Search results

The application of pervasive systems to healthcare has increased in recent years, but resistance to such systems by patients remains high. In this study, the aim is to examine patient and caregiver perceptions of this technology to further develop an understanding of the benefits and functionalities that prospective patients deem as desirable, undesirable, inadequate or in need of further development. The study was conducted as part of the European Union BraveHealth project which is developing a patient‐centred pervasive healthcare system to support cardiac patients at home in everyday life using innovative monitoring and diagnosis, thereby enabling the patient to be more proactive in health management.

Focus group studies were conducted in Italy and the Midlands area of the UK, along with a 31‐item questionnaire. The findings were categorized under seven main headings: personal profile; benefits; adoption; acceptance; risks; security, privacy and trust; and (use of) cell phone.

In the focus group study, most participants felt that there is a great future for this technology and showed positive response to the potential benefits but there are concerns over reliability, security, privacy and trust.

Even though this study constitutes only a small group of participants, the Italian and UK study does represent similar patients' and caregivers perceptions towards at‐home healthcare systems.

This paper contributes to the understanding of the benefits and functionalities that prospective patients and care‐givers deem as either desirable or undesirable.

The purpose of this paper is two-fold. First, it sets the context for the special issue by considering conceptions of patients and their roles in service delivery and improvement. Second, it introduces the contributions to the special issue, and identifies thematic resonance.

The paper utilises a literature synthesis and thematic analysis of the special issue submissions. These emanated from the Ninth International Organisational Behaviour in Healthcare Conference, hosted by Copenhagen Business School on behalf of the Learned Society for Studies in Organizing Healthcare.

The articles evidence a range of perspectives on patients’ roles in healthcare. These range from their being subject to, a mobilising focus for, and active participants in service delivery and improvement. Building upon the potential patient roles identified, this editorial develops five “ideal type” patient positions in healthcare delivery and improvement. These recognise that patients’ engagement with health care services is influenced both by personal characteristics and circumstances, which affect patients’ openness to engaging with health services, as well as the opportunities afforded to patients to engage, by organisations and their employees.

The paper explores the relationally embedded nature of patient involvement in healthcare, inherent in the interdependence between patient and providers’ roles. The typology aims to prompt discussion regarding the conceptualisation patients’ roles in healthcare organisations, and the individual, employee, organisational and contextual factors that may help and hinder their involvement in service delivery and improvement. The authors close by noting four areas meriting further research attention, and potentially useful theoretical lenses.

This paper aims to explore patients' satisfaction with access to treatment in both the public and private healthcare sectors in London.

Qualitative and quantitative methods were employed to determine patients' levels of satisfaction. A semi‐structured face ‐to‐face non‐probability quota sampling and a probability sample drawn from multistage cluster sampling methods were employed.

The results revealed varying access experiences among public and private care users. Public, as opposed to private, healthcare users experience unsatisfactory outcomes in relation to service climate factors (e.g. getting attention from doctors, time taken to get appointments, access to core treatment and opening hours). Overall, while women are more disadvantaged by spatial accessibility to treatment than men, both public and private healthcare users indicate major problems in accessing healthcare despite the myriad intervention strategies aimed at ameliorating the situation in both sectors. Therefore, access‐to‐care problems are significant and need to be addressed by managers and healthcare providers in order to improve the quality of service delivery and patient satisfaction. Private care users fare better than public users in obtaining medical care at short notice, having more agreeable opening hours for treatment and getting appointments for treatment with less difficulty.

Whereas the limitation of the study was due to its small sample size, it nevertheless will stimulate insight into further academic endeavours.

Academics and practitioners will find the results very useful when making decisions about healthcare provisions and how they can best meet user/patient satisfaction.

This study is significant in drawing on the current literature on satisfaction which is usefully applied to evaluate patients' response to the quality management initiatives in the healthcare sector.

Taking the physician sourced observation that “wasting time is always more expensive than saving it” leads naturally to the conclusion that effective and efficient patient‐centred healthcare delivery systems are highly desirable targets for the National Health Service (NHS) and similar providers. But has “joined up healthcare” even been achieved, and if so, how? What procedures must be in place to maximise the chances of its occurrence? This paper aims to investigate these issues.

This paper answers these questions experientially via “Insider Action Research” projects plus careful critique of published case studies.

Recurring themes for effective improvement of healthcare delivery organisations emerge in the paper, as do identification of the inevitable barriers to change.

The paper takes stock of NHS service developments in a broader theoretical light.

It is essential that healthcare leaders and managers recognise the importance of values; how they relate to the delivery of healthcare to patients as well as shape individual, professional and organisational practice. This paper attempts to address these issues.

The paper considers the concepts of values, managerialism and leadership in the present climate of rapid change, financial austerity, quality improvement and the drive towards patient‐centred care. It discusses a number of values‐based academic and professional standards, models and policy‐drivers to inform effective leadership and management for the improvement of healthcare delivery.

Shared values, when underpinned by an emphasis on patient care, can empower relationships between professions, providers and commissioners and advance discussions about priorities beyond a focus on morals and politics towards issues of shared goals and strategy implementation.

This paper bridges the gap between theory and practice and will appeal to leaders and managers irrespective of background or seniority. It offers a clear review of key issues, theories and practice skills which support effective values‐based leadership and management in healthcare settings.

Lean Six Sigma in public and private healthcare organisations has received considerable attention over the last decade. Nevertheless, such process improvement methodologies are not generalizable, and their effective implementation relies on contextual variables. The purpose of this study is to explore the readiness of Italian hospitals for Lean Six Sigma and Quality Performance Improvement (LSS&QPI), with a focus on gender differences.

A survey comprising 441 healthcare professionals from public and private hospitals was conducted. Multivariate analysis of variance was used to determine the mean scores on the LSS&QPI dimensions based on hospital type, gender and their interaction.

The results showed that public healthcare professional are more aware of quality performance improvement initiatives than private healthcare professionals. Moreover, gender differences emerged according to the type of hospital, with higher awareness for men than women in public hospitals, whereas for private hospitals the opposite was true.

This study contributes to the Lean Six Sigma literature by focusing on the holistic assessment of LSS&QPI implementation.

This study informs healthcare managers about the revolution within healthcare organisations, especially public ones. Healthcare managers should spend time understanding Lean Six Sigma as a strategic orientation to promote the “lean hospital”, improving processes and fostering patient-centredness.

This is a preliminary study focussing on analysing inter-relationship between perceived importance of soft readiness factors such as gender dynamics as a missing jigsaw in the current literature. In addition, the research advances a holistic assessment of LSS&QPI, which sets it apart from the studies on single initiatives that have been documented to date.

The purpose of this paper is to explore how the use of self‐help bibliotherapy developed from a local pilot scheme to become national policy in Wales. Analysis aims to focus on the use of evidence‐based practice (EBP) as a justification in the process of policy creation.

A mixed methodological approach was used to gather data, incorporating semi‐structured interviews, documents, and descriptive statistics. Actor‐network theory (ANT) was used as a critical lens to frame analysis.

The study finds that the translation from local pilot to national initiative was achieved using legitimising discourses including EBP. These discourses were used selectively, and in response to the needs of the focal actors in the network. The complex relationship between EBP and self‐help bibliotherapy is explored in connection with healthcare policy, concluding that the use of EBP legitimises a lack of patient‐centred evaluation.

Limitations of the research include a lack of engagement with patients using the scheme, and future research should aim to present a more patient‐centred account to complement this policy‐focused work.

Little in‐depth work has been conducted on the strategy behind the introduction of bibliotherapy schemes in the UK or elsewhere, and this paper presents an in‐depth theoretical analysis of the first nationwide bibliotherapy scheme in the world.

Using a complexity-informed approach, we aim to understand why introduction of a mobile service delivery model for osteoporosis across diverse organisational and country contexts in the UK National Health Service (NHS) met with variable success.

Six comparative case studies; three prospectively in Scotland using an action research-informed approach; and three retrospectively in England with variable degrees of success. The Non-adoption, Abandonment, Scale-up, Spread and Sustainability framework explored interactions between multi-level contextual factors and their influence on efforts to introduce and sustain services.

Cross-boundary service development was a continuous process of adaptation and evolution in rapidly shifting healthcare context. Whilst the outer healthcare policy context differed significantly across cases, inner contextual features predominated in shaping the success or otherwise of service innovations. Technical and logistical issues, organisational resources, patient and staff actions combined in unpredictable ways to shape the lifecycle of service change. Patient and staff thoughts about place and access to services actively shaped service development. The use of tacit “soft intelligence” and a sense of “chronic unease” emerged as important in successfully navigating around awkward people and places.

“Chronic unease” and “soft intelligence” can be used to help individuals and organisations “tame” complexity, identify hidden threats and opportunities to achieving change in a particular context, and anticipate how these may change over time. Understanding how patients think and feel about where, when and how care is delivered provides unique insights into previously unseen aspects of context, and can usefully inform development and sustainability of patient-centred healthcare services.

This study has uniquely traced the fortunes of a single service innovation across diverse organisational and country contexts. Novel application of the NASSS framework enabled comparative analysis across real-time service change and historical failures. This study also adds to theories of context and complexity by surfacing the neglected role of patients in shaping healthcare context.

In Canada, integrated care pilot projects are often implemented as a local reform strategy to improve the quality of patient care and system efficiencies. In the qualitative study reported here, the authors explored the experiences of healthcare professionals when first implementing integrated care pilot projects, bringing together physical and mental health services, in a community hospital setting.

Engaging a qualitative descriptive study design, semi-structured interviews were conducted with 24 healthcare professionals who discussed their experiences with implementing three integrated care pilot projects one year following project launch. The thematic analysis captured early implementation issues and was informed by an institutional logics framework.

Three themes highlight disruptions to established logics reported by healthcare professionals during the early implementation phase: (1) integrated care practices increased workload and impacted clinical workflows; (2) integrating mental and physical health services altered patient and healthcare provider relationships; and (3) the introduction of integrated care practices disrupted healthcare team relations.

Study findings highlight the importance of considering existing logics in healthcare settings when planning integrated care initiatives. While integrated care pilot projects can contribute to organizational, team and individual practice changes, the priorities of healthcare stakeholders, relational work required and limited project resources can create significant implementation barriers.