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Open Access
Article
Publication date: 7 April 2020

Betty Steenkamer, Esther de Weger, Hanneke Drewes, Kim Putters, Hans Van Oers and Caroline Baan

The purpose of this paper is to gain insight into how population health management (PHM) strategies can successfully integrate and reorganize public health, health care, social…

4679

Abstract

Purpose

The purpose of this paper is to gain insight into how population health management (PHM) strategies can successfully integrate and reorganize public health, health care, social care and community services to improve population health and quality of care while reducing costs growth, this study compared four large-scale transformation programs: Greater Manchester Devolution, Vancouver Healthy City Strategy, Gen-H Cincinnati and Gesundes Kinzigtal.

Design/methodology/approach

Following the realist methodology, this explorative comparative case-study investigated PHM initiatives' key features and participants' experiences of developing such initiatives. A semi-structured interview guideline based on a theoretical framework for PHM guided the interviews with stakeholders (20) from different sectors.

Findings

Five initial program theories important to the development of PHM were formulated: (1) create trust in a shared vision and understanding of the PHM rationale to establish stakeholders' commitment to the partnership; (2) create shared ownership for achieving the initiative's goals; (3) create shared financial interest that reduces perceived financial risks to provide financial sustainability; (4) create a learning environment to secure initiative's credibility and (5) create citizens' and professionals' awareness of the required attitudes and behaviours.

Originality/value

The study highlights initial program theories for the implementation of PHM including different strategies and structures underpinning the initiatives. These insights provide a deeper understanding of how large-scale transformation could be developed.

Details

Journal of Health Organization and Management, vol. 34 no. 3
Type: Research Article
ISSN: 1477-7266

Keywords

Open Access
Article
Publication date: 3 June 2022

Chantal Edge, Nikki Luffingham, Georgia Black and Julie George

This paper seeks to understand relationships between prison healthcare and integrated care systems (ICS), including how these affect the delivery of new healthcare interventions…

1754

Abstract

Purpose

This paper seeks to understand relationships between prison healthcare and integrated care systems (ICS), including how these affect the delivery of new healthcare interventions. It also aims to understand how closer integration between prison and ICS could improve cross system working between community and prison healthcare teams, and highlights challenges that exist to integration between prison healthcare and ICS.

Design/methodology/approach

The study uses evidence from research on the implementation of a pilot study to establish telemedicine secondary care appointments between prisons and an acute trust in one English region (a cross-system intervention). Qualitative interview data were collected from prison (n = 12) and community (n = 8) healthcare staff related to the experience of implementing a cross-system telemedicine initiative. Thematic analysis was undertaken on interview data, guided by an implementation theory and framework.

Findings

The research found four main themes related to the closer integration between prison healthcare and ICS: (1) Recognition of prison health as a priority; (2) Finding a way to reconcile networks and finances between community and prison commissioning; (3) Awareness of prison service influence on NHS healthcare planning and delivery; and (4) Shared investment in prison health can lead to benefits.

Originality/value

This is the first article to provide research evidence to support or challenge the integration of specialist health and justice (H&J) commissioning into local population health.

Open Access
Article
Publication date: 13 July 2020

Felix Gradinger, Julian Elston, Sheena Asthana, Chloe Myers, Sue Wroe and Richard Byng

This integrated care study seeks to highlight how voluntary sector “wellbeing co-ordinators” co-located in a horizontally and vertically integrated, multidisciplinary community…

2649

Abstract

Purpose

This integrated care study seeks to highlight how voluntary sector “wellbeing co-ordinators” co-located in a horizontally and vertically integrated, multidisciplinary community hub within one locality of an Integrated Care Organisation contribute to complex, person-centred, co-ordinated care.

Design/methodology/approach

This is a naturalistic, mixed method and mixed data study. It is complementing a before-and-after study with a sub-group analysis of people receiving input from the wider hub (including Wellbeing Co-ordination and Enhanced Intermediate Care), qualitative case studies, interviews, and observations co-produced with embedded researchers-in-residence.

Findings

The cross-case analysis uses trajectories and outcome patterns across six client groups to illustrate the bio-psycho-social complexity of each group across the life course, corresponding with the range of inputs offered by the hub.

Research limitations/implications

To consider the effectiveness and mechanisms of complex system-wide interventions operating at horizontal and vertical interfaces and researching this applying co-produced, embedded, naturalistic and mixed methods approaches.

Practical implications

How a bio-psycho-social approach by a wellbeing co-ordinator can contribute to improved person reported outcomes from a range of preventive, rehabilitation, palliative care and bereavement services in the community.

Social implications

To combine knowledge about individuals held in the community to align the respective inputs, and expectations about outcomes while considering networked pathways based on functional status, above diagnostic pathways, and along a life-continuum.

Originality/value

The hub as a whole seems to (1) Enhance engagement through relationship, trust and activation, (2) Exchanging knowledge to co-create a shared bio-psycho-social understanding of each individual’s situation and goals, (3) Personalising care planning by utilising the range of available resources to ensure needs are met, and (4) Enhancing co-ordination and ongoing care through multi-disciplinary working between practitioners, across teams and sectors.

Details

Journal of Integrated Care, vol. 28 no. 4
Type: Research Article
ISSN: 1476-9018

Keywords

Open Access
Article
Publication date: 18 April 2017

Alec Knight, Peter Littlejohns, Tara-Lynn Poole, Gillian Leng and Colin Drummond

The purpose of this paper is to explore factors affecting implementing the National Institute for Health and Care Excellence (NICE) quality standard on alcohol misuse (QS11) and…

2288

Abstract

Purpose

The purpose of this paper is to explore factors affecting implementing the National Institute for Health and Care Excellence (NICE) quality standard on alcohol misuse (QS11) and barriers and facilitators to its implementation.

Design/methodology/approach

Qualitative interview study analysed using directed and conventional content analyses. Participants were 38 individuals with experience of commissioning, delivering or using alcohol healthcare services in Southwark, Lambeth and Lewisham.

Findings

QS11 implementation ranged from no implementation to full implementation across the 13 statements. Implementation quality was also reported to vary widely across different settings. The analyses also uncovered numerous barriers and facilitators to implementing each statement. Overarching barriers to implementation included: inherent differences between specialist vs generalist settings; poor communication between healthcare settings; generic barriers to implementation; and poor governance structures and leadership.

Research limitations/implications

QS11 was created to summarise alcohol-related NICE guidance. The aim was to simplify guidance and enhance local implementation. However, in practice the standard requires complex actions by professionals. There was considerable variation in local alcohol commissioning models, which was associated with variation in implementation. These models warrant further evaluation to identify best practice.

Originality/value

Little evidence exists on the implementing quality standards, as distinct from clinical practice guidelines. The authors present direct evidence on quality standard implementation, identify implementation shortcomings and make recommendations for future research and practice.

Details

International Journal of Health Care Quality Assurance, vol. 30 no. 3
Type: Research Article
ISSN: 0952-6862

Keywords

Open Access
Article
Publication date: 26 July 2021

James Brackley, Penelope Tuck and Mark Exworthy

This paper examines the contested value of healthy life and wellbeing in a context of severe austerity, exploring how the value of “Public Health” is constructed through and with…

1747

Abstract

Purpose

This paper examines the contested value of healthy life and wellbeing in a context of severe austerity, exploring how the value of “Public Health” is constructed through and with material-discursive practices and accounting representations. It seeks to explore the political and ethical implications of constructing the valuable through a shared consensus over the “facts” when addressing complex, multi-agency problems with long time horizons and outcomes that are not always easily quantifiable.

Design/methodology/approach

The theorisation, drawing on science and technology studies (STS) scholars and Karen Barad's (2007) agential realism, opens up the analysis to the performativity of both material and discursive practices in the period following a major re-organisation of activity. The study investigates two case authorities in England and the national regulator through interviews, observations and documentary analysis.

Findings

The paper demonstrates the deeply ethical and political entanglements of accounting representations as objectivity, consensus and collective action are constructed and resisted in practice. It goes on to demonstrate the practical challenges of constructing “alternative accounts” and “intelligent accountabilities” through times of austerity towards a shared sense of public value and suggests austerity measures make such aims both more challenging and all the more essential.

Originality/value

Few studies in the accounting literature have explored the full complexity of valuation practices in non-market settings, particularly in a public sector context; this paper, therefore, extends familiar conceptual vocabulary of STS inspired research to further explore how value(s), ethics and identity all play a crucial role in making things valuable.

Details

Accounting, Auditing & Accountability Journal, vol. 34 no. 7
Type: Research Article
ISSN: 0951-3574

Keywords

Open Access
Article
Publication date: 13 May 2019

Karen Elisabeth Engel and Jeroen Frank Warner

The purpose of this paper is to present the findings of a qualitative and exploratory study aimed at learning more about the local forms of resilience that emerged in two…

1860

Abstract

Purpose

The purpose of this paper is to present the findings of a qualitative and exploratory study aimed at learning more about the local forms of resilience that emerged in two localities (one rural and one urban locality) in Talcahuano, Chile, in response to the major earthquake and devastating tsunami that hit them on February 27, 2010.

Design/methodology/approach

To ensure that people’s experiences remained leading throughout the study, data were collected in the field by the first author over a period of 13 months using a variety of qualitative methods. The primary methods were observation, participation and semi-structured interviews with a variety of actors, ranging from community members to local leaders and emergency professionals. For the analysis, a scheme was used that categorizes manifested resilience using two dimensions: damage and responsiveness. Since this scheme has been mostly used to evaluate tree populations, it was adapted to fit the appraisal of a social system.

Findings

The findings suggest that damage levels in the two communities were similar, but that the responsiveness was not. One locality revealed high levels of resilience, while the other exposed increased susceptibility to future similar events.

Originality/value

This research initiative was relevant because it exposed actual resilience. Also, the specificities of the findings enable insights about prevalent vulnerability, in particular the local capacity of response, and that can be used to elaborate concrete earthquake/tsunami disaster scenarios and design local disaster risk reduction interventions.

Details

Disaster Prevention and Management: An International Journal, vol. 28 no. 5
Type: Research Article
ISSN: 0965-3562

Keywords

Open Access
Article
Publication date: 28 November 2023

Georgia Watson, Cassie Moore, Fiona Aspinal, Andrew Hutchings, Rosalind Raine and Jessica Sheringham

Many countries have a renewed focus on health inequalities since COVID-19. In England, integrated care systems (ICSs), formed in 2022 to promote integration, are required to…

Abstract

Purpose

Many countries have a renewed focus on health inequalities since COVID-19. In England, integrated care systems (ICSs), formed in 2022 to promote integration, are required to reduce health inequalities. Integration is supported by population health management (PHM) which links data across health and care organisations to inform service delivery. It is not well-understood how PHM can help ICSs reduce health inequalities. This paper describes development of a programme theory to advance this understanding.

Design/methodology/approach

This study was conducted as a mixed-methods process evaluation in a local ICS using PHM. The study used Framework to analyse interviews with health and care professionals about a PHM tool, the COVID-19 vaccination uptake Dashboard. Quantitative data on staff Dashboard usage were analysed descriptively. To develop a wider programme theory, local findings were discussed with national PHM stakeholders.

Findings

ICS staff used PHM in heterogeneous ways to influence programme delivery and reduce inequalities in vaccine uptake. PHM data was most influential where it highlighted action was needed for “targetable” populations. PHM is more likely to influence decisions on reducing inequalities where data are trusted and valued, data platforms are underpinned by positive inter-organisational relationships and where the health inequality is a shared priority.

Originality/value

The COVID-19 pandemic accelerated a shift toward use of digital health platforms and integrated working across ICSs. This paper used an evaluation of integrated data to reduce inequalities in COVID-19 vaccine delivery to propose a novel programme theory for how integrated data can support ICS staff to tackle health inequalities.

Details

Journal of Integrated Care, vol. 31 no. 4
Type: Research Article
ISSN: 1476-9018

Keywords

Open Access
Article
Publication date: 31 March 2021

Joy Akehurst, Paul Stronge, Karen Giles and Jonathon Ling

The aim of this action research was to explore, from a workforce and a patient/carer perspective, the skills and the capacity required to deliver integrated care and to inform…

2823

Abstract

Purpose

The aim of this action research was to explore, from a workforce and a patient/carer perspective, the skills and the capacity required to deliver integrated care and to inform future workforce development and planning in a new integrated care system in England.

Design/methodology/approach

Semi-structured interviews and focus groups with primary, community, acute care, social care and voluntary care, frontline and managerial staff and with patients and carers receiving these services were undertaken. Data were explored using framework analysis.

Findings

Analysis revealed three overarching themes: achieving teamwork and integration, managing demands on capacity and capability and delivering holistic and user-centred care. An organisational development (OD) process was developed as part of the action research process to facilitate the large-scale workforce changes taking place.

Research limitations/implications

This study did not consider workforce development and planning challenges for nursing and care staff in residential, nursing care homes or domiciliary services. This part of the workforce is integral to the care pathways for many patients, and in line with the current emerging national focus on this sector, these groups require further examination. Further, data explore service users' and carers' perspectives on workforce skills. It proved challenging to recruit patient and carer respondents for the research due to the nature of their illnesses.

Practical implications

Many of the required skills already existed within the workforce. The OD process facilitated collaborative learning to enhance skills; however, workforce planning across a whole system has challenges in relation to data gathering and management. Ensuring a focus on workforce development and planning is an important part of integrated care development.

Social implications

This study has implications for social and voluntary sector organisations in respect of inter-agency working practices, as well as the identification of workforce development needs and potential for informing subsequent cross-sector workforce planning arrangements and communication.

Originality/value

This paper helps to identify the issues and benefits of implementing person-centred, integrated teamworking and the implications for workforce planning and OD approaches.

Details

Journal of Integrated Care, vol. 30 no. 5
Type: Research Article
ISSN: 1476-9018

Keywords

Open Access
Article
Publication date: 13 April 2015

Philip Hubbard

This paper aims to explore how municipal law, in its various guises, serves to police the boundaries of acceptable sexual conduct by considering how Sexual Entertainment Venues…

5925

Abstract

Purpose

This paper aims to explore how municipal law, in its various guises, serves to police the boundaries of acceptable sexual conduct by considering how Sexual Entertainment Venues (SEVs) in British cities are controlled through diverse techniques of licensing and planning control.

Design/methodology/approach

The paper describes the emergence of permissive new licensing controls that provide local authorities considerable control over SEVs. Licensing decisions, judicial review cases and planning inspectorate adjudications since the inception of the new powers are examined to explore the logic of judgements preventing SEVs operating in specific localities.

Findings

Through analysis of case studies, it is shown that local authorities have almost total discretion to prevent SEVs operating in specific localities, particularly those undergoing, or anticipated to be undergoing, redevelopment and regeneration.

Originality/value

This paper offers unique insights on the “scope” of municipal law by highlighting how land uses associated with “sexual minority” interests are regulated in the interests of urban regeneration, redevelopment and restructuring.

Details

International Journal of Law in the Built Environment, vol. 7 no. 1
Type: Research Article
ISSN: 1756-1450

Keywords

Open Access
Article
Publication date: 30 May 2022

Amani Mejri

This corpus-based study provides a descriptive account of the distribution of the polysemous noun nafs in two Arabic varieties, Modern Standard Arabic (MSA) and Classical Arabic…

Abstract

Purpose

This corpus-based study provides a descriptive account of the distribution of the polysemous noun nafs in two Arabic varieties, Modern Standard Arabic (MSA) and Classical Arabic (CA). The research objective is to survey the use of nafs as a reflexive marker in local binding domains and as a self-intensifier in NP-adjoined positions.

Design/methodology/approach

The consulted corpora are Timespamped JSI Web corpus for MSA and Quran corpus for CA. While attending to corpora size differences, MSA and CA exhibit a pattern of difference and similarity in nafs diffusion.

Findings

In the modern variety, nafs is pervasively used as reflexive marker in canonical binding domains, along with a less frequent, yet notable, intensifier user, and these uses are partially and cautiously attributed to the specific genre in which they occur. In CA, nafs is mainly recurrent as a polysemous noun, along with extensive use as a reflexive marker in local binding settings. As an intensifier, nafs is totally non-existent in the CA corpus, in the same way as it is in absentia in VP-constituent extraction in MSA.

Originality/value

Examining whether nafs, as a reflexive marker, deviates from canonical binding in Arabic the way English reflexive pronouns do. Building a general account of this distribution is relevant in understanding the explicit (syntactic) and implicit (discourse-based) dimensions of reflexive marker and self-intensifier processing and interpretation in Arabic as a first and second language.

Details

Saudi Journal of Language Studies, vol. 2 no. 2
Type: Research Article
ISSN: 2634-243X

Keywords

1 – 10 of 139