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Ambulance service trusts in England have historically had little or no competition for non-emergency patient transport services (NEPTS), but following the imposition of the NHS Procurement, Patient Choice and Competition (PPCC) Regulation (Number 2) 2013, NHS commissioners could accept suitable bids for NEPTS work from third-party commercial competition. This paper describes how NEPTS evolved in England and how an Ambulance Service Trust Board had to step-up their approach to bidding for NHS NEPTS work and to protect their brand and financial position in a competitive commercial market place.

The Trust Board developed a competitive bidding strategy with a market research project using “grounded theory” to identify and categorise stakeholders' issues followed by re-engineering to achieve new operational goals. A fundamental element of the bid was an opportunity to share patient information between local NHS facilities using a common access data warehouse. This would represent a serious barrier to entry to any third-party non-NHS commercial competitor.

Key projects were identified in the bidding process, including relocation of NEPTS resource bases, use of third-party resources and the establishment of a local NHS-wide data warehouse. They were all self-financing within the contract period and accepted by the commissioners. However, the establishment of NEPTS hubs at hospitals with clinics scattered throughout their grounds was rejected by the commissioners due to incompatibility with existing hospital practices.

This case study defines the challenges and opportunities faced by an English Ambulance Service Trust Board when responding to an invitation to tender (ITT) from NHS commissioners for NEPTS and competing with third-parties on a commercial basis. Any emergency service would face similar challenges bidding for work in a competitive environment.

Summarizes the management of change in a high profile public service with more than its fair share of political influences. Demonstrates the scale of change possible, given a clear strategy and a strong managerial commitment. Argues that this leads to high productivity, quality and value for money, with a strong element of organizational loyalty and ownership of the end product.

Mass casualty incidents are characterised by an immediate, unforeseen and unquantifiable surge in demand for ambulance services which soon becomes apparent and will exceed any “local” resources available. Casualties require the correct treatment, promptly, at an appropriate resource without incurring any further harm. In the absence of firm operational guidelines, this paper provides templates for ambulance commanders both at call centre and on-site to approach the management of mass casualty incidents.

Desk research indicated that there were both guidelines on how various elements of the emergency services should work together plus academic papers on techniques to adopt in mass casualty situations. Standing orders or written protocols for ambulance commanders, however, provide little or no specific guidance or an outline plan upon how they should command in a mass casualty situation. Following analysis of relevant public enquiry reports and discussions with ambulance commanders and using the materials from desk research, a four-stage approach was devised for testing using retrospective analysis from field and desktop exercises.

To have confidence, each commander needs simple digital real-time templates from which they understand their role and how the overall plan defines priorities with the greatest need. A plan should cover call-centre and on-site operations including a basic operational checklist from start to finish; resource structure and inter-relationships; sources and availability of resources plus information and control procedures to impose limited quality control procedures.

The design and implementation of digital templates to provide minute-by-minute visibility to all commanders which have not been recorded before. Such templates give commanders confidence to determine, locate and call forward relevant resources to attend casualties in order of priority of need. Time-lapsed records are useful not just in the minute-by-minute decision processes but also for critical organisational learning and in any post-event review by either a coroner or lawyers at a public enquiry.

The purpose of this paper is to present an evaluation of a collaborative commissioning approach to improve quality and experience and reduce cost within integrated health and social care.

A multi-method approach is used involving qualitative interviews, documentary analysis and non-participant observation.

The findings suggest that the approach provides a suitable framework for the collaborative commissioning of integrated health and social care services.

Further research is now needed to provide a definitive evaluation of its value outside of Wales.

With the significant scrutiny on health systems, the approach demonstrates effectiveness in securing quality improvements, achievement of recognised care standards and patient outcomes, while providing scope for financial gains and a goal for stakeholders to engage in effective communication.

This research presents an innovative method for collaborative commissioning and reveals activities that appear to contribute to more effective commissioning processes.

To assess the effectiveness of an integrated care program for post-acute care of stroke patients, the return home program (RHP program), deployed in Barcelona (North-East Spain) between 2016 and 2017 in a context of health and social care information systems integration.

The RHP program was built around an electronic record that integrated health and social care information (with an agreement for coordinated access by all stakeholders) and an operational re-design of the care pathways, which started upon hospital admission instead of discharge. The health outcomes and resource use of the RHP program participants were compared with a population-based matched control group built from central healthcare records of routine care data.

The study included 92 stroke patients attended within the RHP program and the patients' matched controls. Patients in the intervention group received domiciliary care service, home rehabilitation, and telecare significantly earlier than the matched controls. Within the first two years after the stroke episode, recipients of the RHP program were less frequently institutionalized in a long-term care facility (5 vs 15%). The use of primary care services, non-emergency transport, and telecare services were more frequent in the RHP group.

The authors' analysis shows that an integrated care program can effectively promote and accelerate delivery of key domiciliary care services, reducing institutionalization of stroke patients in the mid-term. The integration of health and social care information allows not only a better coordination among professionals (thus avoiding redundant assessments) but also to monitor health and resource use outcomes of care delivery.

This paper aims to present the current state of evidence regarding the mental health literacy of paramedics and student paramedics and whether mental health literacy affects the care that paramedics provide to their patients with mental illness.

Embase, PubMed, Medline and Google Scholar were searched for recent (2010–2020) English language published articles using the key phrases paramedic AND/OR ambulance AND mental health AND mental health literacy. Additional searches of the reference lists of included articles were undertaken. A descriptive thematic analysis was used to arrive at a narrative synthesis of the study findings.

The emergency medical services system has taken a primary role in the care of patients with mental illness but has limited capacity for non-emergency psychosocial situations. Negative and judgemental attitudes amongst paramedics towards patients with mental illness is a significant issue and remains a barrier to patients seeking medical care for mental illness. Improved care provision and patient engagement might result from specific education aimed to better enhance paramedics’ mental health literacy.

This literature review provides insights into the current practice of mental health training for Australian undergraduate paramedic science students and the implications for patient care. Recommendations for educational strategies are provided.

With the increasing demand on ambulance services, paramedics are tasked to arrange as much out of hospital care as possible, to develop integrated systems of care and work with hundreds of different providers – all in the 15 minutes allocated for assessment. A UK ambulance trust is navigating and leading much of this work as one of the first trusts to implement a general practitioner referral policy as an alternate to direct conveyance. The paper aims to discuss this issue.

Here the authors discuss the referral scheme, examine the limited evidence available and discuss what is needed to influence prospective success of implementing this scheme in other trusts.

Limited evidence for these schemes are described, however there is a clear gap in critical appraisal and methodologically rigorous evidence needed to implement these schemes in other ambulance schemes.

In order to facilitate collaboration of healthcare services and to minimize the burden of increasing numbers of patients, communication and discussion of alternate routes of care is crucial. This viewpoint piece is one of the first to emphasize the potential benefits of such schemes.

The purpose of this paper is to explore the supply-side factors that determines the quality of global healthcare services from medical tourism healthcare providers’ (MTHP) perspective, which provide value-in-medical-travel to foreign patients/medical tourists, who travel to India for medical treatment/surgery.

The thematic content analysis of in-depth interviews with 15 senior MTHP, from 15 private hospitals in India was undertaken, to generate the themes, and identify the supply-side factors necessary for sustainable medical tourism management.

The findings conclude that MTHP ranked in ascending order, less waiting-time for surgery, healthcare quality and accreditation, staff/surgeon’s expertise, healthcare information, hospital facilities and services, patient-safety, travel-risk, surgical costs and holiday opportunity as essential factors for providing sustainable quality and value-in-medical-travel to patients.

Many private hospital spokespersons declined to be interviewed due to confidentiality and privacy policy

The findings are generalised in case of global private hospitals treating foreign patients. Policy implications suggest that private hospitals in developing countries need to focus on providing value-in-medical-travel, such as accreditation quality of healthcare, no waiting-time, patient-safety, qualified and experienced medical and non-medical staff, hospital facilities and post-surgery care with positive healthcare outcomes.

Medical-tour facilitators, hotels and tourism sites need to collaborate with agencies to provide inclusive built environment, first-aid and wheelchair access, to medical tourists, having financial and legal implications for business.

There is little qualitative empirical research on the views of MTHP, regarding management of essential supply-side factors that provide value-in-medical-travel to attract medical tourists to India.

医疗保健提供者对印度医疗旅行价值的看法

本文的目的是从医疗旅游医疗保健提供者的角度探讨决定全球医疗服务质量的供应方因素, 这些因素可为前往印度求医的外国患者/医疗游客提供医疗旅行的价值治疗/手术.

对印度15家私立医院的15家高级医疗旅游保健提供者（MTHP）进行了深度访谈, 对主题内容进行了分析, 以生成主题并确定可持续医疗旅游管理所必需的供应方因素。

研究结果得出结论, MTHP以升序排列的顺序是：手术等待时间, 医疗质量和认证, 工作人员/外科医生的专业知识, 医疗保健信息, 医院设施和服务, 患者安全, 旅行风险, 手术费用和度假时间机会是为患者提供医疗旅行可持续质量和价值的重要因素。

由于医院的机密性和隐私权政策, 许多私立医院发言人拒绝接受采访。

如果全球私立医院为外国医疗游客提供治疗, 那么研究结果将得到概括。政策含义表明, 发展中国家的私立医院需要集中精力提供医疗旅行价值, 例如无需等待时间的医疗保健认证质量和患者安全, 合格和经验丰富的医务人员和非医务人员, 医院设施和后期医疗服务。具有积极医疗效果的手术护理。

旅馆, 医疗旅行促进者和旅游景点需要与机构合作, 为医疗游客提供紧急急救和轮椅通道, 这对企业有财务和法律影响。

关于MTHP观点的定性实证研究很少, 涉及对提供医疗旅行价值以吸引医疗游客前往印度的基本供应方因素的管理。

印度, 医疗旅游, 全球化 等待时间, 患者安全, 认证质量

研究论文

Perspectiva del valor de los proveedores del cuidado de la salud en viajes con propositos medicos a la India

El propósito de esta investigación es explorar los factores que del lado de la oferta determinan la calidad de los servicios globales de salud desde el punto de vista del proveedor, el cual agrega valor al viaje con propósitos médicos a pacientes/turistas médicos quienes viajan a la India para tratamientos médicos ó cirugía.

El análisis de contenido temático de las detalladas entrevistas, con-15 proveedores experimentados de asistencia sanitaria de turismo medico, en-15 hospitales de la India, fué realizado para generar los temas é identificar los factores que del lado de la oferta son necesarios para la gestión sostenible del turismo médico.

Los hallazgos concluyen que proveedores experimentados de turismo ranquearon en orden ascendente la reducción en tiempos de espera para cirugías, acreditación de la calidad del cuidado de la salud, experticia del personal no médico y de cirugía, información del cuidado de la salud, servicios é instalaciones de los hospitales, seguridad del paciente, riesgos de viaje, costos de cirugías, y oportunidades vacacionales, como factores esenciales para proveer calidad sostenible y valor en los viajes con propósitos médicos a los pacientes.

Muchos representates de los hospitales privados se rehusaron a ser entrevistados debido las políticas de privacidad y confidencialidad del hospitales.

Los hallazgos son generalizables en el caso de hospitales privados globales que tratan a turistas médicos extranjeros. Las implicaciones políticas sugieren que los hospitales privados en los países en vía de desarrollo necesitan enfocarse en agregar valor al viaje médico, por medios como la calidad de acreditación de la atención médica, reduccion de tiempos de espera y la seguridad del paciente, personal médico y no médico calificado y experimentado, instalaciones hospitalarias y servicios posoperatorios con resultados sanitarios positivos.

Los hoteles, los facilitadores de toures médicos y los sitios de turismo necesitan colaborar con las agencias para proveer primeros auxilios de emergencia y acceso en silla de ruedas a los turistas médicos, teniendo esto implicaciones financieras y legales para los negocios.

Existe poca investigación empírica cualitativa sobre los puntos-de vista-de (MTHP) proveedores de asistencia sanitaria de turismo médico con respecto a la gestión de los factores esenciales del lado de la oferta que agregan valor al turismo con fiines médicos para atraer turistas médicos a la India.

India, globalización, turismo médico, tiempo-de-espera, calidad, seguridad-del- paciente

Trabajo de investigación

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.

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.

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).

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.

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.