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Millions of people die of chronic diseases within inpatient settings annually in the United States, despite patient preferences for dying at home. This medicalization of dying has received social and economic critiques for decades. This chapter offers a further analysis to these critiques by examining the ecological impacts of inpatient end-of-life care on the natural environment and occupational and public health.

We compare the ecological health outcomes of medical care in three inpatient units (conventional cancer unit, palliative care ward, and hospice facility) using ethnographic observations, semi-structured interviews, and institutional records on medical supply use, waste generation, and pharmaceutical administration and disposal.

Care provided on all three medical units had significant socioecological impacts. Cumulative impacts were greatest on the conventional unit, followed by palliative care, and lowest on the hospice unit. Variations in impacts mirrored differences in dependence on material interventions, which arose from variations in patient needs, institutional policies, and nursing cultures between the three units.

Social and economic concerns have been major drivers in reforming end-of-life medical care, and our analysis shows that ecological concerns must also be considered. Transitioning terminal patients to less materially intensive modes of care when appropriate could mitigate ecological health impacts while honoring patient preferences.

This chapter describes how the medicalization of dying has converged with institutional policies, practices, and actors to increase the negative consequences of medical care, and recognizes that the far-reaching impacts of clinical decisions make the provision of medical care a socioecological act.

Purpose – The purpose of this paper is to identify and analyze factors influencing the mutual relationship between patients and medical units in the virtual environment. Since introduction of the internet and other electronic tools for medical services provision is at the very initial stage, it is necessary to examine factors which condition engagement of patients and medical units in building bilateral relations in a new virtual environment and to develop relationship models on the health services market. Design/methodology/approach – The paper presents findings of the field study conducted in Poland, being a representative market under transition. Surveys were conducted among patients and medical units by means of structured questionnaires. The identification of relationship factors was based on the approach used in consumer behavior models, where the method of the so‐called summary of variables is left behind. Findings – According to research results, the most important factors affecting relationships between patients and medical units in the virtual environment include: the motivation, ability and market opportunity. With respect to patients, the most powerful factor is represented by the ability, whereas with respect to medical units by the market opportunity. Practical implications – Identified factors and developed models may be widely applied in practical operation of medical units, particularly in developing marketing programs for introduction of virtual service and communication tools, as well as in building patient loyalty programs. Originality/value – The paper is one of the first to have defined factors determining relationships on the virtual healthcare market and to have provided useful insights into the subject. Moreover, it constitutes a basis for future studies. The findings can greatly contribute to development of customer behavior and partnership marketing theories.

This article examines how a profit-centered restructuring of labor relations in an academic medical center undermined team-based care practices in its intensive care unit. The Institute of Medicine has promoted team-based care to improve patient outcomes, and the staff in the intensive care unit researched for this paper had established a set of practices they defined as teamwork. After hospital executives rolled out a public relations campaign to promote its culture of teamwork, they restructured its workforce to enhance numerical and functional flexibility in three key ways: implementing a “service line” managerial structure; cutting a range of staff positions while combining others; and doubling the capacity of its profitable and highly regarded intensive care unit. Hospital executives said the restructuring was necessitated by changes to payment models brought forth by the Affordable Care Act. Based on 300 hours of participant-observation and 35 interviews with hospital staff, findings show that the restructuring lowered staff resources and intensified work, which limited their ability to practice care they defined as teamwork and undermined the unit’s collective identity as a team. Findings also show how staff members used teamwork as a sensitizing concept to make sense of what they did at work. The meanings attached to teamwork were anchored to positions in the hospitals’ organizational hierarchy. This paper advances our understanding of he flexible work arrangements in the health care industry and their effects on workers.

Purpose – In the last decades, Italian healthcare organisations have been subject to important normative changes, aimed at increasing their efficiency. As a response, performance measurement and evaluation (PME) systems have been introduced. The present study attempts to examine PME system changes as institutional processes. In studying such processes the healthcare literature acknowledges the presence of two logics: managerial and professional, as peculiar to healthcare settings, whose convergence or divergence can explain the success of any institutional process.

Design/methodology/approach – We adopt Busco et al.'s (2007) framework as an approach for unbundling PME system change into four relevant coordinates, namely: (1) the object (PME system), (2) the subjects (institutional forces), (3) the place and time of change (the managerial and professional logics) and (4) the how and why change happens (change as an institutional process). We conducted a longitudinal case study at a large teaching hospital in Southern Italy, directed to interpret PME system changes during the period from 1998 until 2009.

Findings – Our observation distinguishes episodes of successful institutional processes, where the introduced innovations are transformed into objectivated practices, from episodes of missed institutionalisation, where new procedures were rapidly abandoned.

Research and social implications – This theoretical framework can be useful for interpreting the PME system changes in different institutional contexts.

Originality – The Busco et al.'s framework allows us to understand PME system changes by integrating the perspectives from Neo-Institutional Sociology, representing healthcare organisational responses to external institutional pressures, and Old-Institutional Economics, conceptualising PME system changes as an institutionalisation process.

The purpose of this paper is to highlight how the variety of the actors involved in a performance measurement system (PMS) innovation are spread out in time and space. Healthcare contests are examined, where such an innovation is influenced by present and past systems and practices (spread out in time), and by managerial and health-professional actors (spread out in space).

Drawing on Callon’s actor network theory, the authors describe PMS innovations as processes of translation, and distinguish between incremental and radical innovations. The theoretical arguments are used to explain the evidence drawn from a longitudinal case study carried out in an Italian public teaching hospital, referring to the period from 1998 up to 2003.

The conceptual framework shows how the translation moments lead to a recognition of the different actants involved in a PMS innovation, how their interests are interrelated and mobilized. Moreover, it shows how the interaction among the actants involved in the process is related to the type of PMS innovation, i.e. radical vs incremental. The case evidence offers detailed insights into the phenomenon, testing the explanatory power of the framework, and highlights how the failure of one of the translation moments can compromise the success of a PMS innovation.

This study differs from the extant accounting literature on PMS innovations as it highlights how the introduction of a new PMS can be affected by some elements of the previous systems “package,” which are relevant for the mobilization of the actants through the new project.

This paper describes the development and implementation of care pathways in two orthopaedic units in Scotland. Although originally developed as a tool of project management, care pathways have been promoted internationally as a response to concerns for patient safety, variability in care and increasing costs. Generally, care pathways can be seen as an example of clinician led rather than management led reform. However, it does reflect a wider shift towards process and away from hierarchical approaches to management. Within the UK care pathways have been promoted as a response to the modernisation initiative of the Labour Government. While the initiative was a success in both units it was more difficult to implement care pathways in a trauma rather than an elective unit. In conclusion, it is questionable whether care pathways are a universal response to the requirement for modernisation and service redesign in the NHS.

This article aims to describe and analyze the results of efforts to improve patient‐centered care (PCC) in psychiatric healthcare.

Using the methodology of a qualitative case study, the authors studied three Swedish child and adolescent psychiatric care (CAP) units in order to describe how patient‐centered actions are performed. They conducted 62 interviews, made 11 half‐day observations, and shadowed employees for two days.

The article shows that the increased focus on accountability for unit performance and medical risks results in unintended consequences. The patient's medical risk is transformed to a personal risk for the psychiatrist and the resource risk is transformed to a personal risk for the unit manager. Patients become risk objects for both psychiatrists and unit managers, which creates an alignment between them to try to send patients elsewhere. New public management (NPM) reforms may consequently lead to the institutionalization of unintended healthcare practices.

The article shows that accountability pressure to reduce patient risk may create new risks for patients.

The study uses theoretical concepts of risk tradeoffs (risk substitution and risk transformation), which were developed for the macro level, to explain the unintended consequences of NPM reforms at the micro level.

The calculation of buildings’ carbon footprint (CFP) is an important basis for formulating energy-saving and emission-reduction plans for building. As an important building type, there is currently no model that considers the time factor to accurately calculate the CFP of hospital building throughout their life cycle. This paper aims to establish a CFP calculation model that covers the life cycle of hospital building and considers time factor.

On the basis of field and literature research, the basic framework is built using dynamic life cycle assessment (DLCA), and the gray prediction model is used to predict the future value. Finally, a CFP model covering the whole life cycle has been constructed and applied to a hospital building in China.

The results applied to the case show that the CO₂ emission in the operation stage of the hospital building is much higher than that in other stages, and the total CO₂ emission in the dynamic and static analysis operation stage accounts for 83.66% and 79.03%, respectively; the difference of annual average emission of CO₂ reached 28.33%. The research results show that DLCA is more accurate than traditional static life cycle assessment (LCA) when measuring long-term objects such as carbon emissions in the whole life cycle of hospital building.

This research established a carbon emission calculation model that covers the life cycle of hospital building and considered time factor, which enriches the research on carbon emission of hospital building, a special and extensive public building, and dynamically quantifies the resource consumption of hospital building in the life cycle. This paper provided a certain reference for the green design, energy saving, emission reduction and efficient use of hospital building, obviously, the limitation is that this model is only applicable to hospital building.

The Spanish health care system has undergone important changes, particularly in the development of new homecare services. In practice, however, results have been mixed. Some homecare services have been successful, but implementation failures are common and the intended patients are frequently reluctant to use home care services. A possible explanation for efficiency and effectiveness gaps of services provided by hospital‐in‐the‐home units may relate to the advantages and disadvantages of the knowledge processes that these units highlight as a result of their different structural properties. The purpose of this paper is to present a conceptual framework for hospital‐in‐the‐home units developed to guide learning within the context of homecare services.

Using data collected from the hospital‐in‐the‐home unit at a Spanish regional hospital, this work examines how the existence of some practices is linked to knowledge transfer and how this component is linked to patient service.

This paper reports a knowledge management program that is customised and based on four frameworks – i.e. technical infrastructure; people to facilitate and drive the process; a system that supports and rewards sharing; and the team leader.

Conducting this type of single case study (an interview‐based case study approach) is to be understood foremost as a prelude to further quantitative studies including common measures for patients, clinicians, staff, managers and board members.

In an applied sense, the model provides homecare practitioners with identifiable factors that enable the four frameworks and address the relevant issues by changing strategies at both the individual and organisational levels. Without a knowledge management program, practitioners may lose the ability to see the market signals stemming from healthcare members, and they may decide to go solely by their own ways of doing and interpreting things.

Drawing on the author’s personal experience within the UK National Health Service, outlines at the macro level what information is needed, and why, in facilities management. Suggests that top‐level data gathering is a priority, describes the processes required, and finally considers the advantages of sharing information with competitors and others.