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Emergency Department (ED) presentations in older people are associated with a wide range of adverse events, which increase the risk of lengthy hospitalisation and poor outcomes. Pathfinder is an inter-organisational initiative delivered in partnership between Beaumont Hospital Occupational Therapy and Physiotherapy departments and the National Ambulance Service. Pathfinder responds to non-serious and non-life-threatening emergency medical service (EMS) calls. This study aims to demonstrate how Pathfinder can safely treat a proportion of older people at home by using alternative care pathways (ACPs), therefore avoiding unnecessary ED presentations. Once a decision has been reached to treat the person at home, the Pathfinder follow-up team delivers functional rehabilitation and case management in the persons’ home over the subsequent days.

This paper outlines the Pathfinder assessment, management and interventions in one clinical case example. Outcome measures include the level of patient satisfaction obtained via routine telephone feedback questionnaire and re-presentation to Beaumont Hospital within 30 days.

This paper illustrates through a case example the benefit of a collaborative multi-disciplinary rapid response team for non-serious and non-life-threatening EMS calls in older adults. The patient in this case example had no further EMS calls or ED presentations for 30 days after Pathfinder intervention and reported a high level of satisfaction with the service.

ED presentation was avoided through comprehensive multi-disciplinary assessment, including immediate access to intensive follow-up support in the person’s own home.

The Pathfinder service is improving access to ACPs for older people in the Beaumont Hospital catchment area. Pathfinder will now be spread nationally, with local adaptation, so that older people in other parts of Ireland will also benefit from this integrated model of care.

Patient feedback surveys confirm older adults want access to alternative care pathways.

Between 2006 and 2011, Nicaragua shipped an average of US$9.4 million per year of smallholder-produced fresh taro (Colocasia esculenta) to the USA; however, by 2016, the US market for Nicaraguan taro had effectively collapsed. The purpose of this paper is to analyze the short-lived taro boom from the perspective of complex adaptive systems, showing how shocks, interactions between value chain actors, and lack of adaptive capacity among chain actors together contributed to the collapse of the chain.

Primary data were collected from businesses and smallholders in 2010 and 2016 to understand the actors involved, their business relations, and the benefits and setbacks they experienced along the way.

The results show the capacity of better-off smallholders to engage in a demanding market, but also the struggles faced by more vulnerable smallholders to build new production systems and respond to internal and external shocks. Local businesses were generally unprepared for the uncertainties inherent in fresh horticultural trade or for engagement with distant buyers.

Existing guides and tools for designing value chain interventions will benefit from greater attention to the circumstances of local actors and the challenges of building productive inter-business relations under higher levels of risk and uncertainty.

This case serves as a wake-up call for practitioners, donors, researchers, and the private sector on how to identify market opportunities and the design of more robust strategies to respond to them.

This study aims to investigate the contribution of knowledge-intensive business services firms to small- and medium-sized manufacturers’ digital servitization journeys, addressing the standardization versus customization dichotomy of services and solutions provision.

To identify the challenges that small- and medium-sized firms must face in the digital servitization journey and the role that knowledge-intensive business services firms may play in the innovation processes, the authors conduct a review on two still unrelated literature streams and develop a longitudinal single-case study, with a particular focus on knowledge generation mechanisms.

Digital servitization is a particularly challenging transformational journey for minor firms. Knowledge-intensive business services firms can act as sources, facilitators, and carriers of knowledge, and they can orchestrate further contributions of other external partners and firms.

The paper contributes to theory describing the roadmap and the role of external service providers in digital servitization journeys of smaller firms’, that are frequently excluded from mainstream research although being the backbone of European economies.

Digital servitization in minor manufacturing firms requires a long-term orientation and a multi-stage roadmap. Mixing standardized technology-based solutions and complementary professional services, knowledge-intensive business services firms can significantly contribute to lowering the journey’s uncertainties, operational complexity, and costs.

The paper sheds lights on how the collaboration between knowledge-intensive business services firms and small manufacturers generates novel knowledge and capabilities that contribute to takle the challenges of the different stages of the digital servitization roadmap.

This paper aims to present a dual-perspective framework for maintenance service delivery that should be used by manufacturing companies to structure and manage their maintenance service delivery process, using aggregated historical and real-time data to improve operational decision-making. The framework, built for continuous improvement, allows the exploitation of maintenance data to improve the knowledge of service processes and machines.

The Dual-perspective, data-based decision-making process for maintenance delivery (D3M) framework development and test followed a qualitative approach based on literature reviews and semi-structured interviews. The pool of companies interviewed was expanded from the development to the test stage to increase its applicability and present additional perspectives.

The interviews confirmed that manufacturing companies are interested in exploiting the data generated in the use phase to improve operational decision-making in maintenance service delivery. Feedback to improve the framework methods and tools was collected, as well as suggestions for the introduction of new ones according to the companies' necessities.

The paper presents a novel framework addressing the data-based decision-making process for maintenance service delivery. The D3M framework can be used by manufacturing companies to structure their maintenance service delivery process and improve their knowledge of machines and service processes.

A recent paradigm-shift in patient care advocates for long-term recovery and quality of life in survivors of critical illness. Evidence suggests that occupational therapists in critical care can contribute to recovery in areas such as functional outcomes, length of stay and delirium, although poor role understanding can limit service-utilisation. The purpose of this study is to investigate current and future roles and practices of critical care occupational therapists in the UK.

Occupational therapists with clinical experience in adult critical care were invited to participate in a mixed-methods design using a locally developed online questionnaire and semi-structured interviews, concurrently. Descriptive statistics were generated through SPSS. Qualitative data were analysed using the framework approach.

Twelve occupational therapists participated in the survey element, with five continuing to interview. Occupational therapists described a multifaceted role in critical care where the majority reported practice in upper limb function, seating/positioning, cognition, psychosocial sequelae and discharge planning. Role and internal characteristics impacted on service delivery. It is envisaged that earlier intervention in a greater percentage of patients, a greater evidence-base, raising awareness and adequate staffing will be features for future development.

This study provides new insight into the current role and practices of adult critical care occupational therapists in England and generates insights into their role in addressing physical and non-physical morbidity for this patient cohort. Findings are preliminary in nature; however, future research is warranted to evaluate the effectiveness of interventions.

The purpose of this paper is to increase the understanding of organizational challenges when decision-makers try to comply with technological developments and increasing demands for a more rational distribution of health care services. This paper explores two decision-making processes from 2007–2019 in the area of vascular surgery at a regional and a local level in Norway.

The study draws upon extensive document analyses, semi-structured interviews and field conversations. The empirical material was analyzed in several steps through an inductive approach and described and explained through a theoretical framework based on rational choice (i.e. bounded rationality), political behavior and institutionalism. These perspectives were used in a complementary way.

Both decision-making processes were resource-intensive, long-lasting and produced few organizational changes for the provision of vascular services. Stakeholders at both levels outmaneuvered the health care planners, though by different means. Regionally, the decision-making ended up in a political process, while locally the decision-making proceeded as a strategic game between different departments and professional fields.

Decision-makers need to prepare thoroughly for convincing others of the benefits of new ways of organizing clinical care. By providing meaningful opportunities for public involvement, by identifying and anticipating political agendas and by building alliances between stakeholders with divergent values and aims decision-makers may extend the realm of feasible solutions.

This paper contributes to the understanding of why decision-making processes can be particularly challenging in a field characterized by rapid technological development, new treatment options and increasing demands for more rational distribution of services.

The purpose of this paper is to examine the effect of the intensive lifestyle modification program on weight and metabolic syndrome risk reduction in rural obese women who have no underlying non-communicable diseases in Thailand.

A randomized controlled trial was conducted. In total, 60 healthy obese women aged 30-50 years were recruited and randomly assigned to either the intervention (n=30) or control (n=30) group after health screening. Tailored nutritional counseling, health education and exercise training were included in the lifestyle modification program. Behavioral modification techniques were also incorporated. The intervention was conducted weekly for the first eight weeks, then biweekly until week 16.

The student’s t-test was used to compare mean difference between groups. The total weight loss in the intervention group (n=29) was significantly higher, 7.6±2.9 kg, compared with the control group (n=30) who lost 0.7±1.4 kg (p<0.001). The intervention group lost weight 10.2 percent from baseline which was significantly higher than that in the control group (p<0.001). Systolic and diastolic blood pressures, fasting blood sugar, and waist circumference were significantly improved. Triglyceride levels slightly improved while high density lipoprotein cholesterol was slightly lowered. The intervention group showed a statistical reduction in abnormal components of metabolic syndrome compared with the control group, with the relative risk=0.24, 95% confidence interval=0.072-0.791, and p=0.018.

Compatibility of the program activities conducted by a health professional who had achieved healthy weight loss and accepted as a role model was a key to achieving effective weight loss and metabolic syndrome risk reduction in obese women in rural areas. The program should be integrated into the conventional practice of health care centers.

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.

Global evidence indicates that multiple structural, biological, and behavioural mechanisms link gender-based violence (GBV), HIV/HCV, and substance misuse among women and adolescent girls. The aim of this chapter is to briefly summarise and synthesise recent literature that examines the complex and bi-directional relationships among these epidemics in different populations of adolescent girls and women around the world. To inform this chapter, a selective search strategy was conducted, prioritising use of meta-analytic epidemiological studies and research on interventions and policies that address different aspects of the syndemic among women and girls who use drugs worldwide. The search targeted publications from 2015 to 2019 using PubMed, MEDLINE, and Google Scholar. The chapter highlights methodological and geographic gaps in existing policy, intervention, and implementation research and makes recommendations for strategies to tackle these gaps. It also identifies a continuum of multilevel evidence-based interventions that target the risk environments and key syndemic mechanisms linking these intersecting epidemics that have been found to be effective in reducing intimate partner violence and other forms of GBV, substance use, and HIV/HCV risks. This chapter also assesses inclusiveness of existing research and interventions for underserved and disproportionately affected populations, affecting adolescent girls, sexual minority women, and racial/ethnic minority women and identifies strategies to target gaps or disparities for these key affected populations. Finally, this chapter describes the gaps and opportunities that harm reduction programmes, medical settings, and other community organisations experience in implementing gender-responsive programmes and policies to redress these intersecting epidemics.

A major part of knowledge management for knowledge-intensive firms such as professional service firms is the increasing focus on thought leadership. Despite being a well-known term, it is poorly defined and analysed in the academic and practitioner literature. The aim of this article is to answer three questions. First, what is thought leadership? Second, what tensions exist when seeking to create thought leadership in knowledge-based organisations? Third, what further research is needed about thought leadership? The authors call for cross-disciplinary and academic–practitioner approaches to understanding the field of thought leadership.

The authors review the academic and practitioner literature on thought leadership to provide a rich oversight of how it is defined and can be understood by separating inputs, creation processes and outcomes. The authors also draw on qualitative data from 12 in-depth interviews with senior leaders of professional service firms.

Through analysing and building on previous understandings of the concept, the authors redefine thought leadership as follows: “Knowledge from a trusted, eminent and authoritative source that is actionable and provides valuable solutions for stakeholders”. The authors find and explore nine tensions that developing thought leadership creates and propose a framework for understanding how to engage with thought leadership at the industry/macro, organisational/meso and individual/micro levels. The authors propose a research agenda based on testing propositions derived from new theories to explain thought leadership, including leadership, reducing risk, signalling quality and managing social networks, as well as examining the suggested ways to resolve different tensions.

To the best of the authors’ knowledge, they are the first to separate out thought leadership from its inputs, creation processes and outcomes. The authors show new organisational paradoxes within thought leadership and show how they can play out at different levels of analysis when implementing a thought leadership strategy. This work on thought leadership is set in a relatively under-explored context for knowledge management researchers, namely, knowledge-intensive professional service firms.