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1 – 10 of over 1000Jitse Jonne Schuurmans, Nienke van Pijkeren, Roland Bal and Iris Wallenburg
The purpose of this paper is to explore the formation and composition of “regions” as places of care, both empirically and conceptually.
Abstract
Purpose
The purpose of this paper is to explore the formation and composition of “regions” as places of care, both empirically and conceptually.
Design/methodology/approach
This paper draws on action-oriented research involving experiments aimed at designing, implementing and evaluating promising solutions to the entwined problems of a burgeoning elderly population and an increasing shortage of medical staff. It draws on ethnographic research conducted in 14 administrative areas in the Netherlands, a total of 273 in-depth interviews and over 1,000 h of observations.
Findings
This research challenges the understanding of a healthcare region as a clearly bounded topological area. It shows that organizations and professionals collaborate in a variety of different networks, some conterminous with the administrative region established by policymakers and others not. These networks are by nature unstable and dynamic. Attempts to form new regional collaborations with neighbouring organizations are complicated by existing healthcare governance and accountability structures that position organizations as competitors.
Practical implications
Policymakers should take the pre-established partnerships of healthcare organizations into account before delineating the area in which regionalization is meant to take place. A better alignment of governance and accountability structures is also needed for regionalization to occur in healthcare.
Originality/value
This paper combines insights from valuation studies with sociogeographical literature and provides a framework for understanding the assembling and disassembling of “regions”.
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Francesco Schiavone, Daniele Leone, Annarita Sorrentino and Alessandro Scaletti
The study aims to provide an exploratory investigation of the magnitude of the customer-centric approach in the specific area of healthcare as a contribution to the scarce and…
Abstract
Purpose
The study aims to provide an exploratory investigation of the magnitude of the customer-centric approach in the specific area of healthcare as a contribution to the scarce and preliminary literature on this topic. In particular, it explores the role of sharing economy-based (SE-based) platforms as an experiential touchpoint to co-create value within different levels. Specifically, the purpose of the study is threefold. First, it aims to address the service experience innovation in healthcare with a customer-centric approach. Second, it seeks to define the role of the SE-based platform as a touchpoint to redefine business processes, and third, it measures the co-created value within the network when redesigning the service experience.
Design/methodology/approach
To address the research question, the authors proposed an analysis of service innovation and customer centricity in healthcare networks by using the case study of Saluber, an SE-based platform that offers logistics services for non-emergency medical transportation in the Campania region (south of Italy). By using a qualitative approach, the authors analysed primary and secondary data from multiple sources of evidence.
Findings
The results show that a customer-centric approach based on the SE-based platform can improve the customer experience and help to redesign and expand the business processes of healthcare organisations. A multilevel model demonstrates the possible service innovations that use SE principles that can co-create value for the customer (micro level), for the healthcare network (meso level) and for the community (macro-level).
Research limitations/implications
This study provides managerial implications for the players who intend to take advantage of the possibilities offered by service innovations developed by the health and social organisations in the network. The SE-based platform helps redefine business processes to improve clinical and financial outcomes and improves the overall customer experience within this network.
Originality/value
This study allows new and important reflections from ethical, social and managerial points of view and underlines how digital platforms act as a support for healthcare services, not as a substitute.
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Rod Sheaff, Verdiana Morando, Naomi Chambers, Mark Exworthy, Ann Mahon, Richard Byng and Russell Mannion
Attempts to transform health systems have in many countries involved starting to pay healthcare providers through a DRG system, but that has involved managerial workarounds…
Abstract
Purpose
Attempts to transform health systems have in many countries involved starting to pay healthcare providers through a DRG system, but that has involved managerial workarounds. Managerial workarounds have seldom been analysed. This paper does so by extending and modifying existing knowledge of the causes and character of clinical and IT workarounds, to produce a conceptualisation of the managerial workaround. It further develops and revises this conceptualisation by comparing the practical management, at both provider and purchaser levels, of hospital DRG payment systems in England, Germany and Italy.
Design/methodology/approach
We make a qualitative test of our initial assumptions about the antecedents, character and consequences of managerial workarounds by comparing them with a systematic comparison of case studies of the DRG hospital payment systems in England, Germany and Italy. The data collection through key informant interviews (N = 154), analysis of policy documents (N = 111) and an action learning set, began in 2010–12, with additional data collection from key informants and administrative documents continuing in 2018–19 to supplement and update our findings.
Findings
Managers in all three countries developed very similar workarounds to contain healthcare costs to payers. To weaken DRG incentives to increase hospital activity, managers agreed to lower DRG payments for episodes of care above an agreed case-load ‘ceiling' and reduced payments by less than the full DRG amounts when activity fell below an agreed ‘floor' volume.
Research limitations/implications
Empirically this study is limited to three OECD health systems, but since our findings come from both Bismarckian (social-insurance) and Beveridge (tax-financed) systems, they are likely to be more widely applicable. In many countries, DRGs coexist with non-DRG or pre-DRG systems, so these findings may also reflect a specific, perhaps transient, stage in DRG-system development. Probably there are also other kinds of managerial workaround, yet to be researched. Doing so would doubtlessly refine and nuance the conceptualisation of the ‘managerial workaround’ still further.
Practical implications
In the case of DRGs, the managerial workarounds were instances of ‘constructive deviance' which enabled payers to reduce the adverse financial consequences, for them, arising from DRG incentives. The understanding of apparent failures or part-failures to transform a health system can be made more nuanced, balanced and diagnostic by using the concept of the ‘managerial workaround'.
Social implications
Managerial workarounds also appear outside the health sector, so the present analysis of managerial workarounds may also have application to understanding attempts to transform such sectors as education, social care and environmental protection.
Originality/value
So far as we are aware, no other study presents and tests the concept of a ‘managerial workaround'. Pervasive, non-trivial managerial workarounds may be symptoms of mismatched policy objectives, or that existing health system structures cannot realise current policy objectives; but the workarounds themselves may also contain solutions to these problems.
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Sophie Guthmuller, Paolo Paruolo and Stefano Verzillo
This chapter summarises the role of EU actions in supporting healthcare policies in the EU Member States, both looking at implemented actions and describing current priorities for…
Abstract
This chapter summarises the role of EU actions in supporting healthcare policies in the EU Member States, both looking at implemented actions and describing current priorities for the future. It argues that these coordinated actions can be beneficial for EU Member States by helping them to avoid duplication of effort and to attain economies of scale. Moreover, data sharing with proper safeguards can unleash vast amount of ‘learning what works’ both for medical treatments and for healthcare sustainability measures. The need for this common learning appears ever more urgent while facing the health and economic consequences of the present pandemic.
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Value-based healthcare suggested using patient-reported information to complement the information available in the medical records and administrative healthcare data to provide…
Abstract
Purpose
Value-based healthcare suggested using patient-reported information to complement the information available in the medical records and administrative healthcare data to provide insights into patients' perceptions of satisfaction, experience and self-reported outcomes. However, little attention has been devoted to questions about factors fostering the use of patient-reported information to create value at the system level.
Design/methodology/approach
Action research design is carried out to elicit possible triggers using the case of patient-reported experience and outcome data for breast cancer women along their clinical pathway in the clinical breast network of Tuscany (Italy).
Findings
The case shows that communication and engagement of multi-stakeholder representation are needed for making information actionable in a multi-level, multispecialty care pathway organized in a clinical network; moreover, political and managerial support from higher level governance is a stimulus for legitimizing the use for quality improvement. At the organizational level, an external facilitator disclosing and discussing real-world uses of collected data is a trigger to link measures to action. Also, clinical champion(s) and clear goals are key success factors. Nonetheless, resource munificent and dedicated information support tools together with education and learning routines are enabling factors.
Originality/value
Current literature focuses on key factors that impact performance information use often considering unidimensional performance and internal sources of information. The use of patient/user-reported information is not yet well-studied especially in supporting quality improvement in multi-stakeholder governance. The work appears relevant for the implications it carries, especially for policymakers and public sector managers when confronting the gap in patient-reported measures for quality improvement.
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Abstract
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Federica Bosco, Chiara Di Gerio, Gloria Fiorani and Giulia Stola
This paper aims to identify the key issues that healthcare knowledge-intensive organizations (KIPOs) should focus on to define themselves as socioenvironmentally and governance…
Abstract
Purpose
This paper aims to identify the key issues that healthcare knowledge-intensive organizations (KIPOs) should focus on to define themselves as socioenvironmentally and governance responsible for integrating environmental, social, and governance (ESG) logic into their business strategy. At the same time, this provides an understanding of how healthcare KIPOs contribute to achieving the Sustainable Development Goals of the 2030 Agenda.
Design/methodology/approach
Taking a cue from the model developed by the World Economic Forum, an “ESG Processing Map” was constructed to identify qualitative disclosures that a healthcare company should consider when implementing sustainability logic. The aspects investigated were processed, considering national and international standards, frameworks and disclosures. The social network analysis technique was used to systemize and combine the outcomes of these processes and analyze their consistency with sustainable development.
Findings
Through the “ESG Processing Map,” 13 areas of action and 27 topics specific to the health sector were defined on which to intervene in sustainability in order to concretely help HCOs to place specific corrective and improvement actions over time concerning socioenvironmental and governance aspects.
Originality/value
The paper provides contribute, on the one hand, to enriching and updating the academic literature on ESG logic in a still underexplored field and, on the other hand, to provide these types of organizations with a “compass” to guide and orient their business strategies towards sustainability.
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Jean Claude Mutiganda and Janne T. Järvinen
Research was conducted to investigate whether, and how, political accountability might stabilise when agents are faced with profound changes in external structures such as…
Abstract
Purpose
Research was conducted to investigate whether, and how, political accountability might stabilise when agents are faced with profound changes in external structures such as competition laws and austerity policies.
Design/methodology/approach
We performed a field study from 2007 to 2015 in a regional hub in Finland and worked with data from document analysis, interviews and meeting observations. We have used embedded research design, where we apply methodological bracketing as well as composite sequence analysis for field research.
Findings
Accountability declined when irresistible external structures were the dominant influence on the unreflective actions of agents-in-focus. With time, however, the agents started acting critically by drawing on structures that could facilitate strategic actions to stabilise political accountability.
Research limitations/implications
The field research and interpretation of the data were limited to the organisation analysed; however, the theoretical arguments allow for analytical generalisations.
Practical implications
The research demonstrates how public officials and political decision-makers can eventually adopt a strategic approach when faced with irresistible change in external structures.
Social implications
The research demonstrates how public officials and political decision-makers can eventually adopt a strategic approach when faced with irresistible changes in external structures.
Originality/value
The study locates political accountability in the context of strong structuration theory and discusses how it is redefined by external structures.
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Siti Norida Wahab, Nusrat Ahmed and Mohamed Syazwan Ab Talib
The Indian pharmaceutical industry has contributed significantly to global healthcare by securing superior-quality, inexpensive and reachable medicines worldwide. However, supply…
Abstract
Purpose
The Indian pharmaceutical industry has contributed significantly to global healthcare by securing superior-quality, inexpensive and reachable medicines worldwide. However, supply chain management (SCM) has been challenging due to constantly shifting requirements for short lifecycles of products, the convergence of industry and changeable realities on the ground. This study aims to identify, assess and prioritize the strengths, weaknesses and opportunities of the pharmaceutical SCM environment in India.
Design/methodology/approach
The paper employs a Strength, Weakness, Opportunity, Threat (SWOT) analysis and recognizes strategies to utilize the advantages of the strengths and opportunities, rectify weaknesses and resolve threats.
Findings
A variety of strategies that could have a positive effect on the Indian pharmaceutical business are presented. Findings and suggested strategies can significantly advance knowledge, enhance understanding and contribute to the growth of a successful SCM for the Indian pharmaceutical sector.
Originality/value
This paper would act as a roadmap to greater comprehension of the market leaders and market leaders' operating climate. The findings from this study will offer academic scholars and business practitioners deeper insights into the environment of SCM.
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