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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 healthcare sector is experiencing a major paradigm shift toward a people-centered approach. The key issue with transitioning to a people-centered approach is a lack of understanding of the ever-increasing role of technology in blended human-technology healthcare interactions and the impacts on healthcare actors' well-being. The purpose of the paper is to identify the key mechanisms and influencing factors through which blended service realities affect engaged actors' well-being in a healthcare context.

This conceptual paper takes a human-centric perspective and a value co-creation lens and uses theory synthesis and adaptation to investigate blended human-technology service realities in healthcare services.

The authors conceptualize three blended human-technology service realities – human-dominant, balanced and technology-dominant – and identify two key mechanisms – shared control and emotional-social and cognitive complexity – and three influencing factors – meaningful human-technology experiences, agency and DART (dialogue, access, risk, transparency) – that affect the well-being outcome of engaged actors in these blended human-technology service realities.

Managerially, the framework provides a useful tool for the design and management of blended human-technology realities. The paper explains how healthcare services should pay attention to management and interventions of different services realities and their impact on engaged actors. Blended human-technology reality examples – telehealth, virtual reality (VR) and service robots in healthcare – are used to support and contextualize the study’s conceptual work. A future research agenda is provided.

This study contributes to service literature by developing a new conceptual framework that underpins the mechanisms and factors that influence the relationships between blended human-technology service realities and engaged actors' well-being.

This paper aims to: analyze the challenge of health services fragmentation; present the attributes of integrated health service delivery networks (IHSDNs); review lessons learned on integration; examine recent developments in selected countries; and discuss policy implications of implementing IHSDNs.

A literature review, expert meetings, and country consultations (national, subregional, and regional) in the Americas resulted in a set of consensus‐based essential attributes for implementing IHSDNs. The analysis of 11 country case studies on integration allowed for the identification of lessons learned.

Studies suggest that IHSDNs could improve health systems performance. Principal findings include: integration processes are difficult, complex, and long term; integration requires extensive systemic changes and a commitment by health workers, health service managers and policymakers; and, multiple modalities and degrees of integration can coexist within a system. The public policy objective is to propose a design that meets each system's specific organizational needs.

The analysis presented in this paper is qualitative.

Some policy implications for implementing IHSDNs are presented in the paper.

The research and evidence on integration remains limited. The paper expands the knowledge‐base on the topic, presenting lessons learned on integration and recent developments in selected countries, which can support integration efforts in the region.

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.

The purpose of this paper is to explore the challenges, interplay and potential directions for future service research to address the first three Sustainable Development Goals (SDGs) of no poverty, zero hunger and good health and well-being.

This commentary examines how service research has addressed these SDGs in the literature, and through the development of a theory of change, the authors propose an agenda for service research going beyond serving, to enabling and transforming service systems, expanding the current focus on individual to community and population well-being through promotion and prevention.

Service research has increasingly advocated human-centered approaches but requires a shift towards an all of humanity perspective. Individual and collective well-being have gained attention in service research, emphasizing the importance of considering collective well-being.

The commentary underscores the need for a comprehensive approach to develop services that contribute to the well-being of the human species. It calls for research that transcends dyadic interactions, considers systemic dynamics and broadens the focus from individual to collective and population well-being.

This paper discusses important societal issues of poverty, hunger and good health and well-being and the need for integrated and ecosystem approaches to develop equitable and sustainable solutions for collective well-being.

While SDGs 1, 2 and 3 address individual goals, they collectively underpin the well-being of communities and societies.

The aim of this paper is to present a conceptual model on foreign-born health care workers from developing countries working in the US. The model covers their motivations for migration, the consequences in terms of the inequality and exclusion they may experience and the role of institutional responses at micro-, macro- and meso-level of intervention.

The paper is based on: (1) in-depth review of key literature studies on the foundation theories of international migration including sociology, economics, anthropology, psychology and human resource management, (2) analysis of theoretical approaches to medical migration across disciplines, (3) analysis of the international and national documentary sources of micro-, macro- and meso-level policies on migration and (4) analysis of evidence on best practices, solutions and aspirational changes across different levels of institutions.

(1) Migration of international medical graduates (IMGs) from developing countries to the US can be explained from a micro-, macro- and meso-level of analysis. (2) IMGs who identify as racial/ethnic minorities may experience unfair discrimination differently than their US-born counterparts. (3) Although political/legislative remedies have had some successes, proactive initiatives will be needed alongside enforcement strategies to achieve equity and inclusion. (4) While diversity management initiatives abound in organizations, those designed for the benefit of IMGs from developing countries are rare. (5) Professional identity groups and some nonprofits may challenge structural inequities, but these have not yet achieved economies of scale.

Although it is well-documented in the US health care literature how ethnic/racial minorities are unfairly disadvantaged in work and career, the studies are rarely disaggregated according to sub-groups (e.g. non-White IMGs and US-born MGs). The implication is that Black IMG immigrants have been overlooked by the predominant narratives of native-born, Black experiences. In placing the realities of native-born Blacks on the entire Black population in America, data have ignored and undermined the diverse histories, identities and experiences of this heterogeneous group.

An awareness of the challenges IMGs from developing countries face have implications for managerial decisions regarding recruitment and selection. Besides their medical qualifications, IMGs from developing countries offer employers additional qualities that are critical to success in health care delivery. Considering organizations traditionally favor White immigrants from Northern and Southern Europe, IMGs from developed countries migrate to the US under relatively easier circumstances. It is important to balance the scale in the decision-making process by including an evaluation of migration antecedents in comprehensive selection criteria.

The unfair discrimination faced by IMGs who identify as racial/ethnic minority are multilayered and will affect them in ways that are different compared to their US-born counterparts. In effect, researchers need to make this distinction in research on racial discrimination. Since IMGs are not all uniformly impacted by unfair discrimination, organization-wide audits should be in tune with issues that are of concerns to IMGs who identify as racial/ethnic minorities. Likewise, diversity management strategies should be more inclusive and should not ignore the intersectionality of race/ethnicity, nationality, country of qualification and gender.

Immigrant health care workers from developing countries are integral to the health care industry in the United States. They make up a significant proportion of all workers in the health care industry in the US. Although the literature is replete with studies on immigrant health care workers as a whole, research has rarely focused on immigrant health care workers from developing countries. The paper makes a valuable contribution in drawing attention to this underappreciated group, given their critical role in the ongoing pandemic and the need for the US health industry to retain their services to remain viable in the future.

The aim of this study was to identify key components of integrated mental health and social care services that contribute to value for service users in Sweden.

An explorative research study design was used, based on data from four group interviews conducted in June and August 2017 with service user representatives.

The analysis resulted in eight subcategories reflecting components that were reported to contribute to value for service users. These subcategories were grouped into three main categories: (1) professionals who see and support the whole person, (2) organizational commitment to holistic care and (3) support for equal opportunities and active participation in society.

The findings are primarily transferable to integrated mental health and social care services, as they emphasize key components that contribute to value for service users in these specific settings.

The complexity of integrated mental health and social care services requires coordination across the individual and organizational levels as well as ongoing dialogue and partnerships between service users, service user associations and health and social care organizations. In this integration, it is important that service users and service user associations not only are invited but also keen to participate in the design of care and support efforts.

Service User Associations (SUAs) can act as a bridge between county and municipal services through their participation in the development of local activities; at the regional and national levels, SUAs can help achieve more equitable integrated services. It is important that SUAs are not only invited but encouraged to actively participate in the design of such care and support efforts.

The purpose of this explanatory case study is to explain the implementation of interprofessional, multitiered lean daily management (LDM) and to quantitatively report its impact on hospital safety.

This case study explained the framework for LDM implementation and changes in quality metrics associated with the interprofessional, multitiered LDM, implemented at Saint Francis Hospital and Medical Center (SFHMC) at the end of 2018. Concepts from lean, Total Quality Management (TQM) and high reliability science were applied to develop the four tiers and gemba rounding components of LDM. A two-tailed t-test analysis was utilized to determine statistical significance for serious safety events (SSEs) comparing the intervention period (January 2019–December 2019) to the baseline period (calendar years 2017 and 2018). Other quality and efficiency metrics were also tracked.

LDM was associated with decreased SSEs in 2019 compared to 2017 and 2018 (p ≤ 0.01). There were no reportable central line-associated blood stream infection (CLABSI) or catheter-associated urinary tract infection (CAUTI) for first full calendar quarter in the hospital's history. Hospital-acquired pressure injuries were at 0.2 per 1,000 patient days, meeting the annual target of <0.5 per 1,000 patient days. Outcomes for falls with injury, hand hygiene and patient experience also trended toward target. These improvements occurred while also observing a lower observed to expected length of stay (O/E LOS), which is the organizational marker for hospital’s efficiency.

LDM may contribute greatly to improve safety outcomes. This observational study was performed in an urban, high-acuity, low cost hospital which may not be representative of other hospitals. Further study is warranted to determine whether this model can be applied more broadly to other settings.

LDM can be implemented quickly to achieve an improvement in hospital safety and other health-care quality outcomes. This required a redistribution of time for hospital staff but did not require any significant capital or other investment.

As hospital systems move from a volume-based to value-based health-care delivery model, dynamic interventions using LDM can play a pivotal role in helping all patients, particularly in underserved settings where lower cost care is required for sustainability, given limited available resources.

While many hospital systems promote organizational rounding as a routine quality improvement process, this study shows that a dynamic, intense LDM model can dramatically improve safety within months. This was done in a challenging urban environment for a high-acuity population with limited resources.

Effective refractive error (RE) coverage in a resource-constrained country such as Kenya could possibly be achievable if the current dominant commercial entrepreneurship is supplemented with alternative avenues such as social entrepreneurship. This study aims to explore the perceived impact of social enterprises (SEs) in scaling effective RE coverage in Kenya.

This was an exploratory study with data collected from representatives of SEs (n = 29), trainees of SEs (n = 112) and beneficiaries of eye care services provided by SEs (n = 674). Participants were recruited purposively with data collected through telephonic calls. Thematic analysis was carried out by categorizing the codes into categories and themes based on the semantic meaning of the codes.

The perceived impact of SEs from the representative perspective included entrepreneurship and livelihood (n = 3; 10.3%), skills development (n = 20; 69%), technology development (n = 7; 24.1%), access to specialized services (n = 7; 24.1%) and affordability, accessibility and availability of RE services (n = 27; 93.1%). From the perspective of trainees, the themes included economic empowerment (n = 99; 88.4%), improved quality of life (n = 84; 75.0%), sensitizing locals to RE during screening events (n = 112; 100.0%) and enhancing accessibility, availability and affordability (n = 107; 95.5%).

The perceived impact of SEs highlighted in this paper showcases that they are useful for integration into the eye health ecosystem in a resource-constrained country such as Kenya. Integration of SEs into the eye health ecosystem could potentially address the human resource challenge, scale RE service delivery, enhance awareness creation and address the cost barriers to current RE service delivery coverage.

This article aims to analyze the incorporation of harm reduction health workers with lived experience in all services focused on the care for drug users in Belo Horizonte’s mental health network, one of the largest Brazilian Psychosocial Care Networks (Rede de Atenção Psicossocial [RAPS]), and reports the findings of a qualitative study on the life stories, recovery journeys and the professional practice of harm reducers in Belo Horizonte.

For the development of this research, the authors chose the following methodological tools: documentary research; follow-up of harm reduction interventions; access to harm reducers’ field diaries; joint writing of the life stories of the harm reducers.

It indicates that these professionals, as harm reducers empowered by their life experience, have developed various elements and active ingredients of peer support. Their practices and the results of their actions have consolidated their inclusion as Belo Horizonte RAPS’ health workers and highlight that recovery-oriented care and peer support are a real possibility in Brazil.

In this research, harm reducers are coauthors and report their own life experience. In this article, they also talk about the impact of this experience on their work and on the lives of users of mental health services, emphasizing the protagonism and exercise of citizenship by harm reducers.