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Value-based health care (VBHC) argues that health-care needs to re-focus to maximise value creation, defining value as the quota when dividing the outcomes important for the patient, by the cost for health care to deliver such outcomes. This study aims to explore the perception of value among different stakeholders involved in the process of implementing VBHC at a Swedish hospital to support leaders to be more efficient and effective when developing health care.

Participants comprised 19 clinicians and non-clinicians involved in the implementation of VBHC. Semi-structured interviews were conducted and content analysis was performed.

The clinicians described value as a dynamic concept, dependent on the patient and the clinical setting, stating that improving outcomes was more important than containing costs. The value for non-clinicians appeared more driven by the interplay between the outcome and the cost. Non-clinicians related VBHC to a strategic framework for governance or for monitoring different continuous improvement processes, while clinicians appreciated VBHC, as they perceived its introduction as an opportunity to focus more on outcomes for patients and less on cost containment.

There is variation in how clinicians and non-clinicians perceive the key concept of value when implementing VBHC. Clinicians focus on increasing treatment efficacy and improving medical outcomes but have a limited focus on cost and what patients consider most valuable. If the concept of value is defined primarily by clinicians’ own assumptions, there is a clear risk that the foundational premise of VBHC, to understand what outcomes patients value in their specific situation in relation to the cost to produce such outcome, will fail. Health-care leaders need to ensure that patients and the non-clinicians’ perception of value, is integrated with the clinical perception, if VBHC is to deliver on its promise.

This paper describes a model of “Learning to care” derived from a study exploring how care workers in care homes learn to care for people living with dementia. The “Learning to care” model is primarily informal in nature in which influences such as formalised training and organisational culture impact care outcomes indirectly rather than directly.

This study used a focused, critical ethnographic approach in two care homes in England resulting in 63 h of observation of care of people living with advanced dementia, 15 semi-structured interviews and 90 in-situ ethnographic interviews with care staff.

The findings reveal a three-level model of learning to care. At the level of day-to-day interactions is a mechanism for learning that is wholly informal and follows the maxim “What Works is What Matters”. Workers draw on resources and information within this process derived from their personal experiences, resident influences and care home cultural knowledge. Cultural knowledge is created through a worker’s interactions with colleagues and the training they receive, meaning that these organisational level influences affect care practice only indirectly via the “What Works is What Matters” mechanism.

This study makes an original contribution by explaining the nature of day-to-day informal learning processes as experienced by care workers and those living with dementia in care homes. In particular, it illuminates the specific mechanisms by which organisational culture has an effect on care practice and the limitations of formal training in influencing such practice.

This study applies Garfinkel’s (1967) concept of ‘breaching experiment’ to explore the impact of COVID-19-induced disruptions on the ‘emotion management’ practices of residential care workers in the United Kingdom and Germany. It examines the influence of professional feeling rules on workers, emphasizing the prescribed importance of displaying affective, empathetic concern for residents’ health and well-being. Findings demonstrate that authenticity and adherence to professional feeling rules in relation to emotional management are not mutually exclusive. The authors underscore how adherence to professional feeling rules upholds authentic care by reinforcing a professional ethos, which acts as a cornerstone motivating residential care workers. Ultimately, the study showcases how a professional ethos substantiates altruistic motivations, guiding proficient emotion management practices among care workers. It highlights how these workers drew upon their personal understanding and experiences to determine the appropriate emotions to express while providing care for residents amid the unprecedented challenges of the pandemic.

This paper aims to highlight the factors influencing the conceptualisation of return on investment (ROI) from healthcare quality improvement (QI) programmes.

In their previous work, the authors found that the concept of ROI from QI is broad and includes numerous internal and external benefits for organisations. In this paper, the authors developed a framework outlining the factors that influence this conceptualisation of QI-ROI from an institutional theory perspective. The framework is based on the synthesis of their serial studies on the determinants of the concept of ROI from QI. The research was performed from 2020–2023 and involved a global multidisciplinary systematic literature review (N = 68), qualitative interviews (N = 16) and a Delphi study (N = 23). The qualitative and Delphi studies were based on the publicly-funded mental healthcare in UK. Participants included board members, clinical and service directors, as well as QI leaders.

The authors outline a framework of internal and external institutional forces that influence the conceptualisation of ROI from QI programmes in mental healthcare and similar organisations. Based on these factors, the authors state several conjectures. In doing this, the authors highlight the ambiguities and uncertainties surrounding QI-ROI conceptualisation. These challenge leaders to balance various monetary and non-monetary benefits for organisations and health systems. This explains the broadness of the QI-ROI concept.

The authors developed a framework highlighting the forces underpinning the broad, ambiguous and sometimes uncertain nature of the QI-ROI concept. They raise awareness about dilemmas to be confronted in developing or applying any tool to evaluate the value for money of QI programmes. Specifically, the work highlights the limitations of the ROI methodology as a primary tool in the QI context and the need for a more comprehensive tool.

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.

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.

The purpose of this paper is to present the views of people living with dementia in extra care housing (ECH). This is a model of housing with care and support aiming to support older people, including those with dementia, to live independently. Previous research identifies benefits but is predominantly derived from third-party accounts, with the voices of those living with dementia in ECH significantly absent.

This study adopted a qualitative approach conducting 100 interviews across 8 ECH schemes in England. Over half of the interviews were conducted with people living with dementia and their families with the remainder involving staff and commissioners.

Findings suggest there are a range of benefits including owning your own home, having a safe, age friendly location with flexible support, social interaction and continuing to live as a couple. Challenges included availability of staff, flexible resourcing, loneliness and the advancing symptoms of dementia.

Despite efforts to create an inclusive, diverse sample, the participants were all White British. Participants involved were identified by gatekeepers, which may present some bias in the selection.

Whilst ECH offers benefits to people living with dementia, addressing the challenges is essential for effective dementia care. Improving staff training, promoting person-centred care and fostering an inclusive community are critical for enhancing residents’ well-being and quality of life.

This paper explored the lived experiences of residents and family members, providing new insight into the advantages and disadvantages of ECH for people living with dementia.

The purpose of this study is to describe peer support work in a men’s mental health unit from a lived experience and service user’s perspective. The intertwining of process (a lived experience perspective) and subject (the therapeutic value of peer support) leads to greater knowledge and insight into peer support for people with mental health problems.

This service user narrative draws on the extracts from a reflective journal of interactions and conversations with people with mental health problems as well as feedback from service users and staff about the value of peer support. These methods allow a first-person, service user’s, reflective and narrative account of peer support work.

Peer support work, particularly hearing voices sessions, are found to be highly therapeutic and worthwhile. They promote insight and create feelings of safety and hope in what can sometimes be a frightening and hostile ward environment. Peer support provides emotional and practical support. Sharing stories and experiences of mental illness with people leads to trust, feelings of being valued, heard and accepted as well as better experiences of care and being seen as a person first. Due to their shared experiences, peer support workers are able to befriend people with mental health problems on the ward. Peer support work bridges the gap and vacuum of care between people with mental health problems and staff. It compensates for understaffing to provide more holistic and person-centred care and support.

Lived experience/ service user perspectives and narratives on peer support are rare, particularly in a hospital setting. This article provides a rich, perhaps overlooked and hidden narrative on the nature of peer support work. People with mental health problems, like Ben, are often excluded from society, health and social care, education, employment and research. This narrative opens up a pathway to understanding peer support from a service user perspective.

In 2014, the Health Service Executive (HSE) in Ireland published its Safeguarding National Policy and Procedures (HSE, 2014). Under this policy, all agencies providing services through the social care directorate must ensure a robust culture of safeguarding is in place. Concurrent to this has been a move in social policy, practice and research to include the voice of the service user, both in terms of planning and reviewing services. (e.g. HIQA, 2012; Flanagan, 2020) This article examines whether service users with intellectual disabilities want to be involved in safeguarding plans and, if so, how that can be supported. Using focus groups service users demonstrated their knowledge of safeguarding as a concept, how they felt about the issues raised, and, crucially what they felt they would like to see happen next in addressing a safeguarding incident or concern. The focus groups took place in a large organisation providing residential services, day services, independent living supports and clinical supports. Engaging service users in planning and responding to safeguarding concerns is a fundamental principle of human rights legislation, both nationally and internationally. This study aims to highlight that it is both possible and desirable to engage fully with service users using a range of simple communication tools. For this to be implemented as routine practice in services providing support for people with intellectual disabilities, authentic leadership is required. Services will need to devote time, human resources and will need champions to get on board with the necessary culture shift.

Qualitative research examined peoples’ “lived experiences” and knowledge of safeguarding. Focus groups were used with thematic analysis highlighting common themes throughout, as guided by Braun and Clarke (2006). There were two objectives: Objective 1: measuring participant’s understanding of the safeguarding process. Objective 2: compare the potential differences between safeguarding plans devised by the participants in the focus groups, versus plans devised by trained designated officers responsible for safeguarding within the service.

Four principal themes emerged – 1. participants understanding of safeguarding; 2. restorative justice; 3. consent; and 4. high levels of emotional intelligence and compassion. Participants demonstrated that they could and did want to be involved in safeguarding planning and showed little variation in the plans compared to those completed by trained staff.

The study was completed with a small sample size in a single service in one area. It may not represent the lived experiences and knowledge of safeguarding in other services and indeed other countries. The video may have led to some priming; for instance, the Gardai in the footage being called may have resulted in the participants stating that contacting Gardai should be part of the plan. After the video was shown, there was a heightened awareness of safeguarding. This may indicate that participants are aware of safeguarding but unsure of the terminology or how to discuss it out of context.

For this to be implemented as routine practice in services providing support for people with intellectual disabilities, authentic leadership is required. Services will need to devote time and human resources and will need champions in the safeguarding arena to get on board with the shift in culture required.

While there did not appear to be many barriers to listening to participants, to progress this as a standard practice a very real shift in culture will be needed. It is important for practitioners to ask: Is the vulnerable person aware that this concern has been raised? What is known of the vulnerable person’s wishes in relation to the concern? To truly engage with service users in safeguarding plans these questions need to be more than a “tick box” exercise. This process needs to be fully embedded into a culture that promotes a person-centred, rights-based, inclusive approach as a standard rather than a one-off project. Some structural changes will be needed regarding the time given to designated officers, and what resources they can access (such as speech and language therapy). However, the real difference will be made by services operating authentic leadership that champions engagement on this scale, to fully answer the question posed by the researchers at the beginning of this report, “Whose safeguarding is it anyway?”

There appears to be little evidence of service user engagement in terms of planning and processing safeguarding responses, either in research or anecdotally.

The aim of this study is twofold: (1) to gain insight into the different perspectives on the relationship between patient and person centeredness and (2) to learn more about the differences between non-academic and academic stakeholders in the healthcare system.

This mixed-methods study includes a scoping review on person and patient centeredness and in-depth interviews with patients, caregivers, staff and management of healthcare organizations. The data were analyzed by following the six phases of Braun and Clarke.

The analysis of the data showed four different perspectives on patient versus person centeredness: (1) they are synonyms; (2) one term is favorite; (3) they should be in balance; and (4) person centeredness is the surplus on top of patient centeredness.

There are different perspectives on patient versus person centeredness. Perspectives differ between people and can change over time. Some people feel like a patient all the time, other people feel like a person all the time, and some feel like a patient at one point in time and as a person at another point in time.

These different perspectives can have important implications for the so-called moments of truth. In their role as patients, people value functional encounters and in their identity as people they value meaningful encounters with caregivers.

By unraveling these different perspectives, novel insights were found in the different perspectives people can take.