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Healthcare delivery faces increasing pressure to move from a provider-centered approach to become more consumer-driven and patient-centered. However, many of the actions taken by clinicians, patients and organizations fail to achieve that aim. This paper aims to take a paradox-based perspective to explore five specific tensions that emerge from this shift and provides implications for patient experience research and practice.

This paper uses a conceptual approach that synthesizes literature in health services and administration, organizational behavior, services marketing and management and service operations to illuminate five patient experience tensions and explore mitigation strategies.

The paper makes three key contributions. First, it identifies five tensions that result from the shift to more patient-centered care: patient focus vs employee focus, provider incentives vs provider motivations, care customization vs standardization, patient workload vs organizational workload and service recovery vs organizational risk. Second, it highlights multiple theories that provide insight into the existence of the tensions and how they may be navigated. Third, specific organizational practices that engage the tensions and associated examples of leading organizations are identified. Relevant measures for research and practice are also suggested.

The authors develop a novel analysis of five persistent tensions facing healthcare organizations as a result of a shift to a more consumer-driven, patient-centered approach to care. The authors detail each tension, discuss an existing theory from organizational behavior or services marketing that helps make sense of the tension, suggest potential solutions for managing or resolving the tension and provide representative case illustrations and useful measures.

The purpose of this paper is to understand the degree to which a quality and safety culture exists after healthcare workers in an academic medical center complete a quality improvement and patient safety education program focused on developing leaders to change the future of healthcare quality and safety.

The safety attitudes questionnaire (SAQ) short-form was used for measuring the culture of quality and safety among healthcare workers who were graduates of an academic medical center’s healthcare quality and safety program. A 53 percent response rate from program alumni resulted in 54 usable responses.

This study found that 42 (78 percent) of the respondents report that they are currently working in a healthcare quality and safety culture, with 25 (59 percent) reporting promotion into a leadership role after completion of the quality improvement education program. This compares favorably to AHRQ culture of safety survey results obtained by the same academic medical center within the year prior revealing only 63 percent of all inpatient employees surveyed reported working in a quality and safety culture.

The study design precluded knowing to what degree a quality and safety culture, as measured by the SAQ, existed prior to attending the healthcare quality and safety program.

This study has practical value for other organizations considering a quality and safety education program. For organizations seeking to build capacity in quality and safety, training future leaders through a robust curriculum is essential. This may be achieved through development of an internal training program or through attending an outside organization for education.

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.

Between 2012 and 2016, the Government of Canada modified health insurance for refugees and asylum seekers. In Quebec, this resulted in refusals of care and uncertainties about publicly reimbursed services, despite guaranteed coverage for people with this status under the provincial plan. The Chronic Viral Illness Service (CVIS) at the McGill University Health Centre in Montreal continued to provide care to refugees and asylum seekers living with HIV. The purpose of this paper is to explain how and why challenges brought by this policy change could be overcome.

A qualitative case study was conducted using interviews with patients and staff members, observation sessions and a review of media, documents and articles. A discussion group validated the interpretation of preliminary results.

The CVIS provides patient-centered care through a multidisciplinary team. It collectively responds to medical, social and legal issues specific to refugees. Its organizational culture and expertise explain the sustained provision of care. The team’s empathetic view of patients, anchored in the service’s history, care for men who have sex with men and commitment to human rights, is key. A culture of care developed over time thanks to the commitment of exemplary figures. Because they countered the team’s values, changes in refugee healthcare coverage strengthened the service’s culture of care. However, the healthcare system reform launched in 2014 in Quebec is perceived as jeopardizing the culture of care, as it makes, refugee and asylum-seeker patients a non-lucrative venture for providers.

This research analyzes the origin of sustained provision of care to refugees and asylum seekers living with HIV through the lens of culture of care. It considers the historical and political contexts in which this culture developed.

This paper considers the question: what would happen if healthcare providers, like their counterparts in the hospitality industry, adopted the principles of customer experience management (CEM) in order to facilitate a more holistic and personalized patient experience? It proposes an alternative vision of the patient experience by adding to an emerging hospitality–healthcare literature base, this time focusing upon CEM. A hospitality-oriented patient experience (HOPE) framework is introduced, designed to enhance the patient experience across all the touchpoints of the healthcare journey.

This is a conceptual paper that draws upon three distinct literatures: hospitality literature; healthcare literature; and CEM literature. It utilizes this literature to develop a framework, the HOPE framework, designed to offer an alternative lens to understanding the patient experience. The paper utilizes descriptions of three unique patient experiences, one linked to chronic pain, a second to gastro issues and a third to orthopedic issues, to illustrate how adopting the principles of hospitality management, within a healthcare context, could promote an enhanced patient experience.

The main theoretical contribution is the development of the HOPE framework that brings together research on CEM with research on cocreative customer practices in health care. By selecting and connecting key ingredients of two separate research streams, this vision and paradigm provide an alternative lens into ways of addressing the key challenges in the implementation of person-centered care in healthcare services. The HOPE framework offers an actionable roadmap for healthcare organizations to realize greater understanding and to operationalize new ways of improving the patient experience.

This paper applies the principles of hospitality and CEM to the domain of health care. In so doing it adds value to a hospitality literature primarily focused upon extensive employee–customer relationships. To a healthcare literature seeking to more fully understand a person-centered care model typically delivered by a care team consisting of professionals and family/friends. And to a CEM literature in hospitality, which seeks to facilitate favorable employee–customer interactions. Connecting these separate literature streams enables an original conceptual framework, a HOPE framework, to be introduced.

High-quality nursing home (NH) care has long been a challenge within the United States. For decades, policymakers at the state and federal levels have adopted and implemented regulations to target critical components of NH care outcomes. Simultaneously, our delivery system continues to change the role of NHs in patient care. For example, more acute patients are cared for in NHs, and the Center for Medicare and Medicaid Services (CMS) has implemented value payment programs targeting NH settings. As a part of these growing pressures from the broader healthcare delivery system, the culture-change movement has emerged among NHs over the past two decades, prompting NHs to embody more person-centered care as well as promote settings which resemble someone's home, as opposed to institutionalized healthcare settings.

Researchers have linked culture change to high-quality outcomes and the ability to adapt and respond to the ever-changing pressures brought on by changes in our regulatory and delivery system. Making enduring culture change within organizations has long been a challenge and focus in NHs. Despite research suggesting that culture-change initiatives that promote greater resident-centered care are associated with several desirable patient outcomes, their adoption and implementation by NHs are resource intensive, and research has shown that NHs with high percentages of low-income residents are especially challenged to adopt these initiatives.

This chapter takes a novel approach to examine factors that impact the adoption of culture-change initiatives by assessing knowledge management and the role of knowledge management activities in promoting the adoption of innovative care delivery models among under-resourced NHs throughout the United States. Using primary data from a survey of NH administrators, we conducted logistic regression models to assess the relationship between knowledge management and the adoption of a culture-change initiative as well as whether these relationships were moderated by leadership and staffing stability. Our study found that NHs were more likely to adopt a culture-change initiative when they had more robust knowledge management activities. Moreover, knowledge management activities were particularly effective at promoting adoption in NHs that struggle with leadership and nursing staff instability. Our findings support the notion that knowledge management activities can help NHs acquire and mobilize informational resources to support the adoption of care delivery innovations, thus highlighting opportunities to more effectively target efforts to stimulate the adoption and spread of these initiatives.

This paper examines the relationship between human resource practices in 173 hospitals in the United Kingdom and four organizational outcome categories – clinical, financial, employee attitudes and perceptions, and patient attitudes and perceptions. The overarching proposition set forth and examined in this paper is that human resource management (HRM) practices and delivery of care practices have varied effects on each of these outcomes. More specifically, the authors set forth the proposition that specific practices will have positive effects on one outcome category while simultaneously having a negative effect on other performance outcomes, broadly defined.

The paper introduces a broader stakeholder framework for assessing the HR–performance relationship in the healthcare setting. This multi-dimensional framework incorporates the effects of human resource practices on customers (patients), management, and frontline staff and can also be applied to other sectors such as manufacturing. This approach acknowledges the potential for incompatibilities between stakeholder performance objectives. In the healthcare industry specifically, our framework broadens the notion of performance.

Overall, our results provide support for the proposition that different stakeholders will be affected differently by the use of managerial practices. We believe that the findings reported in this paper highlight the importance of examining multiple stakeholder outcomes associated with managerial practices and the need to identify the inherent trade-offs associated with their adoption.

The healthcare system in the USA is undergoing unprecedented change and its share of unintended consequences. This paper explores the leadership role of the physician in transforming the present culture of healthcare to restore, refine and preserve its traditional care components.

The literature on change, organizational culture and leadership is leveraged to describe the structural interdependencies and dynamic complexity of the present healthcare system and to suggest how physicians can strengthen the care components of the healthcare culture.

When an organization’s culture does not support internal integration and external adaptation, it is the responsibility of leadership to transform it. Leaders can influence culture to strengthen the care components of the healthcare system. The centrality of professionalism in the delivery of patient services places a moral, societal and ethical responsibility on physicians to lead a revitalization of the care culture.

This paper focuses on cultural issues in healthcare and provides options and guidance for physicians as they attempt to lead and manage the context in which services are delivered.

The Competing Values Framework, the major interdependent domains and five principal mechanisms for leaders to embed and fine tune culture serve as the main tenets for describing the ongoing changes in healthcare and defining the role of the physician as leaders and advocates for the Patient Care Culture.

This paper explores how service design can contribute to the evolution of health service systems, moving them toward people-centered, integrated and technology-enabled care; the paper develops a research agenda to leverage service design research for healthcare transformation.

This conceptual study starts by analyzing healthcare challenges in terms of demographic trends and economic constraints, along with the problems of lack of people-centricity, dispersion of care and slowness in incorporating emerging technologies. Then, it examines the theoretical underpinnings of service design to develop a framework for exploring how a human-centered, transformative and service systems approach can contribute to addressing healthcare challenges, with illustrative cases of service design research in healthcare being given.

The proposed framework explores how a human-centered service design approach can leverage the potential of technology and advance healthcare systems toward people-centered care; how a transformative service design approach can go beyond explanatory research of healthcare phenomena to develop innovative solutions for healthcare change and wellbeing; and how a service systems perspective can address the complexity of healthcare systems, hence moving toward integrated care.

This paper systematizes and develops a framework for how service design can contribute to healthcare transformation. It identifies key healthcare application areas for future service design research and pathways for advancing service design in healthcare by using new interdisciplinary bridges, methodological developments and theoretical foundations.

The purpose of this paper is to describe the processes and results of implementing and evaluating the Releasing Time to Care™ (RTC™) model in a 45‐bed Neurosciences unit in a tertiary care hospital in Saskatchewan province of western Canada.

Organizational restructuring in healthcare systems has impacted the ability of clinical registered nurses (CRNs) in participation and in influencing the decision making that affect the delivery and outcomes of patient‐centered care. At the same time, CRNs' work has intensified because of increases in patient acuity, technological advances, complexity of care provided to patient families and communities, in addition to the intensifying demands put on by an aging population and dwindling resources. The work reported in this paper shows that significant improvements have been made based on the current needs and the change is forever imminent. Establishing solid people connections and networking opportunities proved valuable for current and future exchange of information and knowledge translation.

Model implementation resulted in positive narrative and empirical data including: improved patient safety, staff engagement, leadership opportunities and an affirmative shift in organizational culture. Improved patient safety was evidenced by a reduction in falls and decreased medication errors.

The paper focuses on including the clinical nurse in organizational and system change towards improving patient‐centered quality care. Neurosciences 6300 at Royal University Hospital (RUH) in Saskatoon, was viewed as an RTC™ champion and one of the first to implement and complete the 11‐module toolkit.