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This study aims to examine relationships between corporate social responsibility (CSR) toward two key stakeholder groups – patients and society and hospital brand advocacy, and the mediating role of trust and patient-hospital identification (PHI) and the moderating role of hospital type on these associations.

The sample of 455 hospital patients was surveyed in Vietnam.

The results suggest that both CSR toward society and patients are positively related to brand advocacy. The influence of CSR toward patients on brand advocacy was stronger for private hospitals than public hospitals. Trust and PHI independently and partially mediate relationships between both stakeholder groups of CSR and brand advocacy with the exception of the trust, which fully mediates the relationship between CSR toward society and brand advocacy. Trust and PHI serve as serial mediators.

Hospitals can promote patients’ organic word of mouth through CSR initiatives and focusing on the reliability, safety and quality of care.

This study examines the mediation effects of trust and PHI and moderating role of hospital type in the relationships between two components of CSR effort and hospital brand advocacy.

This paper aims to discuss an audit evaluation of a specialist independent mental health advocacy service based in the London Borough of Bexley.

The audit included qualitative interviews with ten service users, resident in two specialist forensic mental health and challenging behaviour units. All participants were long‐term in‐patient residents. A number of ethical issues required consideration, in particular respondent confidentiality and informed consent.

Findings indicate that the service's approach, which combines formal advocacy methods with a proactive ethos, had a positive impact on engagement. The importance of trust in the relationships between advocates and service users was also highlighted by the study and is discussed here. The audit also indicates a significant increase in self‐reported wellbeing, self‐efficacy and empowerment for participants. Given that enhancing personal empowerment is one of the primary objectives of the advocacy service, the positive wellbeing outcomes reported are encouraging.

The paper relies on a small number of individuals. There is no attempt to claim representativeness or endeavour to generalise from the findings.

It is recommended that, in the absence of a comprehensive national evidence base, the advocacy needs of patients in forensic and specialist settings be constantly reviewed. Additionally, further action research, to inform educational material and guides for advocacy in specialist settings, may be beneficial and timely.

Improvements in organisational culture are a common recommendation of enquiries into system failure and an aspiration of policy. The purpose of this paper is to explore an initiative to change culture in a low-secure service through the introduction of a self-advocacy group.

An independent evaluation was carried out by a university research team. A theory-based methodology was deployed with qualitative data gathered through observations, interviews and focus groups.

Culture change was reported by senior managers and clinicians in relation to the transparency of the service, decision making regarding resources, and engagement of patients in redesign. Self-advocacy group members reported a different relationship with senior management which in turn enabled greater influence in the organisation. Achieving these impacts relied on independent and skilled external facilitation, support from senior managers, and a calm and democratic atmosphere in the meetings. Ward staff were kept at an arms-length from the group and were less certain that it had made any difference to the way in which the ward operated.

The research was only based in one organisation and the impacts of the initiative may vary with a different local context. Research in a wider sample of organisations and culture change initiatives will provide greater insights.

Self-advocacy groups can lead to organisation culture change alongside benefits for individual group members but require funding, external and independent facilitation, and organisational endorsement and support.

This paper adds to the limited literature regarding culture change in secure services and services for people with a learning disability in general and also to the understanding of the impact of self-advocacy groups.

This article aims to provide a description of principal aspects of policy and practice associated with orphan drugs and treatments of rare diseases, and give perspectives for 2011 on new and emerging approaches for addressing patient access.

Information has been synthesized from a wide variety of sources including the authors' experience and familiarity with this topic, having over the past ten years developed market access strategies for many orphan drugs. This is supplemented by pertinent information from conferences, meetings and articles published over the last 20 years and from policy documents released by relevant regulatory bodies.

While a small number of people suffer from any one rare disease, approximately 30 million in the EU and 25 million in the USA are affected by such diseases. Annual orphan drug treatment costs may approach $500,000. High costs coupled with relatively sparse supportive clinical data and difficulty in meeting standard cost‐effectiveness benchmarks raise significant issues for payers in allocating finite budgetary resources. Since the US (1983) and European (European Parliament, 2000) orphan drug regulations were approved, hundreds of agents have been granted orphan status although many fewer have achieved marketing authorization. Agencies have introduced a slew of incentives to help sponsors develop and market orphan medicinal products. The nature and focus of the programs are undergoing a metamorphosis as access to funding is becoming as important as supporting development.

The article represents a contemporary examination of orphan drug policy and practice, bringing together historic elements which influenced practice up to 2010 and the latest, emerging trends and approaches which stakeholders are now embracing and which will shape procedures from 2011.

This paper aims to show the particular difference Independent Mental Capacity Advocates (IMCA) can make towards specific decisions which some acquired brain injury clients, who are eligible for the IMCA service, experience.

A case study is highlighted in which the role of the IMCA is described against the background of a selective literature review on the history of advocacy in relation to its emergence as a profession. This analysis references issues of spirituality and culture.

Themes raised in the case are discussed with reference to ongoing research and these are related to the best interests of clients, and to reflexivity as a basis for the professionalisation of advocacy.

IMCA practitioners are instructed in well‐defined “best interests” situations, where an individual has no capacity, support or representation, or requires safeguarding measures in relation to certain decisions. In these cases, social, cultural, emotional, religious or spiritual factors can contribute to the decisions which need to be made.

The emerging role of the IMCA in the “best interests” process is outlined, including how health and social care professionals, or decision‐makers, may relate to, benefit from, or respond to challenges by the IMCA in supporting clients in decisions made on their behalf.

Healthcare professionals and those advocating, including IMCA, could more intentionally weigh up the values and beliefs of clients using, for example, the “best interests checklist” or by referring to “spiritual assessment”, as used increasingly by mental health ward staff and chaplains.

The aim of this paper is to contribute to a greater understanding of non-profit organization (NPO) management control systems (MCS) and accountability in organizations providing support service for capacity constrained service users. Specifically, the paper examines the role of MCS and accountability in supporting mission realization in NPOs providing services to people with intellectual disabilities and reflects on this in the context of the COVID-19 pandemic.

The research comprised a case study of four NPOs providing services to people with intellectual disabilities in Ireland conducted prior to the global COVID-19 pandemic. The study probed management's perceptions of stakeholders and examined the manner in which the design and use of MCS and accountability processes supported mission realization.

Service users were regarded as the least powerful stakeholder and consequently the least attended to in terms of MCS and accountability processes. The absence of relational and dialogical accountability with service users is not only central to maintaining this power asymmetry but also poses a threat to mission realization. These deficits can be addressed through the integration and monitoring of internal advocacy activities into MCS and accountability processes, which, on reflection, may also mitigate some of the negative consequences for service users of isolation from external support networks in times of crisis.

This research has opened up an area for enquiry – internal advocacy – heretofore not addressed in the management accounting literature, opening up a novel vein for future research. Such research could further examine the role of internal advocacy, drawing from and adding to the research in other support service domains. A number of objectives and questions might be considered: (1) probing the level of management recognition of the role of direct engagement in advocacy activities in supporting service user agency; (2) identifying with service users and management the nature and attributes of effective advocacy activities and practices; (3) questioning how such advocacy activities and practices might be reflected in MCS; (4) identifying what service user stakeholders regard as effective accountability to them in relation to their needs and objectives; and (5) assessing the impact on service user experience and on NPO mission realization of internal advocacy activities and the monitoring and review thereof through MCS. These suggestions for future research draw attention to aspects of support service delivery that have the potential to be profoundly influential on service outcomes.

A performance management model reflecting the identified need to incorporate internal advocacy mechanisms into organizational management control systems is proposed in an effort to increase accountability of NPOs to their core mission stakeholder – service users. This model may be of value to NPO management as they move from a medical-model of care to a rights-based model for service delivery in care settings.

The paper reflects the importance of listening to the voice of vulnerable service users in NPO care settings and proposes a mechanism for embedding internal advocacy in formal management control systems and accountability processes.

In proposing an “agency” supportive relational and dialogical accountability logic for such organizations, underpinned by “internal advocacy”, this research provides theoretical and practical insights for accountability processes and the design of MCS. The findings contribute empirically, not just to the NPO management and MCS literature but also to understanding the relational interaction of service users with service organizations, and what this means in supporting service user objectives and realization of organizational mission.

This paper seeks to assess the implementation of Ghana's Patients' Charter by investigating the level of awareness and knowledge of the Charter's content, some socio‐demographic factors that may influence awareness and knowledge of the Charter and how providers have discharged their responsibilities under the Charter.

A survey research approach, sampling respondents from providers and patients in four facilities from the Greater Accra region, was used. Simple frequencies and Chi‐square test were used for analysing responses.

Study findings show that the majority of patients (53.4 per cent) are not aware of the existence of the Charter of those that know about it, a sizeable minority (33.7 per cent) are not knowledgeable about its contents. Relative to patients, providers exhibit better awareness (61.8 per cent) and content knowledge (61.8 per cent) of the Patients' Charter, but on the whole are not yet carrying out their responsibilities under it. In terms of socio‐demographic factors influencing awareness and knowledge of content, only education was found to be a positive correlate of awareness and knowledge. The relationship between providers and patients is generally cordial and could be used as a platform for improving awareness and knowledge of the charter, which could be crucial for improving service delivery.

This is an initial exploratory research with a limited sample, which was biased towards the educated. Findings are, however, instructive and essential for more extensive and representative research in this area.

Since the Charter was launched in 2002, this study is the first of its kind and therefore provides important information for policy and further research.