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Book part
Publication date: 11 August 2014

Jenna M. Evans, Ross G. Baker, Whitney Berta and Barnsley Jan

To examine the evolution of health care integration strategies and associated conceptualization and practice through a review and synthesis of over 25 years of…

Abstract

Purpose

To examine the evolution of health care integration strategies and associated conceptualization and practice through a review and synthesis of over 25 years of international academic research and literature.

Methods

A search of the health sciences literature was conducted using PubMed and EMBASE. A total of 114 articles were identified for inclusion and thematically analyzed using a strategy content model for systems-level integration.

Findings

Six major, inter-related shifts in integration strategies were identified: (1) from a focus on horizontal integration to an emphasis on vertical integration; (2) from acute care and institution-centered models of integration to a broader focus on community-based health and social services; (3) from economic arguments for integration to an emphasis on improving quality of care and creating value; (4) from evaluations of integration using an organizational perspective to an emerging interest in patient-centered measures; (5) from a focus on modifying organizational and environmental structures to an emphasis on changing ways of working and influencing underlying cultural attitudes and norms; and (6) from integration for all patients within defined regions to a strategic focus on integrating care for specific populations. We propose that underlying many of these shifts is a growing recognition of the value of understanding health care delivery and integration as processes situated in Complex-Adaptive Systems (CAS).

Originality/value

This review builds a descriptive framework against which to assess, compare, and track integration strategies over time.

Details

Annual Review of Health Care Management: Revisiting The Evolution of Health Systems Organization
Type: Book
ISBN: 978-1-78350-715-3

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Article
Publication date: 29 June 2010

Fan Wu

The purpose of this paper is to understand the demand pattern and housing preference of young consumers in Guangzhou, China. This study seeks to offer more information for…

Abstract

Purpose

The purpose of this paper is to understand the demand pattern and housing preference of young consumers in Guangzhou, China. This study seeks to offer more information for urban planners and housing developers about housing demand from social and cultural perspective.

Design/methodology/approach

Assisted by a questionnaire survey, a housing environment preference pattern is generated by ranking quality attributes with respect to their relative importance to young consumers. The outcome is analysed by pair‐wise comparison of attributes based on the analytic hierarchy process (AHP).

Findings

It is found that “public traffic network” (11.72 per cent), “proximity to workplace” (10.22 per cent), “sense of safety” (9.74 per cent), “medical and health facility” (8.54 per cent) and “education facility” (8.50 per cent) are the top five determinants in housing consumption of young consumers in Guangzhou.

Research limitation/implication

The database used is relatively small.

Originality/value

The housing environment has been well‐researched in developed countries, but not in Guangzhou, China. This is one of the few papers that looks at the housing physical and social environment preference for young consumers using an AHP framework.

Details

Property Management, vol. 28 no. 3
Type: Research Article
ISSN: 0263-7472

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Article
Publication date: 1 June 2002

Andrew Jameton and Catherine McGuire

Sustainable health care combines three key factors: quality patient care, fiscally responsible budgeting and minimizing environmental impact. Although pollution is well…

Abstract

Sustainable health care combines three key factors: quality patient care, fiscally responsible budgeting and minimizing environmental impact. Although pollution is well understood as a health problem, US health planners have not fully recognized the need to reduce health‐care pollution. Minimizing health‐care pollution, moreover, requires reducing the throughput of energy and materials. Ultimately, sustaining healthy ecosystems requires that health‐care material and energy utilization be limited. However, traditional conceptions of health‐care ethics maintain a philosophy of rescue that makes limiting life‐saving resources, except at a patient’s request, morally worrisome. Moreover, the media image of health care as technologically intensive, together with the common medical view that nature is the enemy, render suspect philosophical perspectives respectful of Earth’s limits. Nevertheless, academic medical centers have advantages as sites for pursuing sustainability: students often uphold environmental ideals, a public health perspective, and an interest in providing services universally; basic biomedical research on campus permits innovative research combining health and environmental considerations; opportunities exist for including environmental concerns in health professional education; some academic medical centers have already stated environmental criteria for purchasing contracts; and health‐care professionals and institutions are increasingly addressing such environmental concerns as mercury use, latex allergies, dioxin pollution, and waste volume. To address these challenges, a visioning process is proposed, designed to formulate a practical plan by means of public, local, and professional participation in the process of articulating creative and morally sound proposals for change.

Details

International Journal of Sustainability in Higher Education, vol. 3 no. 2
Type: Research Article
ISSN: 1467-6370

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Content available
Article
Publication date: 11 March 2021

Lana L. Wylie

The purpose of this paper is to examine the relevance of Cuba’s medical system, its health tourism and related diplomacy in the context of the recent COVID-19 pandemic for…

Abstract

Purpose

The purpose of this paper is to examine the relevance of Cuba’s medical system, its health tourism and related diplomacy in the context of the recent COVID-19 pandemic for the global response to disease outbreaks. In addition to Cuba being a destination for leisure tourists in the Caribbean, the renowned Cuban medical system attracts thousands of health tourists seeking low-cost but high-quality treatment. This paper demonstrates how Cuba’s unique response to the pandemic, which included sending thousands of medical staff abroad, can inform structural and global issues and contribute to a more sustainable future.

Design/methodology/approach

The research in this study is primarily drawn from published academic and media sources that address Cuba’s medical system, its health tourism and the government’s response to the recent pandemic. The author, a political scientist and an author of many publications on Cuba, and the PI of a study focused on Cuban tourism, will also draw on her expertise.

Findings

This paper addresses the Cuban Government’s ongoing response to the COVID-19 pandemic and places this response in the context of Cuba’s medical system, its health tourism and related diplomacy. It reveals key lessons from Cuba’s response for other tourist destination states and, more broadly, for the worldwide response to global outbreaks and the management of health systems. The findings will further research in diplomacy and tourism as well as inform policy and practice.

Research limitations/implications

This paper explores an ongoing topic and thus further research will be required following the pandemic.

Practical implications

This research note offers important implications for practice including providing accurate, research-based information that challenges misinformation about Cuba’s health system, its medical diplomacy program, health tourism and its response to COVID-19. It offers valuable lessons for public health authorities including the importance of preventative health measures, community medicine and the benefits of working globally to combat outbreaks through the sharing of medical staff and resources.

Social implications

This research note reveals the health, political and social implications of Cuba’s response in this time of crisis. It shows the benefits of a robust but low-cost community-based medicine program, medical diplomacy and how a state’s response during crisis can moderate the global inequities and injustices such as unequal access to care that often accompany disease outbreaks such as COVID-19.

Originality/value

This research note is an early analysis of a response by an important tourist destination country to the pandemic. The author anticipates that the information provided to the international community via this open access journal will offer practical implications for the ongoing global efforts to manage this crisis and contribute to the research on tourism, diplomacy, justice and health policy.

Details

Journal of Tourism Futures, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 2055-5911

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Book part
Publication date: 9 December 2003

William Lyons

Community policing has been around for at least two decades now and it is safe to say that it has become, in large part, more about managing disruptive subjects and…

Abstract

Community policing has been around for at least two decades now and it is safe to say that it has become, in large part, more about managing disruptive subjects and virtuous citizens than preventing crime or disorder (Crank, 1994; DeLeon-Granados, 1999; Yngvesson, 1993). While the rhetoric of community may be succeeding where the policing policy is failing, the experience has certainly contributed to the growth of homologous efforts that include community prosecution and community correction. We see a criminal justice system pro-actively seeking to blur the boundaries between its institutions and the communities they work within and, all too often, without. In recent years, there has been a rapid growth in justice approaches that turn their attention toward the community. There are literally hundreds of examples of this trend, from offender-victim reconciliation projects in Vermont and Minneapolis to ‘beat probation’ in Madison, Wisconsin; from neighborhood-based prosecution centers in Portland, Oregon, and New York City, to community probation in Massachusetts. Of course, the most well-known version of community justice is community policing, but localized projects involving all components of the justice system have been widely promoted (Clear & Karp, 1998, p. 3).Like community policing and community prosecution, community correction programs generally focus on partnering with service providers and community groups in order to more finely calibrate their service delivery. For community corrections the recent focus has been on delivering re-entry programs and expanding the availability of intermediate sanctioning options. The sheriff (above) focuses on re-entry, to link jails and communities in two ways: extending the correctional continuum into power-poor communities and increasing political support for expanding the criminal justice system in more affluent communities. Even as fiscal stress translates into budget cuts in education, housing, drug treatment, and other services, the reach of the criminal justice system expands outside the fences as new community-based partnerships and inside the fences as an increasingly program-rich environment. These partnerships are, not surprisingly as we shall see, dominated by criminal justice professionals and dependent on coercive control techniques. Further, their budgets are growing with funds in previous eras earmarked for providing many of the same services in a social welfare, rather, than social control, service delivery context. While these budgetary trends map a macro political trend from an old democratic New Deal toward a new republican new deal network of patronage relationships (see Lyons, forthcoming 2004), this paper examines the micro politics of community corrections developing within an increasingly punitive American political-culture.

Details

Punishment, Politics and Culture
Type: Book
ISBN: 978-0-76231-072-2

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Article
Publication date: 3 July 2017

Sherry Ball, Michelle Montpetite, Christine Kowalski, Zach Gerdes, Glenn Graham, Susan Kirsh and Julie Lowery

The Veterans Healthcare Administration (VHA) has promoted Specialty Care Neighborhoods (SCN) to enhance the coordination of services between primary and specialty care…

Abstract

Purpose

The Veterans Healthcare Administration (VHA) has promoted Specialty Care Neighborhoods (SCN) to enhance the coordination of services between primary and specialty care. Care coordination agreements (CCAs) were included as a critical element in the SCN program. The purpose of this paper is to examine the role of these documents in the successful implementation of SCNs.

Design/methodology/approach

Content, quality, and perceived usefulness of CCAs from 19 SCN sites were evaluated. CCA content was defined as the presence or absence of eight key components: contact information, process for urgent consults, process for e-consults, content of consults, primary and specialty care responsibilities, expected response time, discharge criteria, and review criteria. CCA quality was based on a qualitative assessment of CCA content; and perceived usefulness was based on a qualitative assessment of interview responses from CCA users. CCA characteristics were compared to SCN implementation levels using descriptive statistics. SCN implementation level was defined and measured by VHA Specialty Care Services.

Findings

Participating sites with medium-high or high SCN implementation levels had CCAs with more key components and of higher quality than sites with medium-low to medium SCN implementation levels. Perceived usefulness of CCAs was not associated with implementation level.

Research limitations/implications

Since this study built on a quality improvement effort to facilitate care coordination, a rigorous research approach was not used. Specific CCA components could not be examined nor could specific hypotheses be tested due to the small and diverse sample. Findings presented are only preliminary.

Practical implications

The examination of CCAs suggests that these documents may be helpful to improve communication among primary and specialty care providers by explicitly stating agreed upon processes, mechanisms and criteria for referrals, roles and responsibilities for the co-management of patients, and timelines for review of CCAs.

Originality/value

This small study suggests that high-quality CCAs, which include a number of key components, can facilitate the implementation of coordinated care. Key characteristics of CCAs are identified in this study, including measures of CCA content, quality, and usefulness, which can be used in future efforts to develop and evaluate efforts to improve care coordination.

Details

Journal of Integrated Care, vol. 25 no. 3
Type: Research Article
ISSN: 1476-9018

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Article
Publication date: 1 June 1989

Kenneth Ojo

One of the most serious obstacles to the development of effectivehealth services is inadequate supply of trained health manpower. Anoverview is presented of the current…

Abstract

One of the most serious obstacles to the development of effective health services is inadequate supply of trained health manpower. An overview is presented of the current numbers and types of health personnel, their roles and trends over time, their geographical distribution across Nigeria and efforts to influence it. It is indicated that in Nigeria the geographical distribution of medical personnel is extremely uneven and that there is a need for fundamental changes in health manpower policy.

Details

International Journal of Manpower, vol. 10 no. 6
Type: Research Article
ISSN: 0143-7720

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Book part
Publication date: 21 October 2008

Donna B. Barnes

Women with HIV have increased longevity and the potential for decreasing mother to child transmission with the use of antiretroviral therapy. Since the beginning of the…

Abstract

Women with HIV have increased longevity and the potential for decreasing mother to child transmission with the use of antiretroviral therapy. Since the beginning of the AIDS epidemic in 1980, the disease has evolved from an acute condition to a chronic one. How have women long-term survivors transitioned from a “death sentence” to living with HIV/AIDS as a chronic illness? In this study, we investigate the reproductive, mothering, and living experiences of HIV positive women 10 years after their participation in a study of their reproductive decisions. The sample was taken from two groups of women living with HIV (n = 60), one in Oakland, California (n = 30) and one in Rochester, New York (n = 30). Both groups participated in the initial study (1995–2001). The inclusion criteria for this study are women with HIV who are living and well enough to participate in a face-to-face interview. Of the original 60 women, 52 women are living. Two and one half years into this 4-year study, the author has completed interviews with 25 women from Oakland (n = 10) and Rochester (n = 15). An unexpected life with HIV challenges participants to live a viable life different from their pre-diagnosed life. It involves a life of defining normalcy in everyday experiences and building a legacy of a life worth living. Participants’ issues and concerns of living with HIV/AIDS identify what kinds of cultural notions, and medical and social interventions support or undermine women's reproductive, mothering, and long-term living with HIV/AIDS.

Details

Care for Major Health Problems and Population Health Concerns: Impacts on Patients, Providers and Policy
Type: Book
ISBN: 978-1-84855-160-2

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Article
Publication date: 1 January 1910

“WHAT a place to be in, is an old library! It seems as though all the souls of all the writers, that have bequeathed their labours to these Bodleians, were reposing here…

Abstract

“WHAT a place to be in, is an old library! It seems as though all the souls of all the writers, that have bequeathed their labours to these Bodleians, were reposing here, as in some dormitory or middle state. I do not want to handle, to profane the leaves, their winding sheets… I seem to inhale learning, walking amid their foliage.” Thus wrote Charles Lamb, of the Bodleian Library, which is the largest library to bear the name of a private benefactor, and amongst British libraries, is second only in importance to the British Museum.

Details

New Library World, vol. 12 no. 7
Type: Research Article
ISSN: 0307-4803

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Expert briefing
Publication date: 15 May 2017

The dismissal of Caporale, a gynaecologist by profession, followed a damning report on the scale of the health crisis in Venezuela, which was released on May 9 and…

Details

DOI: 10.1108/OXAN-DB220847

ISSN: 2633-304X

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