of society, academia notwithstanding. Women academicians, in particular, face many barriers that prevent them from advancing–including a continued unsupportive climate, competing work and family demands, and interpersonal discrimination. This paper reflects on a collaborative research effort in the United States to enhance allyship for women in academia.

The authors partnered with a major university to hold ally training for department chairs during a university-wide department chair meeting. The authors developed a methodology for creating and implementing training content using a focus-group-based training needs analysis and a diversity science grounded approach to allyship training. The authors followed this up with surveys to assess impact.

Participants indicated that they learned from the training, but participation in follow-up data collection was limited, hampering the ability to conduct rigorous quantitative analyses around intervention impact.

Although the sample size may have been too limited to detect effects, the current study provides an approach that furthers the way in which researchers and practitioners can better assess the impact of allyship to women academicians.

Published research on allies is very limited. The current research examines allies in the context of helping women in academia.

Despite widespread recognition of the importance of first-line supervisors in support of diversity, limited intervention designs are available. The authors add to the extant literature on diversity interventions, while highlighting barriers to rigorous intervention evaluation.

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).

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.

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.

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.

Value-based health care (VBHC) argues that health-care needs to re-focus to maximise value creation, defining value as the quota when dividing the outcomes important for the patient, by the cost for health care to deliver such outcomes. This study aims to explore the perception of value among different stakeholders involved in the process of implementing VBHC at a Swedish hospital to support leaders to be more efficient and effective when developing health care.

Participants comprised 19 clinicians and non-clinicians involved in the implementation of VBHC. Semi-structured interviews were conducted and content analysis was performed.

The clinicians described value as a dynamic concept, dependent on the patient and the clinical setting, stating that improving outcomes was more important than containing costs. The value for non-clinicians appeared more driven by the interplay between the outcome and the cost. Non-clinicians related VBHC to a strategic framework for governance or for monitoring different continuous improvement processes, while clinicians appreciated VBHC, as they perceived its introduction as an opportunity to focus more on outcomes for patients and less on cost containment.

There is variation in how clinicians and non-clinicians perceive the key concept of value when implementing VBHC. Clinicians focus on increasing treatment efficacy and improving medical outcomes but have a limited focus on cost and what patients consider most valuable. If the concept of value is defined primarily by clinicians’ own assumptions, there is a clear risk that the foundational premise of VBHC, to understand what outcomes patients value in their specific situation in relation to the cost to produce such outcome, will fail. Health-care leaders need to ensure that patients and the non-clinicians’ perception of value, is integrated with the clinical perception, if VBHC is to deliver on its promise.

This study aims to investigate how institutional and organisational factors affect case management of patients with mental disorders by GPs in Italy and Spain. The paper highlights the importance of improving the effectiveness of primary care to ensure easy access to mental health services, which is crucial in responding to the increasing incidence of mental disorders and preventing negative outcomes.

This article details a qualitative research study that examines the management of patients with mental disorders by general practitioners (GPs) in Italy and Spain, using cross-national comparison and in-depth interviews with GPs as research methods.

The study revealed that Italian self-employed GPs have more scheduling autonomy than Spanish Health Centre GPs. Both face high work pressure and resource scarcity, highlighting the need for targeted training. The COVID-19 pandemic led to a rise in phone consultations.

This study provides novel insights into mental health management by examining the case management of patients with mental disorders by GPs in Italy and Spain, with a focus on the impact of institutional and organisational factors. The cross-national comparison and in-depth interviews enhance the originality of the study, offering a nuanced understanding of the constraints faced by GPs in their work context. Furthermore, the comparison of the similar primary care frameworks of Italy and Spain may offer insight into their evolution.

This study aims to identify the street-level approaches of professional workers in complex public social service organisations when attending to social assistance claimants.

The study employed a multifaceted approach comprising documentary analysis, semi-structured individual interviews (17) and focus group discussions (8) with qualified frontline social workers from primary care social services in Tarragona.

Social workers embodied three specific sets of cognitive, normative and emotional dispositions when attending to people with low incomes. First, the compassionate approach conceives clients as defensive regarding social services and emotionally vulnerable because of deprivation. Second, the instructional approach frames clients as being baffled by a new, precarious, institutional and economic context. They also lack information, abilities and the proper mindset to conceive of and attain available welfare and occupational resources. Third, the enforcement approach tends to define clients as suspicious, trying to obtain an excessive and unfair advantage of the welfare system that would eventually hamper their social opportunities.

Research thus far has tended to define public social assistance programmes in Southern welfare state contexts as mostly inefficient and hardly relevant residual social policies. The street-level approach shows that social workers try to resist the mere administrative processing of benefits, which is a professionally troubling and organisationally unsustainable way to proceed. They attempt to help clients by providing inclusive content in order to implement their benefits.

Recent high-profile ethical scandals in start-up organizations have made people wonder whether entrepreneurship may cultivate a work environment with less emphasis on ethics. This study examined a psychological process about how an organization’s entrepreneurial orientation (EO) can affect its treatment of probationary employees, a vulnerable yet understudied group of workers.

The authors recruited 241 participants through Amazon Mechanical Turk. They answered an online survey about their experiences as probationary employees.

This study found that job feedback and meaning moderated the relationship between EO and ethical climate, such that this relationship was statistically significant and positive only among participants who reported high levels of feedback and job meaning. Ethical climate, in turn, was found to be related to a reduction in workplace incivility experienced by probationary employees. The indirect effect of EO on incivility via ethical climate was contingent on job feedback and meaning.

This study extends the discussion on the entrepreneurial context, adds to EO literature with findings on its indirect effect on nonfinancial performance and reinforces institutional theory through job characteristics’ moderating roles. However, a methodological limitation is conducting a cross-sectional single-source survey due to limited access to firms and probationary employees, considering the hidden population involved.

This study found no evidence of probationary employee exploitation in high EO organizations. Job seekers should embrace probationary work at start-ups. Entrepreneurial leaders should balance being proactive, innovative and caring toward employees.

It is debatable whether entrepreneurship leads to unethical organizational conduct. By studying a vulnerable group of employees, the authors discovered that EO, when paired with favorable job design factors, can create a more ethical workplace where temporary talents are treated with dignity and respect.

The purpose of this paper is to understand US federal government policy during the early stages of the COVID-19 pandemic and the connections to graduate education. Using the multiple streams framework, the paper outlines these actions through various streams (problems, policy and political) and perspectives (defining problems, articulating options and mobilizing responses).

The primary sources of data collected for this study were US federal government policies from March 2020 through May 2021. Policies were examined through introduction, implementation and alteration (when possible) within the specific time period of the study. The policies outlined in this paper were connected to the US Department of Education, and to a lesser extent, the National Institutes of Health, the National Science Foundation and other federal agencies. Data analysis was a two-fold process. First, the individual policy was considered as a single case and second, a cross-case comparison occurred across the multiple cases.

Analysing the study’s data in the problem stream provides a strong indicator of how the pandemic was perceived as a challenge for US graduate education. The pandemic served as a focusing event and illuminated the connections of graduate education to key institutional functions, including research and teaching. Broadly, US federal policy actions in this area focused on giving institutions resources and flexibility to support graduate students and allow them to continue their academic work while also seeding funding and incentives to continue the movement of knowledge, activities and people in the research pipeline. Actions in the policy stream aligned with the decentralized nature of the US higher education system and allowed for choice by academic institutions within the parameters of options.

This paper extends extant literature related to policy-making and graduate education to consider policy-making during a time of crisis. The paper offers methodological and conceptual ideas for consideration in future research.