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Describes the physical status and quality of life in ambulatory oncologic patients seen at the Norwegian Radium Hospital (NRH) and assesses their satisfaction with the out‐patient service. During a two‐week period in 1993, 517 consecutive patients completed a qualify‐of‐life questionnaire (EORTC QLQ‐C30) during their out‐patient visit at the NRH. The results of the EORTC QLQ‐C30 were compared with those from a similar study performed in 1991 (211 patients evaluated during one week).

The purpose of this paper is to address a critical problem for health-care organizations: patient referral leakage. This paper explores the nature of patient referrals by examining how health-care providers’ breadth and depth of connectivity within a hospital network and identification with each other influence the likelihood of future patient referrals.

The data was collected by using a multi-sourced data set from the health-care industry. The proposed model was tested by using logistic regression to determine the likelihood of a primary care physician’s (PCP) referral to a specialist within a hospital network.

A model linking provider connectivity to examine co-creation practices in the form of patient referrals is tested. Results indicate that patient referrals are multidimensional. A PCP’s likelihood to refer to a specialist within the hospital network is influenced by the breadth and depth of connectivity of each provider.

This investigation extends service ecosystems to patients, health-care providers and hospital organizations, making it the first to explore how different degrees of connectivity (breadth of referral partners and depth of exchange) between and among health-care providers influence the likelihood of future patient referrals. Findings complement extant literature on service ecosystems by empirically showing that provider relationships are interdependent and rely on the mutual coordination of benefits within the entire health-care organization and network.

Managers and health-care professionals can use the framework to build and strengthen relational ties/alliances within a service organization. An ecosystems perspective reduces patient referral leakage through enhanced organizational performance, competitive advantage and continuity of care.

The authors offer a novel view of referral relationships using hard-to-access proprietary data. Moreover, this study responds to the need for transformative service research by offering service researchers and policymakers a means to enhance consumer well-being. The main contribution of this study is a framework to gain a better understanding of patient referral relationships between employees (i.e., health-care providers) in an organization, thereby affording an opportunity to bolster operational efficiencies, improve clinical outcomes and strengthen referral pathways. By viewing health-care networks through a service ecosystems perspective, contextual boundaries and the relative power of relationships are also identified. The novel use of rarely available hospital data in this setting helps explain how patient leakage compromises the health of the ecosystem and its members.

The purpose of this paper is to consider some notions that are currently in use in integrated care, with the aim of exploring whether these notions improve the quality and integration of care.

Notions like “continuity of care”, “coordination of care”, “team‐working” and “partnerships” are some of the wide variety of terms increasingly employed within the range of initiatives and efforts that aim to enhance the quality of health and social care environments for patients and users. While each of these notions seems to represent a worthy cause in the quest for better care, and is accompanied by varying extents of evidence of its effectiveness, conceptual clarity of each notion remains a challenge. This paper undertook a detailed examination of what each of these notions comprises, how it is measured objectively and subjectively, whilst highlighting any apparent overlap between the notions.

From the analysis of the four notions, two main patterns of dysfunctional features emerged: the first pattern involved issues of multiple, imprecise and constricted definitions; the second pattern had to do with imprecise or conflicting assessments of how the different notions or dimensions thereof are related to one another.

A review of the literature suggests that the meanings, and consequently the measurement, of these notions could benefit from less ambiguity in order to prevent confusion about what precisely is being implemented and measured.

In order that calls for quality improvement do not become slogan statements, there is an urgent need for integrated framework(s) that add clarity to an already compound web of notions. This could contribute to improving the quality of research and evidence base of this complex field.

The purpose of this paper is to propose a general model that examines the contextual factors underlying the decision‐making process of international hospital outshopping.

Patients who chose medical treatment abroad were selected to analyze the drivers of internationalization in medical services. A total number of 27 international patients who traveled from developed countries to receive medical treatment at the largest hospital in Thailand were interviewed and their responses assessed through narrative analysis.

The narrative analysis reveals that while high costs and the deteriorating conditions of health care in developed countries are initially driving consumers to leave their local service area and choose foreign service providers, pull factors such as innovation, organizational efficiency, emotional service quality and patient‐doctor relationships in service encounters are nurturing a real preference for choosing foreign health care providers.

This exploratory study is limited to the largest hospital in South East Asia. Future research could expand upon its findings and comparisons be made with other different foreign health care providers.

In order to attract foreign customers a personal service, such as medical treatment, must be based on and sustained by continuous innovation in service quality.

The paper is the first empirical in‐depth study that examines the factors underlying the decision‐making process of international hospital outshopping.

Older people living in nursing homes have complex care needs and frequently need specialists’ advice and support that can be challenging to deliver in a rural setting. The aim of this paper is to describe a model of integrated care in a rural area supported by a nurse case manager.

A real-world evidence study of people living in Ribes de Freser nursing home, was conducted between specific timeframes in 2019 and 2022, comparing the casemix and outcomes of a traditional care model with the integrated interdisciplinary model.

The integrated care model led to a significant reduction in transfers to the emergency department, hospitalisations, outpatient medical visits and a reduction in the number of medicines. In addition, the number of residents receiving end-of-life care at the nursing home showed a substantial increase.

This case study contributes valuable evidence supporting the implementation of an integrated model of nurse case manager support in nursing homes, particularly in the rural contexts, where access to specialist medical staff may be limited. The findings highlight the potential benefits of person-centred integrated care for older adults, addressing their complex needs and improving end-of-life care in nursing home settings.

The purpose of this paper is to establish the effect of incorporating Centor scoring into antibiotic prescribing in primary care in London, UK, before and after the introduction of an educational package and prescribing software tool.

A quality improvement project with analysis of all sore throat presentations in patients aged 3-14 years, in two phases. Phase 1 (retrospective): 1 January-31 December 2013, followed by an intervention (software tool/education package) and Phase 2 (prospective): 1 March 2014-28 February 2015.

In the initial analysis, 162 out of 202 (80.2 per cent) patients were prescribed antibiotics. Following the educational/software intervention, 191 out of 231 (82.7 per cent) patients were prescribed antibiotics (p=0.56, χ² test). The mean Centor score decreased significantly following the education/software intervention (3.1 vs 2.7, p<0.001, χ² test). In all, 100 per cent of patients with tonsillar exudate were prescribed antibiotics in both phases. The apparent order of importance for predictive signs/symptoms given by the prescribers in both phases of the study was tonsillar exudate>lymphadenopathy>fever>absence of cough.

This is the first time a differential importance given by practitioners on individual Centor criteria has been described. With a low probability of bacterial infection, children with exudate or anterior lymphadenopathy almost always received antibiotics. This is interesting, since studies have previously found that the presence of tonsillar exudate had no significant association with culture-confirmed streptococcal tonsillitis.

Addresses the important question of the optimal share and distribution of primary and hospital care, stating that the end‐user consensus is essential. On a classical medical ground with integrated medical services the care seeking patterns and preferences were investigated in a representative sample of the, hence reasonably unbiased, native population. In a small Cretan township hospital combining secondary and primary care, a questionnaire of habits, perceptions and expectations of health services delivery and provision was distributed to a consecutive visitor sample. Overall, primary care was well and realistically appreciated. In six of the 12 conditions, mostly with fever and/or pain, general practitioners were clearly preferred while in three, as a rule organ‐associated, specialists were the first choice. The consumer‐oriented survey brings additional support to the vital role of primary care in the ongoing health systems development.

This paper assesses the patients' healthcare information needs and expectations when they attend a rheumatology outpatient clinic. It proposes that obtaining the patients' perspectives about the services they use is an essential service-development tool. The aim of this paper is to expand the current domains used to evaluate these perspectives.

This paper is an exploratory study, looking at quality assessment and improvement based on Donabedian's quality model in a rheumatology outpatient setting. A structured interview schedule addressing care pathways was used and 70 consecutive patients were recruited.

The article provides insights about how relevant change can be brought about when service development is contemplated. It suggests that patients are important stakeholders in the ongoing service development process.

Because rheumatological conditions tend to be chronic and require long-term follow-up, the results may lack generalisability. Therefore, researchers are encouraged to test propositions in different clinical settings.

The article highlights healthcare delivery areas that are not meeting patient expectations. Some recommendations (such as informing waiting patients regularly about any delays) require minimal additional resources for successful implementation. Service providers need to obtain the patients' healthcare perspectives to ensure that services are built around their needs.

This article fulfils an identified need to study how patients perceive service quality.

This paper aims to describe relationships among healthcare professionals in a French public hospital using social network analysis (SNA) and to improve health service quality by strengthening health service management and leadership.

This study was based on a questionnaire sent to randomly selected French public hospital professionals and administrators. Network composition measures were obtained using a name generator. Analysis focused on three main indicators: “centrality”, “prestige”, and “clique participants”. The SNA was carried out using UCINET^® and statistical analyses were performed with SPSS version 15.0.

A total of 104 questionnaires were returned and analysed. Centrality, prestige and clique indicators were highly correlated (all p‐value were less than 0.01). Physicians had the highest scores for the three indicators. Older age (≥45 years) was associated with higher centrality and clique numbers scores. Transversal activity was associated with higher scores than other specific activities (hospitalisation, ambulatory care), except for emergency care.

The paper shows how networks and SNA techniques provide novel and useful means to understand communication and collaboration between hospital professionals.

The purpose of this study is to discern the physicians’ perception of leadership effectiveness in their clinical and non-clinical roles (leadership) by identifying their political skill levels.

A sample of 209 Canadian physicians was surveyed using the Political Skills Inventory (PSI) during the period 2012-2014. The PSI was chosen because it assesses leadership effectiveness on four dimensions: social astuteness, interpersonal influence, networking ability and apparent authenticity.

Physicians in clinical roles’ PSI scores were significantly lower in all four PSI dimensions when compared to all other physicians in non-clinical roles, with the principal difference being in their networking abilities.

More emphasis is needed on educating and training physicians, specifically in the areas of political skills, in current clinical roles if they are to assume leadership roles and be effective.

Although this study is located in Canada, the study design and associated findings may have implications to other areas and countries wanting to increase physician leadership effectiveness. Further, replication of this study in other settings may provide insight into the future design of physician leadership training curriculum.