Search results

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.

Healthcare organizations have been facing challenges due to high costs and low efficiency in health services. The growth of costs and losses caused by avoidable mistakes lead to the search for solutions, and Health Lean Management appears as a potential solution to help in solving service quality problems, as well as reducing risks. This study aims to analyse the state of the art in the literature centred on the Lean approach in the context of risk management in healthcare organizations, and to identify new research opportunities, highlighting possible lines of future research.

Following a systematic literature review approach, 51 papers were considered relevant for this research, and reviewed to explore the development of literature in this area.

Based on the results, five main research streams were identified: (1) risk management oriented towards patient safety; (2) risk management oriented towards employee safety; (3) importance of attitudes and behaviours in risk reduction projects; (4) Lean tools used in healthcare risk management and (5) Integration of approaches. Moreover, several shortcomings were identified in literature.

Identified shortcomings represent significant opportunities for further research development.

Housing First (HF) is an evidence-based practice effective in reducing homelessness among those who experience chronic homelessness. However, a strong synthesis evaluating the effectiveness of this intervention is lacking for people who use drugs. The purpose of this study is to explore international literature databases to identify the effectiveness of the HF programme among people who use drugs.

A modified framework from Arksey and O’Malley (2005) was used, namely: identifying the research question; developing inclusion and exclusion criteria; identifying relevant studies for study selection; charting the data; and collating, summarising and reporting the results.

Three main themes were identified: substance use related outcomes, housing-related outcomes and social outcomes. There is strong evidence that HF increases housing retention and reduces homelessness among chronically homeless people who use drugs. However, literature relating to substance use and social outcomes for this population report mixed and inconclusive findings.

This scoping review concludes that additional research is required to conclusively determine whether HF is an effective intervention for homeless substance users. Future researchers must use formal assessments of substance use and ensure clear reporting of the HF intervention is accomplished. It is recommended for researchers and policymakers to consider the specific needs of the people who use drugs before implementation of HF for this population.

Differential effectiveness of HF through diagnostic subgroups such as alcohol use and drug use is varied with alcohol use being found to decrease due to the HF programme, but findings relating to other drug use outcomes are varied. As most previous studies used the Addiction Severity Index (ASI) to measure substance use among participants, however, the ASI, a self-reporting measure has unstable criterion validity and can cause under or over reporting of substance use. Structured toxicology or diagnostic assessments of substance use must be used for research instead to assist researchers in making firm conclusions about the reported rates.

The slightly poorer housing outcomes among people who use substances indicate that this group may need more intensive approaches to finding and maintaining housing. Additional services for the group that address comorbid problems and consequences relating to substance use are required. It is suggested that housing should be provided within an integrated model that offers additional support services such as case management as when well matched to clients, case management appears to be an effective intervention among homeless sub-populations, as it reduces substance use, improves quality of life and health outcomes, improves social connectedness and increases housing tenure and satisfaction.

This scoping review concludes that additional research is required to conclusively determine whether HF is an effective intervention for homeless substance users. Future researchers must use formal assessments of substance use and ensure clear reporting of the HF intervention is accomplished. It is recommended for researchers and policymakers to consider the specific needs of the people who use drugs before HF implementation for this population.

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.

This paper aims to explore how the time and temporal aspects are managed in a financial accounting outsourcing (FAO) transition process in an international interorganizational context. As a research outcome, the authors identify management interventions of both the service provider (SP) and the outsourcing company (OC) at both the corporate and operational levels.

The framework by Huy (2001a, 2001b) was used to analyze the qualitative data, which draw on observations, participation in 32 official meetings during the outsourcing process, informal discussions with key actors from the SP and the OC, and archival data of a single case company.

The authors illustrate how the time and temporal aspects of planned accelerated change are managed through management interventions during the FAO transition process. All four ideal intervention types (commanding, engineering, teaching and socializing) were used sequentially but also jointly to complement one another. The pacing was mostly rapid, owing to strong commanding interventions initiating almost every stage. When analyzing the FAO transition process, the authors identified four stages: contact, contract, convergence and control. Moreover, the authors focused on the role of the operational-level managers and accounting specialists of both organizations. The findings indicate that management interventions vary with the management level.

This study contributes to the interorganizational control literature by considering the time and temporal aspects in planned organizational change and the role of operational-level managers in managing large-scale changes.

This study presents the impact of Economic Policy Uncertainty (EPU)-induced Trade Supply Chain Vulnerability (TSCV) on the Small and Medium-Sized Enterprises (SMEs) in India by leveraging the World Bank Enterprise Survey data for 2014 and 2022. Applying econometric techniques, it examines firm size’ influence on productivity and trade participation, providing insights for enhancing SME resilience and trade participation amid uncertainty.

The econometric techniques focus on export participation, along with variables such as total exports, firm size, productivity, and capital intensity. It addresses crucial factors such as the direct import of intermediate goods and foreign ownership. Utilizing the Cobb-Douglas production function, the study estimates Total Factor Productivity, mitigating endogeneity and multicollinearity through a two-stage process. Besides, the study uses a case study of North Indian SMEs engaged in manufacturing activities and their adoption of mitigation strategies to combat unprecedented EPU.

Results reveal that EPU-induced TSCV reduces exports, impacting employment and firm size. Increased productivity, driven by technological adoption, correlates with improved export performance. The study highlights the negative impact of TSCV on trade participation, particularly for smaller Indian firms. Moreover, SMEs implement cost-based, supplier-based, and inventory-based strategies more than technology-based and risk-based strategies.

Policy recommendations include promoting increased imports and inward foreign direct investment to enhance small firms’ trade integration during economic uncertainty. Tailored support for smaller firms, considering their limited capacity, is crucial. Encouraging small firms to engage in international trade and adopting diverse SC mitigation strategies associated with policy uncertainty are vital considerations.

This study explores the impact of EPU-induced TSCV on Indian SMEs’ trade dynamics, offering nuanced insights for policymakers to enhance SME resilience amid uncertainty. The econometric analysis unveils patterns in export behavior, productivity, and factors influencing trade participation during economic uncertainty.

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.

The future increase of chronic diseases in the world requires new challenges in the health domain to improve patients' care from the point of view of the organizational processes, clinical pathways and technological solutions of digital health. For this reason, the present paper aims to focus on the study and application of well-known clinical practices and efficient organizational approaches through an innovative model (TALIsMAn) to support new care process redesign and digitalization for chronic patients.

In addition to specific clinical models employed to manage chronic conditions such as the Population Health Management and Chronic Care Model, we introduce a Business Process Management methodology implementation supported by a set of e-health technologies, in order to manage Care Pathways (CPs) digitalization and procedures improvement.

This study shows that telemedicine services with advanced devices and technologies are not enough to provide significant changes in the healthcare sector if other key aspects such as health processes, organizational systems, interactions between actors and responsibilities are not considered and improved. Therefore, new clinical models and organizational approaches are necessary together with a deep technological change, otherwise, theoretical benefits given by telemedicine services, which often employ advanced Information and Communication Technology (ICT) systems and devices, may not be translated into effective enhancements. They are obtained not only through the implementation of single telemedicine services, but integrating them in a wider digital ecosystem, where clinicians are supported in different clinical steps they have to perform.

The present work defines a novel methodological framework based on organizational, clinical and technological innovation, in order to redesign the territorial care for people with chronic diseases. This innovative ecosystem applied in the Italian research project TALIsMAn is based on the concept of a continuum of care and digitalization of CPs supported by Business Process Management System and telemedicine services. The main goal is to organize the different socio-medical activities in a unique and integrated IT system that should be sustainable, scalable and replicable.

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.