Search results

New Public Management (NPM) has increased fragmentation in municipal health and social care organizations. In response, post-NPM reforms aim to enhance integration through service integration. Integration of municipal services is important for people with complex health and social challenges, such as concurrent substance abuse and mental health problems. This article explores the conditions for service integration in municipal health and social services by studying how public management values influence organizational and financial structures and professional practices.

This is a case study with three Norwegian municipalities as case organizations. The study draws on observations of interprofessional and interagency meetings and in-depth interviews with professionals and managers. The empirical field is municipal services for people with concurrent substance abuse and mental health challenges. The data were analyzed both inductively and deductively.

The study reveals that opportunities to assess, allocate and deliver integrated services were limited due to organizational and financial structures as the most important aim was to meet the financial goals. The authors also find that economic and frugal values in NPM doctrines impede service integration. Municipalities with integrative values in organizational and financial structures and in professional approaches have greater opportunities to succeed in integrating services.

Applying a public management value perspective, this study finds that the values on which organizational and financial structures and professional practices are based are decisive in enabling and constraining service integration.

Lack of research means guidance regarding the most effective sensory interventions for adults with intellectual disabilities is limited. Preliminary consensus evidence was created by gathering experienced occupational therapists’ views on practice. The purpose of this study was to establish important elements of practice when using sensory integration-informed approaches on assessment and treatment units.

A modified Delphi process was used to gather, explore and synthesise the views of 13 occupational therapists. Data was collected via online surveys and included quantitative importance ratings and qualitative comments.

An experienced panel was in strong agreement regarding many elements of practice they felt were important for use in this setting, and a list of important practice items was created. Two themes were identified: “Complexity” and “Pragmatism vs. Ideal World.” The themes highlight challenges to practice in this area and the complex clinical reasoning used to overcome these.

Participants disagreed about the level of importance of a substantial number of items, therefore items that did not reach consensus may still be important.

This study indicates potentially helpful clinical tools, facilities and training and identifies support needed for occupational therapists working in these settings.

This study contributes to the body of knowledge regarding how occupational therapists do and could work with people with intellectual disabilities and sensory integration difficulties. Although this study takes a UK and Ireland perspective, similar agendas regarding care and support for those with intellectual disabilities internationally mean findings are relevant more widely.

The COVID-19 pandemic has caused severe challenges to ethnic minorities in the UK. While the experiences of migrants are both complex and varied depending on individuals' social class, race, cultural proximity to the host country and acculturation levels, more in-depth studies are necessary to fully understand how COVID-19 affects specific migrant groups and their health. Taiwanese migrants were selected because they are an understudied group. Also, there were widespread differences in pandemic management between the UK and Taiwan, making this group an ideal case for understanding how their acculturation journey can be disrupted by a crisis.

Qualitative data were collected at two different time points, at the start of the UK pandemic (March/April 2020) and six months on (October/November 2020), to explore migrant coping experiences over time. Theoretically, the authors apply acculturation theory through the lens of coping, while discussing health-consumption practices, as empirical evidence.

Before the outbreak of the pandemic, participants worked hard to achieve high levels of integration in the UK. The pandemic changed this; participants faced unexpected changes in the UK’s sociocultural structures. They were forced to exercise the layered and complex “coping with coping” in a hostile host environment that signalled their new marginalised status. They faced impossible choices, from catching a life-threatening disease to being seen as overly cautious. Such experience, over time, challenged their integration to the host country, resulting in a loss of faith in the UK’s health system, consequently increasing separation from the host culture and society.

It is important to note that the Taiwanese sample recruited through Facebook community groups is biased and has a high level of homogeneity. These participants were well-integrated, middle-class migrants who were highly educated, relatively resourceful and active on social media. More studies are needed to fully understand the impact on well-being and acculturation of migrants from different cultural, contextual and social backgrounds. This being the case, the authors can speculate that migrants with less resource are likely to have found the pandemic experience even more challenging. More studies are needed to fully understand migrant experience from different backgrounds.

Public health policymakers are advised to dedicate more resources to understand migrants' experiences in the host country. In particular, this paper has shown how separation, especially if embraced temporarily, is not necessarily a negative outcome to be corrected with specific policies. It can be strategically adopted by migrants as a way of defending their health and well-being from an increasingly hostile environment. Migrants' home country experience provides vicarious learning opportunities to acquire good practices. Their voices should be encouraged rather than in favour of a surprising orthodox and rather singular approach in the discussion of public health management.

The paper has clear public health policy implications. Firstly, public health policymakers are advised to dedicate more resources to understand migrants' experiences in the host country. Acknowledging migrants' voice is a critical first step to contribute to the development of a fair and inclusive society. Secondly, to retain skilful migrants and avoid a future brain-drain, policymakers are advised to advance existing infrastructure to provide more incentives to support and retain migrant talents in the post-pandemic recovery phase.

This paper reveals how a group of previously well-integrated migrants had to exercise “coping with coping” during the COVID crisis. This experience, over time, challenged their integration to the host country, resulting in a loss of faith in the UK’s health system, consequently increasing separation from the host culture and society. It contributes to the understanding of acculturation by showing how a such crisis can significantly disrupt migrants' acculturation journey, challenging them to re-acculturate and reconsider their identity stance. It shows how separation was indeed a good option for migrants for protecting their well-being from a newly hostile host environment.

The purpose of this paper is to introduce the concept of meaning as a relevant but missing link in understanding the building blocks of service innovation informed by service-dominant (S-D) logic. In exploring the role of meaning in service innovation, especially related to new value propositions, resource integration and new value cocreation, the authors suggest using the conceptualization of meaning within human-centered design, which has an established body of knowledge on addressing how actors engage and interact.

The paper builds an actionable conceptual framework that relates meaning to central tenets of service innovation, such as resource integration, value propositions and cocreation of value. It delineates the central building blocks of service innovation and conceptually integrates them with meaning to explain the underlying mechanisms of service innovation related both to its development and adoption.

The findings highlight how and why meaning precedes value creation and directs resource integration. Indicating that meaning is driven by experience of earlier interactions it delineates its relationships with new value formation and positions resource interpretation as a driver of this process.

This paper extends the understanding of service innovation in relation to S-D logic, with meaning as a conceptual link to aspects of S-D logic that claim a phenomenological nature. Meaning contributes to S-D logic by providing an understanding of how beneficiaries form intentions to engage in value creation and resource integration. Additionally, by integrating service and design research domains, this paper suggests possibilities for multidisciplinary contributions in future research.

The purpose of this paper is to identify the areas and logic of integration of different stakeholders using different methods and to analyse their applicability and challenges in practical projects. The main aim is to describe how these different methods impact value creation.

Action design research was carried out in a large hospital construction project where the first author acted as an “involved researcher” and the second author acted as an “outside researcher”. Two workshops were organised to evaluate the direct and indirect challenges and benefits of the applied four methods and to explain how different methods enable value creation.

All the studied methods provide good results in terms of usability and commitment to the aims of the project, thus delivering the direct benefits expected. Process, people and tools logic works well in this case project when applying the methods properly. Significant evidence was provided on secondary deliverables of the methods, and all analysed methods had a significant impact in the area of leading people, clarifying what “focus on people” means and how it is enabled.

Focus on people can be achieved through different operative methods if applied in the right way. It is necessary to select the most suitable methods based on all the direct and indirect deliverables.

This case project offered a platform to analyse integration methods in a real-life project using the collaborative contract method. The authors were able to participate in the analysis by taking action from the very beginning of the project in terms of training, learning, continuous development and coaching of these methods and evaluating the applicability.

Emergency care delivery is a process requiring input from various healthcare professionals within the hospital. To deliver efficient and effective emergency care, professionals must integrate rapidly at multiple interfaces, working across functional, spatial and professional boundaries. Yet, the interdisciplinary nature of emergency care presents a challenge to the optimization of patient flow, as specialization and functional differentiation restrict integration efforts. This study aims to question what boundaries exist at the level of professionals and explores how these boundaries may come to influence integration and operational performance.

To provide a more holistic understanding of the inherent challenges to integration at the level of professionals and in contexts where professionals play a key role in determining operational performance, the authors carried out an in-depth case study at a busy, Level 1 trauma center in The Netherlands. In total, 28 interviews were conducted over an 18-month period.

The authors reveal the existence of structural, relational and cultural barriers between (medical) professionals from different disciplines. The study findings demonstrate how relational and cultural boundaries between professionals interrupt flows and delay service processes.

This study highlights the importance of interpersonal and cultural dynamics for internal integration and operational performance in emergency care processes. The authors unveil how the presence of professional boundaries creates opportunity for conflict and delays at important interfaces within the emergency care process, and can ultimately accumulate, disrupting patient flow and increasing lead times.

A critical attribute of open educational practices (OEP) is the pursuit of open scholarship which comprises the release of educational resources under an open licence scheme that permits no-cost access, use, reuse, adaptation, retention and redistribution to others. The degree of openness in relation to this attribute will depend on the context and culture of the place and the people in it. When left to chance, the adoption and practice of open scholarship by educators is at best sketchy. For optimum impact, a design-based approach is essential. A central focus of such an approach will need to target educators’ belief systems and practices about their scholarship. Any such work will involve researchers collaborating with practitioners in real-life settings to improve educational practices through iterative analysis, design, development and implementation. The purpose of this paper is to report on how the development and use of such a design-based approach, implemented by the Open University of Sri Lanka, impacted the adoption and uptake of open scholarship among teachers in the Sri Lankan school system in terms of changes in their use of instructional resources, pedagogical thinking and pedagogical practices.

The study adopted a design-based research (DBR) approach (Reeves, 2006), which involved researchers collaboratively working with practitioners in real-life settings to improve their educational practices along three aspects – instructional resource use, pedagogical perspectives and pedagogical practices. Based on the four stages of the DBR approach – analysis, solution, testing and refinement, and reflection, a professional development intervention programme was designed and implemented to support teachers on the integration of open educational resources (OER) and adoption of OEP in their teaching-learning process. Data collected throughout the process using multiple strategies such as questionnaire surveys, concept mapping, lesson plans, focus group interviews, self-reflections and “stories”, were analyzed using both qualitative and quantitative methods.

By the end of the intervention, significant changes were observed in teachers’ use of instructional resources, their pedagogical thinking and pedagogical practices. While resource usage has shifted from no or low usage of OER to reuse, revise, remix and creation of OER, the pedagogical thinking and practices of teachers moved from a content-centric and individualized patterns to more constructivist, context centric and collaborative ways. The diffusion of OEP was prominent along two dimensions – enhancements in the individual practices in innovative OER use as well as collaborative practices of sharing of resources, knowledge and good practices.

The systematic and flexible methodology adopted based on the DBR approach via a framework designed as a contextualized, process oriented and a self-reflective enquiry has been very useful to support changes in OEP among practitioners over time.

This iterative process allowed the researchers to function as “designers”, while investigating real-life issues in collaboration with the practitioners through reflective enquiry to further refine innovative practices towards OEP. This provides valuable insights for improved design solutions for future interventions in similar contexts.

Container liner shipping companies started expanding their business by investing in container port terminals in the late 1990s. This market entry results in an extensive presence of vertically integrated liners and terminals. This study aims to explore the competition effects of this vertical integration trend based on a regional (European) analysis. In particular, it extracts lessons from the European Commission (EC) cases on the competition effects of vertical integration. The critical analysis of the cases examined at the institutional level intends to reach conclusions on whether liner–terminal vertical integration harmed or advanced competition in the relevant markets and/or the extent that there is a need to revise the current policy practices.

This study critically assesses the EC’s decisional practices in port container terminal vertical mergers in the last 25 years (1997–2021). Based on a literature review comparing maritime and competition economists' perspectives, it reviews the types of mergers examined, the methodology followed for relevant market definition and calculation of market shares and the estimated competition effects. The Hamburg–Le Havre area is the port range used as a case study for comparing the decisional practice with actual market developments. These container ports serve the greatest consuming market of final and intermediate goods in Europe and are gateways to Central and Eastern Europe.

The assessment identifies a need for expanding the investigation as a precondition for reaching conclusions on both the anti- and pro-competitive effects. First, only a limited number of transactions have been notified to the EC. Second, the empirical research identified a gap in this process, as there were no decisions (phase I) on vertical mergers between 2008 and 2016. Third, the exante assessment has not applied a phase II in-depth analysis to any case due to the absence of competition concerns. Finally, due to the absence of complaints, there is a lack of any ex post assessment of the effects of vertical integration.

This assessment is important for understanding the current and emerging features of intra-port and inter-port competition and the potential effects that the continuation and expansion of liner companies' vertical integration strategies will have along maritime supply chains. It also contributes to the broader discussion on liner companies' strategies, such as the research and policy-making efforts around the globe to understand the impact of both vertical and horizontal integration.

These discussions are critical for a diversity of businesses that use liner shipping services or provide facilities and services to container shipping lines or ports. They are important for the interests of customers and consumers as they could inform any needed re-visiting of competition policy to protect from the dominance of any market developments that would lead to conditions limiting competition. Expanding analysis on the competition effects of non-notified mergers would help a better understanding of market changes.

Enhancing competition and limiting monopolies is valuable from a consumer's perspective. This is more so in the case of maritime trade that serves the needs of societies. The study contributes by generating a better understanding of how decision-makers have worked towards that direction and what realignments are worthy.

There are no previous comprehensive reviews and analyses of the ways that policy-makers at the regional level have addressed the competition effects of vertical integration strategies of liner shipping companies when enhancing competition is valuable from a consumer perspective. Comparing maritime economists and competition, the study, via its literature review, also offers a comparison of maritime and competition perspectives on these competition effects, allowing positioning of how effective decisional-making practices have been.