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In this chapter, I analyse the implementation of the reform to the regimen of alternatives to prison in Chile which occurred in 2013 and how the reform affected how punishment is conceived and translated into practice by professionals supervising probation and community services. The findings suggest the reform that led to the new ‘substitutive sanctions’ also introduced a new risk-oriented-managerial culture that has permeated how punishment is currently enforced and envisaged by supervision professionals; a situation that has been deepening over the years, not only through practice, but also via on-going training that has helped to generate the emergence of ‘cultural’ capital that distinguishes supervision professionals from the larger organisation. This has been combined with a rapid expansion in the use of substitutive sanctions, especially probation and ‘partial reclusion’ that can aptly be analysed under the ‘mass supervision’ premise.

A region’s transforming care partnership identified that autistic adults without an intellectual disability (ID) may be falling through gaps in services when presenting with a significant emotional and/or behavioural need in the absence of a mental health diagnosis. The region’s intensive support teams (ISTs) for adults with ID therefore piloted a short-term “behavioural support service” for this population. The purpose of this paper is to evaluate this pilot.

This study represents a mixed-methods service evaluation over a four year pilot period. The quantitative component examined referral rates and demographic data of accepted and declined referrals; and length of referral episodes and Health of The Nation Outcomes Scores (HoNOS) for accepted referrals. The qualitative component used thematic analysis to identify key themes relating to reasons for referral, clinical/therapeutic needs, and the models of support that most informed assessments and interventions at individual and systems levels.

The ISTs accepted 30 referrals and declined 53. Most accepted referrals were male (83%), and under 24 years old (57%). Average HoNOS scores were above the thresholds generally associated with hospital admission. Key qualitative themes were: transitional support; sexual risks/vulnerabilities; physical aggression; domestic violence; and attachment, trauma and personality difficulties. Support mostly followed psychotherapeutic modalities couched in trauma, attachment and second- and third-wave cognitive behavioural therapies. Positive Behaviour Support (PBS) did not emerge as a model of preference for service users or professionals.

This project represents one of the first of this type for autistic adults without an ID in the UK. It provides recommendations for future service development and research, with implications for Transforming Care policy and guidance.

This study intends to improve the quality of venous thromboembolism (VTE) prophylaxis practices including proper VTE risk assessment and the appropriate prophylaxis measures for surgical urology patients.

The authors applied the Six-Sigma define, measure, analyze, improve and control (DMAIC) improvement methodology in a pre–post interventional study that involved all adult patients above 18 years old indicated and scheduled for urology surgical interventions including endoscopic urological surgeries in a urology specialized 60-bed hospital. The pre-intervention sample included all patients meeting the inclusion criteria over a period of six months. Post-intervention sample included all patients meeting the inclusion criteria over a period of six months. The improvement areas included both the VTE risk assessment as well as the VTE prophylaxis prescription.

DMAIC methodology has achieved a substantial sustained improvement in surgical urology VTE prophylaxis practices with an average of 70% on both levels; VTE risk assessment practices and VTE prophylaxis prescribing practices were statistically significant. The post-intervention results also showed a statistically controlled process with no special cause variations. Based on the study results, the Six-Sigma DMAIC methodology can be considered of high value when applied in healthcare clinical practice improvement projects.

The project study includes some pitfalls that can be addressed as follows: 1. The lack of VTE rate incidence tracking. This limitation can be partly refuted when the authors conduct a literature review and explore that the VTE prophylaxis effectiveness had been proven with sufficient evidence to an extent that pushed several scientific societies to develop their own guidelines to support VTE prophylaxis. (Algattas et al., 2018). 2. Another limitation of this study can be that it handled only surgical patients and more specifically surgical urology patients. Of course, VTE prophylaxis is a crucial life-threatening problem not only for the surgical admitted patients but also for all the medical admitted patients either in hospital wards or ICUs. However, the prediction that surgical patients especially surgical urology patients are more prone to VTE development risk as they have -in several cases-two or three main additive risk factors which are age, procedure duration and malignancy in elderly men. (Tikkinen et al., 2014). So, the authors consider the study project to be a prototype that hopefully can be utilized for future study projects that will manage both other surgical specialty patients and medical patients on the national level and can track accurately and effectively report the VTE incidence rates.

Several recommendations can be extracted from the research project that is summarized in the following points: Paying focused attention to continuous healthcare quality improvement initiatives and projects as a main approach for healthcare improvement especially for the public health-related problems. This might be achieved through periodic region-specific or specialty-specific focus groups from which public health problems could be addressed and prioritized to be considered as a part of country healthcare campaigns regarding cost-utility and feasibility studies. The adoption of a system thinking approach in dealing with the improvement strategies; all efforts and resources are to be employed to achieve a common objective. This includes the generation of a national-wide electronic health information system that can aid in healthcare resource allocation and direct the healthcare efforts towards the most important, high-priority public health problems. Electronic national-wide health record is really an effort, and resources consuming activity, but actually, it's worth exerting efforts, and its valuable outcomes may be seen several years later. 3. Development of unified national specialized VTE prophylaxis pathways to standardize the patient-specific VTE prophylaxis plans. Standardization of healthcare pathways enables healthcare professionals to follow an evidence-based practice which will be reflected on the improvement of healthcare quality level, cost-effectiveness enhancement, and timely patient care on all levels especially in high critical areas like ER and ICU. 4. Incorporation of VTE prophylaxis costs in the universal health insurance diagnosis-related group (DRG) insurance packages and service pricing. Universal health insurance is a nationwide strategy that is aiming to cover all Egypt residents by the year 2030. Universal health insurance is being following the DRG reimbursement policy that is thought to control all the healthcare-associated costs so, the VTE prophylaxis costs shall be added as the main cost item to encourage all healthcare facilities to follow an evidence-based VTE prophylaxis pathway taking into consideration the high-risk patient categories who will definitely represent a high-cost burden on the long run if they suffer a VTE event.

DMAIC improvement methodology applications in healthcare are still relatively limited, especially on the clinical level. The study can be considered one of a kind in Egypt dealing with a comprehensive DMAIC methodology application on the clinical level.

Intensive support teams (ISTs) are often poorly understood, despite reports of their effectiveness in managing behaviour that challenges for individuals with an intellectual disability. This paper aims to contribute to the understanding of ISTs through evaluating one IST’s process and their use of positive behaviour support (PBS) as an intervention.

Participants were obtained from the ISTs discharge database, and pre- and post-intervention data from these participants was used for analysis.

Three-paired sample t-tests found that there were significant differences between pre- and post-scores on the behaviour problem inventory, Health of the Nation Outcomes Scale for people with Learning Disabilities and periodic service reviews, which measure quality of targeted, individualised support. This indicates that challenging behaviour frequency and severity were lower post-intervention, quality of life improved post-intervention and staff teams implemented recommended strategies more consistently by the end of the intervention.

This service evaluation captured data over seven-year period, which helps to contribute to the understanding of the effectiveness of ISTs and the PBS framework.

In response to a critical need for uniform school crisis preparedness and response efforts across districts, the National Association of School Psychologists developed PREPaRE, a model and training curriculum aimed to equip school-based professionals to engage in comprehensive school crisis prevention and intervention practices. The PREPaRE acronym stands for: Prevent/Prepare for psychological trauma; Reaffirm physical health, security, and safety; Evaluate psychological trauma; Provide interventions (and) Respond to psychological needs; and Examine the effectiveness of prevention and intervention efforts. The model spans four crisis preparedness phases: Prevention, Mitigation, Response, and Recovery. This chapter provides a detailed overview of the development and structure of the PREPaRE model's core components and the organizational framework of the Incident Command System. It delineates elements of the basic school crisis response plan, assessment of mental health risk following a crisis event, and the provision of crisis interventions within a multitiered system of support framework. Additionally, it summarizes ongoing effectiveness and implementation research used to evaluate and improve the model based on immediate training outcomes assessed through pre and postmeasures and training transfer to applied school contexts. Implications for research and public policy regarding school safety and crisis prevention and intervention, as well as the future of PREPaRE curriculum development, are discussed.

This study aims to address three research questions pertaining to climate neutrality within the supply chain of metal and mining industry: (1) How can an organization implement practices related to climate neutrality in the supply chain? (2) How do members of the supply chain adopt different measures and essential processes to assist an organization in responding to climate change-related concerns? (3) How can the SAP-LAP framework assist in analyzing and proposing solutions to attain climate neutrality?

To address the proposed research questions concerning climate neutrality, this study employs a case study approach utilizing the SAP-LAP (situation, actor, process–learning, action, performance) framework. Within the SAP-LAP framework, adopting a natural resource-based perspective, the study thoroughly examines the intricacies and interactions among existing situations, pertinent actors and processes that impact climate initiatives within a metal and mining company.

The study's findings suggest that organizations can achieve the objective of climate neutrality by prioritizing resources and capabilities that lead to reduced GHG emissions, lower energy consumption and optimal resource utilization. The study further proposes key elements that significantly influence the pursuit of climate neutrality within enterprises.

This study is one of the earliest contributions to the development of a holistic understanding of climate neutrality in the supply chain of the metal and mining industry.

The study will assist practitioners and policymakers in comprehending the present circumstances, actors and processes involved in enterprises' supply networks in order to attain climate neutrality in supply chains, as well as in taking the right steps to enhance performance.

This study presents a climate neutrality model and provides valuable insights into emission management, contributing to the achievement of the climate neutrality objective.

Most prisoners are eventually returned to their communities, making their transition into the community and aftercare a fundamental aspect of successful re-entry. This paper aims to explore the stages of someone’s reintegration from pre-release, through to reintegration and desistance and consider the factors relevant to the re-entry process for those who have offended and how to enhance this process. The aim of this paper was twofold; first to highlight the various factors and issues involved in the re-entry and reintegration process, particularly for those who are released after imprisonment and, second, to consider the significance of aftercare services in facilitating this process.

This paper opted for a brief review of the literature regarding incarceration and reintegration and some of the gaps in the literature. This paper will commence with a discussion of the effects of imprisonment on those who are incarcerated, then a consideration of the re-entry process, followed by a discussion of the reintegration process and desistance. Following will be reflections regarding the implications for practice. A case study is used to illustrate these points.

The current paper proposes a framework by which organisations and service providers working with those who are released from prison can use or incorporate into their practice to enhance aftercare support. The case study is used as an example to further illustrate this.

Implications for practice are also considered as well as recommendations to aid the re-entry and aftercare process. Suggestions are also offered to those agencies that are responsible for the provision of aftercare services for those released from prison.

This paper offers some considerations regarding the importance of the preparing and planning for release with a specific focus on aftercare services and their role in the re-entry and reintegration process.

The primary objective of this paper is to show a systematic and methodological approach for the digitalization of critical clinical pathways (CPs) within the healthcare domain.

The methodology entails the integration of service design (SD) and action research (AR) methodologies, characterized by iterative phases that systematically alternate between action and reflective processes, fostering cycles of change and learning. Within this framework, stakeholders are engaged through semi-structured interviews, while the existing and envisioned processes are delineated and represented using BPMN 2.0. These methodological steps emphasize the development of an autonomous, patient-centric web application alongside the implementation of an adaptable and patient-oriented scheduling system. Also, business processes simulation is employed to measure key performance indicators of processes and test for potential improvements. This method is implemented in the context of the CP addressing transient loss of consciousness (TLOC), within a publicly funded hospital setting.

The methodology integrating SD and AR enables the detection of pivotal bottlenecks within diagnostic CPs and proposes optimal corrective measures to ensure uninterrupted patient care, all the while advancing the digitalization of diagnostic CP management. This study contributes to theoretical discussions by emphasizing the criticality of process optimization, the transformative potential of digitalization in healthcare and the paramount importance of user-centric design principles, and offers valuable insights into healthcare management implications.

The study’s relevance lies in its ability to enhance healthcare practices without necessitating disruptive and resource-intensive process overhauls. This pragmatic approach aligns with the imperative for healthcare organizations to improve their operations efficiently and cost-effectively, making the study’s findings relevant.

There is a proportion of psychiatric service users whose needs are not met by existing models of care. This can lead to a reliance on acute and crisis services. These service users may be considered high intensity users (HIUs). The purpose of this research is to evaluate the Crisis Plus model, an intervention designed to better support HIUs in the community and reduce dependency on acute and crisis services.

Forty-seven HIUs were involved in Crisis Plus. The core intervention of Crisis Plus was an Anticipatory Management Plan (AMP), produced in collaboration with service users, their families and their care coordinators. AMPs were shared with relevant services and attached to electronic patient notes to ensure a uniform, psychologically informed approach to care.

HIU service use was compared pre and post-AMP. On average, number of inpatient admissions, number of days spent on the ward, accepted psychiatric liaison referrals and accepted home treatment team (HTT) referrals decreased significantly.

Crisis Plus has taken a collaborative, proactive approach to engage HIUs, their families and the services that care for them. Crisis interventions that emphasise collaborative working and service user agency are key.

The provision of dedicated psychological support to HIUs and their professional and personal network is crucial to reduce reliance on acute and crisis care. Crisis Plus is unique in that it instigates co-production and active consultation with HIUs and services to improve clinical outcomes, in addition to reducing NHS expenditure.

Barriers to adequate healthcare in rural areas remain a grand challenge for local healthcare systems. In addition to patients' travel burdens, lack of health insurance, and lower health literacy, rural healthcare systems also experience significant resource shortages, as well as issues with recruitment and retention of healthcare providers, particularly specialists. These factors combined result in complex change management-focused challenges for rural healthcare systems. Change management initiatives are often resource intensive, and in rural health organizations already strapped for resources, it may be particularly risky to embark on change initiatives. One way to address these change management concerns is by leveraging socio-technical simulation models to estimate techno-economic feasibility (e.g., is it technologically feasible, and is it economical?) as well as socio-utility feasibility (e.g., how will the changes be utilized?). We present a framework for how healthcare systems can integrate modeling and simulation techniques from systems engineering into a change management process. Modeling and simulation are particularly useful for investigating the amount of uncertainty about potential outcomes, guiding decision-making that considers different scenarios, and validating theories to determine if they accurately reflect real-life processes. The results of these simulations can be integrated into critical change management recommendations related to developing readiness for change and addressing resistance to change. As part of our integration, we present a case study showcasing how simulation modeling has been used to determine feasibility and potential resistance to change considerations for implementing a mobile radiation oncology unit. Recommendations and implications are discussed.