Search results

To explore the mechanisms of the implementation strategy, “oilcloth sessions” and understand and explain the ripple effects of oilcloth sessions as a strategy to implement a new emergency department.

A qualitative design was used whereby data were collected using field notes from an ethnographic study of the oilcloth sessions and follow-up semi-structured interviews with staff, managers and key employees who participated in the oilcloth sessions. The data analysis was inspired by the realist evaluation approach of generative causality proposed by Pawson and Tilley.

The primary ripple effect was that the oilcloth sessions were used for different purposes than the proposed program theory, including being used as: (1) a stage, (2) a battlefield, (3) a space for imagination and (4) a strategic management tool influencing the implementation outcomes. The results bring essential knowledge that may help to explain why and how a well-defined implementation strategy has unplanned outcomes.

Unintended outcomes of implementation strategies are an underexplored issue. This study may help implementation researchers rethink the activities required to reduce unintended negative outcomes or explore potential unplanned outcomes and, in this way, hinder or enhance outcomes, effectiveness and sustainability. Future studies within implementation research should incorporate attention to unintended outcomes to fully understand the impact of implementation strategies.

Humane Entrepreneurship (HumEnt) is strongly purpose-oriented and characterized by a focus on inclusiveness and social and environmental sustainability, with attention to both internal and external stakeholders and their needs. In the attempt to provide new research in this field, this study aims to conduct an empirical investigation within the theory of HumEnt and, in particular, of the Human Resource Orientation (HRO) model among Italian Small and Medium-size Enterprises.

Based on quantitative data, this study used a deductive approach to investigate the relationship between the HumEnt model and firms’ relational embeddedness with different types of stakeholders (value chain stakeholders and societal stakeholders, respectively). More concretely, to investigate the relationships between the dimensions of the HumEnt model and firms’ relational embeddedness, partial least squares structural equation modeling was applied.

Findings of this study suggest that Entrepreneurial Orientation (EO) directly contributes only to value chain embeddedness. However, the results also show that if EO is mediated by an HRO (i.e. companies with a high HRO), a high level of societal embeddedness is also present.

This study represents a first attempt to provide comprehensive empirical evidence about the different dimensions characterizing the HumEnt theoretical model, and to highlight their relevance in supporting companies’ relational embeddedness capacity with different categories of stakeholders.

This article aims to clarify the concepts used to understand, analyze and improve a patient’s progress through a health service system. A patient pathway describes plans and intentions. Within it, we distinguish between the clinical pathway of decisions and interventions and the care pathway of supportive activities. As a patient pathway is implemented, it turns into a patient journey of what is done, what happens to a patient’s medical condition and what is experienced and felt. We introduce “patient journey disruption” (PJD) as a concept describing the events that need to be prevented from happening to accomplish integrated, coordinated and seamless care.

The method used in this paper is concept analysis. First, an expert steering group worked to refine the concept of PJDs; second, an analysis of similar concepts from related fields was done to root the concept into existing theories, and third, semi-structured interviews with professionals and patients were done to test the concept of PJDs in the home care context.

PJDs are agency-based harmful events in the execution of the care pathway that deviate the patient journey from what can be reasonably expected. PJDs are management failures, which is why they should be studied by healthcare operations management (HOM) and service science scholars with the intention to find ways to prevent them from happening.

This study has limitations, including presenting conceptual ideas and preliminary results that are only indicative.

We believe that the introduction of the concept of PJDs into the literature provides a new, systematic way of approaching the different shortcomings in our healthcare production systems. Moreover, by systematically identifying different PJDs, interventions can be designed and targeted more appropriately.

Managerial challenges regarding healthcare processes have been studied but have not been well defined. The concept of PJDs is an original, well-thought-out definition.

Ageing is associated with multi-morbidity, polypharmacy and medication-related harm (MRH). There is limited published literature on MRH in older Egyptian adults. This study aims to determine the incidence and risk factors associated with MRH in an Egyptian cohort of older patients in the 8-weeks period after hospital discharge.

This study recruited 400 Egyptian patients, aged = ≥ 60 years from 3 hospitals in Cairo and followed them up 8 weeks after discharge using a semi-structured telephone interview to verify MRH events (type, probability, severity and preventability) and related factors.

The participants’ ages ranged from 60 to 95 years with 53% females. In the final cohort of 325 patients analyzed, MRH occurred in 99 patients (incidence of 30.5%), of which 26 MRH cases (26.2%) were probable, serious and preventable. MRH included adverse drug reactions (ADRs), non-adherence and medication errors. Multivariate regression analysis showed that non-adherence and inappropriate prescription had highly significant association with MRH (P < 0.001), history of previous ADR, living alone and presence of paid caregiver had significant association (P 0.008, 0.012, 0.02 respectively), while age, medications number, length of stay (LOS) and cognitive impairment were not significantly associated with MRH.

These findings demonstrate the magnitude of MRH in Egypt affecting almost a third of older adults after leaving the hospital. These original data could guide decision-makers to enhance older patients’ medication safety through education, quality improvement and policy.

MRH in Egyptian older adults post-hospital discharge has not been adequately reported in scientific literature.

Providing high-quality and cost-efficient care of older people is an important development priority for many health and social care systems in the world. This paper suggests a shift from acute, episodic and reactive hospital-centered care toward longitudinal, person-centered and proactive home-centered care. The purpose of this paper is to contribute to the knowledge of a comprehensive development strategy for designing and providing home-centered care of older people.

The study design is based on qualitative research with an inductive approach. The authors study development initiatives at the national, regional and local levels of the Swedish health and social care system. The data collection methods included interviews (n = 54), meeting observations (n = 25) and document studies (n = 59).

The authors describe findings related to policy actions and system changes, attempts to achieve collaboration, integration and coordination, new forms of care offerings, characteristics of work settings at home and differences in patients' roles and participation at home and in the hospital.

The authors suggest home-centered care as a solution for providing person-centered and integrated care of older people and give examples of how this can be achieved.

The authors outline five propositions for research and development related to national policies, service modularity as a solution for customized and coordinated care, developing human resources and infrastructure for home settings, expanding services that enable older people living at home and patient co-creation.

The involvement of clients in service encounters and service development has become a central principle for contemporary health and social care organizations. However, in day-to-day work settings, the shift toward client involvement is still in progress. We examined how health and social care professionals, together with clients and managers, co-develop their conceptions of client involvement and search for practical ways in which to implement these in organizational service processes.

The empirical case of this study was a developmental intervention, the client involvement workshop, conducted in a Finnish municipal social and welfare center. The cultural-historical activity theory (CHAT) framework was used to analyze the development of client involvement ideas and the modes of interaction during the intervention.

Analysis of the collective discussion revealed that the conceptions of client involvement developed through two interconnected object-orientations: Enabling client involvement in service encounters and promoting client involvement in the service system. The predominant mode of interaction in the collective discussion was that of “coordination.” The clients' perspective and contributions were central aspects in the turning points from coordination to cooperation; professionals crossed organizational boundaries, and together with clients, constructed a new client involvement-based object. This suggests that client participation plays an important role in the development of services.

The CHAT-based examination of the modes of interaction clarifies the potential of co-developing client-involvement-based services and highlights the importance of clients' participation in co-development.

The United Nations' Sustainable Development Goal of ensuring healthy lives and promoting well-being for people of all ages underscores the vital role of public healthcare facilities (PHFs) in delivering essential healthcare services. However, these facilities often suffer from inadequate maintenance, exacerbated by the insufficient implementation of maintenance strategies. Recognizing the importance of PHFs in enhancing healthcare services, this paper investigates the Critical Success Factors (CSFs) in the maintenance strategies of PHFs in South Africa.

Through semi-structured interviews with nineteen purposively selected maintenance personnel from the Limpopo Department of Health (DoH), this study identified and analyzed the CSFs to enhance maintenance operations in PHFs. Thematic content analysis was employed to derive key insights from the collected data.

The study's findings highlight adequate maintenance planning and effective leadership as the two overarching CSFs in the maintenance of PHFs. These factors play a pivotal role in addressing challenges that hinder the current maintenance team from meeting maintenance requirements to the satisfaction of both staff and patients within PHFs.

The study offers valuable insights for policymakers to improve the effectiveness of maintenance operations in PHFs. By addressing the identified CSFs, policymakers can enhance maintenance operations in PHFs, positively impacting healthcare service delivery and the well-being of both staff and patients.

To analyze the quality of transitional care for patients with COVID-19 at discharge from Brazilian university hospitals.

A cross-sectional descriptive study was carried out in five Brazilian university hospitals between April and December 2021. The sample consisted of 527 participants. Data collection consisted of a sociodemographic questionnaire and the Care Transitions Measure (CTM-15), a care transition assessment instrument, which was translated and validated in Portuguese.

Most participants were patients (n = 369; 70.0%), with primary school completion (n = 218; 43.4%), multiracial (n = 218; 43.5%) and with an income of up to two minimum wages (n = 182; 42.8%). Dimension 1 – management preparation – obtained the highest score (71.2 points, SD = 16.5), while Dimension 4 – care plan – obtained the lowest score (62.2 points, SD = 23.4). Among the participating hospitals, there was a difference in the overall mean with results ranging from 67.0 to 72.9 points.

A satisfactory quality of care transition was found, considering the context of a pandemic. The main weaknesses in the care transitions were related to the care planning after hospital discharge.

Drawing on interviews with two types of essential workers – wound clinicians and care workers – the chapter examines stigma management in dirty care work through the lens of emotion management. The study combines two dimensions of dirty work: physical taint in relation to bodywork and social taint linked to working in close proximity to socially stigmatized clients. Hence, stigma management extends to dealing with the physically and socially dirty features of essential care work. In addition, the authors’ assessment of social stigma includes how essential care workers also sought to alleviate the social stigma encountered by their clients. In so doing, the authors extend the literature on dirty work to identify how emotion management skills are central to the stigma management strategies of the essential care workers in this study. The authors demonstrate how both groups deal with their stigma by emphasizing the emotion management skills in ‘doing’ dirty work and in the ‘purpose’ of this work, which includes acknowledging how the authors attempt to address the social taint encountered by their clients. Additionally, by comparing two occupations with different contexts and conditions of work, the authors show how complex emotion management skills are gendered in care work to expand the understanding of gender and stigma management. Furthermore, these emotion management skills emanate from the deep relational work with clients rather than through occupational communities. The authors argue that by focussing on emotion management, the hidden skills of dirty work in gendered care work are illuminated and contribute to contemporary debates about whether stigma can be overcome.

Integrated care (IC) is mainly studied from the perspectives of organisations or employees. However, less research is focussed on how patients themselves experience person-centred (PC) IC in practice. This context-specific, small-scale study examines what PC-IC means to older patients who went through joint replacement surgery (JRS).

The data consists of ten in-depth interviews of older patients, focussing on their experiences of care during their patient journey related to joint knee or hip replacement surgery. The data were analysed with thematic analysis.

Three central dimensions of PC-IC for older patients were identified: information sharing, continuity of care and compassionate encountering. Human validation and compassionate encountering were experienced as important aspects of PC-IC. Compassionate encountering was concretised through professionals’ very small everyday practices, which made the patient feel comfortable and respected. Instead, probably due to the medical and quite straight-forward nature of the joint replacement care process, patients seem to be pleased to trust the expertise of professionals and did not necessarily expect an active role or participation in the decision-making.

This Finnish case study focusses on the patients’ authentic perceptions of what is central to person-centred IC in the specific context of JRS.