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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.

Workplace voice is well-established and encompasses behaviors such as prosocial voice, informal complaints, grievance filing, and whistleblowing, and it focuses on interactions between the employee and supervisor or the employee and the organizational collective. In contrast, our chapter focuses on employee prosocial advocacy voice (PAV), which the authors define as prosocial voice behaviors aimed at preventing harm or promoting constructive changes by advocating on behalf of others. In the context of a healthcare organization, low quality and unsafe patient care are salient and objectionable states in which voice can motivate actions on behalf of the patient to improve information exchanges, governance, and outreach activities for safer outcomes. The authors draw from the theory and research on responsibility to intersect with theories on information processing, accountability, and stakeholders that operate through voice between the employee-patient, employee-coworker, and employee-profession, respectively, to propose a model of PAV in patient-centered healthcare. The authors complete the model by suggesting intervening influences and barriers to PAV that may affect patient-centered outcomes.

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.

This chapter discusses challenges faced by older adult health-care consumers in obtaining access to responsive care from physicians relevant to a broad spectrum of health issues ranging from prevention to chronic illness and end-of-life care. Based on our prior research with community-dwelling elders (E. Kahana & B. Kahana, 2003, 2010), we propose a conceptual model of consumer self-advocacy for better access to effective health care in late life. We argue that older adults who are well informed and confident health-care partners and who involve their physicians in active dialogue will experience better care, and will be more satisfied with their health care. We present findings from our studies of cancer prevention and from our research focused on end-of-life care relevant to patient self-advocacy. We also discuss the role of educational interventions and of patient empowerment in facilitating greater access to responsive health communication and health care, particularly among elders who are disadvantaged and who have low health literacy.

The problems of providing high-quality care in nursing homes have been extensively documented. Accounts of residents, close family members, and qualitative researchers have described feelings of desperation, anomie, and hopelessness, which accompany the last years, months and days of those reluctantly finding themselves in institutional facilities at the end of their days. However sociologists have, thus far, paid little attention to the actual and potential impact of families in breaking through the barriers set up by institutional life and in enhancing the responsiveness of care in nursing homes. This chapter aims to fill this gap.

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 chapter explores the nuances of anger in the workplace by elucidating the different forms of anger (personal and moral) experienced amongst NHS nurses in the United Kingdom. To do so, I draw upon the Dual Threshold Model of anger as the theoretical lens and employ Interpretive Phenomenological Analysis as the methodological approach. It was found that the behavioural response to particular anger-triggering events differed depending on whether the situation was ‘self-relevant’ or ‘other-relevant’, therefore personal and moral anger, respectively. The findings therefore suggest distinct appraisal pathways and forms of anger, and provide empirical support for a recent re-conceptualisation of moral anger.

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.