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1 – 10 of over 6000
Article
Publication date: 1 July 2005

Gwen M. Hannah, Colin R. Dey and David M. Power

Purpose – The aim of this paper is to examine the effects of government reforms to improve the accountability of primary healthcare providers in Scotland. As a result of…

Abstract

Purpose – The aim of this paper is to examine the effects of government reforms to improve the accountability of primary healthcare providers in Scotland. As a result of the reforms, funding arrangements for GP practices changed and new financing mechanisms were introduced; this paper seeks to investigate the impact of these changes. Design/methodology/approach – The investigation is undertaken using a case study method involving a medical practice in Dundee. Interviews were conducted with staff at the practice and one researcher spent a week on site studying documentation and observing procedures. Findings – The main findings from the case study suggest that as a result of the government reforms, new funding allocation procedures for the practice better resemble a system of financial control rather than demonstrating financial accountability. GPs were more willing to engage in discussions regarding new procedures being introduced to demonstrate clinical accountability; they did not anticipate that practice accreditation or professional revalidation would alter their established practices in any way. Research limitations/implications – The main limitation of this research is that it only relates to one case study in Dundee. In addition, further government reforms in this area mean that follow up case studies are needed to see how subsequent changes have addressed the issues raised in the current research; indeed, some longitudinal studies might investigate how cumulative reforms have impacted upon GPs. Orginality/value – Nevertheless, despite these limitations, this paper does build on previous work in this area and provides a platform on which subsequent work can build.

Details

Qualitative Research in Accounting & Management, vol. 2 no. 2
Type: Research Article
ISSN: 1176-6093

Article
Publication date: 31 August 2012

Mohammad Nurunnabi and Syed Kamrul Islam

The purpose of this paper is to examine the perceived Bangladesh privatized healthcare sector accountability gap.

Abstract

Purpose

The purpose of this paper is to examine the perceived Bangladesh privatized healthcare sector accountability gap.

Design/methodology/approach

Data were collected from 533 patients using services in 45 Dhaka city privatized hospitals. A questionnaire was designed based on 60 patient focus study group and the literature.

Findings

Structural equation modeling provides a comprehensive picture that allows healthcare constructs and accountability to be tested. The goodness‐of‐fit statistics supported the four factors of professionals, administration and management, legal enforcement, ethics and government, which were significantly associated with accountability. Despite Bangladeshi privatized healthcare growth, the study revealed that accountability mainly depends on government initiatives and effectively implementing existing laws.

Research limitations/implications

The study covered one Bangladesh city (Dhaka) owing to resource constraints. Qualitative methods may have enriched the findings.

Practical implications

The accountability dimensions may be applicable to other countries to examine the perceived accountability gap. The study looked at the current Bangladesh privatized healthcare sector. Major issues of Bangladesh privatized healthcare accountability are discussed and recommendations for policymakers are suggested to improve the current circumstances.

Originality/value

The study is the first of its kind to examine accountability among privatized healthcare providers in developing countries. Patientsaccountability views require urgent attention from policy makers.

Details

International Journal of Health Care Quality Assurance, vol. 25 no. 7
Type: Research Article
ISSN: 0952-6862

Keywords

Article
Publication date: 25 May 2012

Thomas Andersson and Roy Liff

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

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Abstract

Purpose

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

Design/methodology/approach

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.

Findings

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.

Practical implications

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

Originality/value

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.

Details

International Journal of Public Sector Management, vol. 25 no. 4
Type: Research Article
ISSN: 0951-3558

Keywords

Article
Publication date: 4 November 2014

Faleh Alshameri, Debra Hockenberry and Robert B. Doll

This paper aims to, by looking at the electronic medical record (EMR) from three points of view, bring light to the dynamics that are essential and are currently missing…

Abstract

Purpose

This paper aims to, by looking at the electronic medical record (EMR) from three points of view, bring light to the dynamics that are essential and are currently missing in the USA. The traditional paper medical record has worked for physicians, management and patients since the beginning of practice. Yet the development of the EMR did not begin with all the essential elements of the traditional record that were working, but instead shreds out important aspects of the patient.

Design/methodology/approach

Triangulation between three studies – medical, information technology and management studies.

Findings

An efficient EMR has to take into consideration more than just one area of study. The dynamics between departments and users of the EMR need an integrated process that includes the necessary pieces of all involved. This hole has not been addressed in academic literature.

Research limitations/implications

The paper triangulates three areas – medicine, management and information management. Most research on the EMR focuses only on one or two of these areas’ concerns. Looking at the three sides of the EMR is important to get a solid understanding of the dynamics that can occur relaying a patient’s story through various departments and uses.

Practical implications

There is a depth, space and volume crucial to the comprehensive nature of medicine. With a perspective or dimension, necessary dialogues can be addressed and more intuitive tacit knowledge from medical expertise can be made available. A prototype, filling the holes of the observed elements in this paper, is possible by using digital objects and including more information than the data of the day. Bringing accountability to the patient, more expertise to the fingertips of the physician and available data for management purposes area are the key ingredients for an effective EMR.

Social implications

With a comprehensive EMR that works more effectively for those who input the data, the patient’s story can be documented with more detailed efficiency. Filling the holes of the observed elements in this paper all support better healthcare and long-term results for the health of society.

Originality/value

The paper triangulates three areas – medicine, management and information management. Most research on the EMR focuses only on one or two of these areas’ concerns. Looking at the three sides of the EMR is important to get a solid understanding of the dynamics that can occur relaying a patient’s story through various departments and uses.

Details

VINE: The journal of information and knowledge management systems, vol. 44 no. 4
Type: Research Article
ISSN: 0305-5728

Keywords

Book part
Publication date: 13 October 2008

Jesse D. Schold

Report cards, performance evaluations, and quality assessments continue to penetrate the lexicon of the healthcare sector. The value of report cards is typically couched…

Abstract

Report cards, performance evaluations, and quality assessments continue to penetrate the lexicon of the healthcare sector. The value of report cards is typically couched as enhancing consumerism among patients, increasing accountability among healthcare providers, and more broadly increasing the transparency of healthcare information. This paper discusses the potential benefits and pitfalls of these performance assessments.

This paper briefly reviews empirical evidence regarding the impact of report cards for healthcare providers and synthesizes the role and limitations of these performance measures into distinct evaluation criteria. The rapid proliferation of report cards for healthcare providers suggests a growing need to develop mechanisms and tools to evaluate their impact. The risks associated with utilizing report cards for provider oversight include the deleterious impact on vulnerable populations and a failure to accurately measure quality of care. The capacity to create report cards should not be the sole criterion to develop and utilize report cards to evaluate healthcare providers. Rather, careful consideration of the benefits and risks should accompany the implementation and utilization of report cards into regulatory processes. This report proposes an evaluation checklist by which to assess the role of report cards in a given healthcare context.

Details

Beyond Health Insurance: Public Policy to Improve Health
Type: Book
ISBN: 978-1-84855-181-7

Article
Publication date: 20 March 2009

Roslyn Sorensen and Rick Iedema

This paper aims to understand the impact of emotional labour in specific health care settings and its potential effect on patient care.

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Abstract

Purpose

This paper aims to understand the impact of emotional labour in specific health care settings and its potential effect on patient care.

Design/methodology/approach

Multi‐method qualitative ethnographic study undertaken in a large ICU in Sydney, Australia using observations from patient case studies, ward rounds and family conferences, open ended interviews with medical and nursing clinicians and managers and focus groups with nurses.

Findings

Clinician attitudes to death and dying and clinicians' capacity to engage with the human needs of patients influenced how emotional labour was experienced. Negative effects were not formally acknowledged in clinical workplaces and institutional mechanisms to support clinicians did not exist.

Research limitations/implications

The potential effects of clinician attitudes on performance are hypothesised from clinician‐reported data; no evaluation was undertaken of patient care.

Practical implications

Health service providers must openly acknowledge the effect of emotional labour on the care of dying people. By sharing their experiences, multidisciplinary clinicians become aware of the personal, professional and organisational impact of emotional labour as a core element of health care so as to explicitly and practically respond to it.

Originality/value

The effect of care on clinicians, particularly care of dying people, not only affects the wellbeing of clinicians themselves, but also the quality of care that patients receive. The affective aspect of clinical work must be factored in as an essential element of quality and quality improvement.

Details

Journal of Health Organization and Management, vol. 23 no. 1
Type: Research Article
ISSN: 1477-7266

Keywords

Book part
Publication date: 23 October 2003

Erica S Breslau

The sequence of stress, distress and somatization has occupied much of the late twentieth-century psychological research. The anatomy of stress can be viewed from…

Abstract

The sequence of stress, distress and somatization has occupied much of the late twentieth-century psychological research. The anatomy of stress can be viewed from interactional and hybrid theories that suggest that the individual relates with the surroundings by buffering the harmful effects of stressors. These acts or reactions are called coping strategies and are designed as protection from the stressors and adaptation to them. Failure to successfully adapt to stressors results in psychological distress. In some individuals, elevated levels of distress and failed coping are expressed in physical symptoms, rather than through feelings, words, or actions. Such “somatization” defends against the awareness of the psychological distress, as demonstrated in the psychosocial literature. The progression of behavior resulting from somatic distress moves from a private domain into the public arena, involving an elaborate medicalization process, is however less clear in sociological discourse. The invocation of a medical diagnosis to communicate physical discomfort by way of repeated use of health care services poses a major medical, social and economic problem. The goal of this paper is to clarify this connection by investigating the relevant literature in the area of women with breast cancer. This manuscript focuses on the relationship of psychological stress, the stress response of distress, and the preoccupation with one’s body, and proposes a new theoretical construct.

Details

Gender Perspectives on Health and Medicine
Type: Book
ISBN: 978-1-84950-239-9

Article
Publication date: 1 April 2003

Zoe Radnor and Bill Lovell

Even though the balanced scorecard (BSC) has become a highly popular performance management tool, usage in local public sector National Health Service (NHS) organisations…

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Abstract

Even though the balanced scorecard (BSC) has become a highly popular performance management tool, usage in local public sector National Health Service (NHS) organisations is still rare. This paper conditionally outlines some grounds in supporting such usage. In particular underlying conceptual concerns with the BSC system and its implementation pitfalls require full consideration. This paper then outlines some factors to be taken into account for “successful” BSC implementation in a NHS multi‐agency setting. These findings emerged from a series of focus groups that took place with contributors drawn from all the key organisations within the Bradford Health Action Zone. Finally, this paper argues that if key criteria are met, successful implementation of the BSC may then proceed. However, “blind” BSC implementation without consideration of these factors may result in potential “failure”.

Details

International Journal of Health Care Quality Assurance, vol. 16 no. 2
Type: Research Article
ISSN: 0952-6862

Keywords

Article
Publication date: 11 September 2007

Alison Baker

The purpose of this paper is to consider the issues which emerge when an autonomous, professional, member‐led organisation attempts to demonstrate its accountability to…

690

Abstract

Purpose

The purpose of this paper is to consider the issues which emerge when an autonomous, professional, member‐led organisation attempts to demonstrate its accountability to patients through lay involvement in its standard‐setting processes.

Design/methodology/approach

The paper reports a project, which is still in progress and could be described as action research. Data were collected through participant observation in a series of discussions and working groups. A limited literature search was carried out at the start of the initiative but found little which relates to lay involvement in professional bodies.

Findings

The paper finds that patient involvement in a professional body is unlikely by itself to be a useful mechanism for delivering greater professional accountability.

Research limitations/implications

The paper is a single case study and can only suggest hypotheses for further research.

Practical implications

The paper shows that professional bodies of various types are increasingly being asked to demonstrate public involvement in their decision making. It is important to identify the most effective mechanisms for this and the limitations inherent in the structures of organisations, which are accountable primarily to their members.

Originality/value

The paper shows that individual doctors are held to account through a number of mechanisms, but little attention has been given to how medical professional bodies can be made more accountable for the collective power they hold. Patient involvement is interpreted within a consumerist model, which focuses on the doctor‐patient relationship and ignores the considerable strategic influence which medical royal colleges exercise within the health service.

Details

Journal of Health Organization and Management, vol. 21 no. 4/5
Type: Research Article
ISSN: 1477-7266

Keywords

Book part
Publication date: 19 August 2017

Farah Nabi, Stephen Gallay, Erik Hellsten, Joel Lobo and Jesse Slade Shantz

The Canadian healthcare system is recognized as one of the best health systems in the world. However, recent social and economic conditions have placed significant…

Abstract

The Canadian healthcare system is recognized as one of the best health systems in the world. However, recent social and economic conditions have placed significant pressure on system administrators to demonstrate value-for-money for the investments made with an increased scrutiny on service delivery and cost structures. Challenges in providing more efficient healthcare often resonate two key constraints: the shortage of overall funding and barriers to accessing appropriate service providers in a timely fashion. The most common solution is simply to increase service provider manpower and invest further financial resources.

In Ontario, Canada’s largest province, The Shoulder Centre (TSC) has introduced a transformative solution to address system constraints through the development of an innovative and comprehensive model of care which builds on (1) novel partnerships between community providers and the Centre’s clinical team, (2) A Patient-Centered Specialty Practice (PCSP) and (3) Leveraging technology solutions.

TSC’s model of care suggests that many challenges in healthcare are attributed to the inappropriate management of human capital and the under-development of social capital. As a solution, TSC has transformed the organizational structure of its health services by converting service providers into partners with shared accountabilities, resulting in economic value through human capital optimization and improved system efficiencies through the building of social capital. TSC’s performance results demonstrate measured system savings, increased patient and provider satisfaction, targeted knowledge growth and confirms that the healthcare system contains a greater than expected abundance of human and financial resources to provide access to appropriate and timely care without any further system investment.

Details

Human Capital and Assets in the Networked World
Type: Book
ISBN: 978-1-78714-828-4

Keywords

1 – 10 of over 6000