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This paper profiles the Maidstone ‘Quality in Care’ project and makes suggestions for how it could be developed and implemented across residential and nursing care for older people and for social care more widely. ‘Quality in Care’ is a quality assurance model of support provided to residential care homes for older people where there are serious concerns about the risks of abuse and/or neglect and the quality of services and care provided. The aim of the intervention is to ensure that vulnerable adults are safeguarded and protected and that service standards are improved in key areas. The model has the potential to be transferred to all client groups and most service types although resource constraints currently limit the project to older people only.

This chapter reports on an action research case study of integrated obstetric care in the Netherlands. Efficient and patient-friendly patient flows through integrated care networks are of major societal importance. How to design and develop such interorganizational patient flows is still a nascent research area, especially when dealing with a large number (n>3) of stakeholders. We have shown that a modification of an existing method to support interorganizational collaboration by system dynamics-based group model building (GMB) (the Renga method, Akkermans, 2001) may be effective in achieving such collaboration.

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 report the key findings from a study of adult protection referrals collected by two English local authorities during 1998‐2005.

Referrals were analysed for patterns relating to risk with client level data supplemented by information from the local authority databases and from the Care Quality Commission. The analysis also examined associations between adult protection processes and outcomes and looked at how adult protection monitoring data could be improved to better inform safeguarding management and practice at local and national level.

Sexual abuse was most frequently reported for people with intellectual disabilities, who were also at higher risk of abuse when living out of area. Older people were most at risk of financial abuse in community settings and of neglect in residential care.

The study identifies patterns of risk in the abuse of older people and those with intellectual disabilities and informs preventive interventions. It also indicates priorities for improving the quality and comparability of adult protection monitoring data.

Patient involvement in the design and improvement of health services is increasingly recognized as an essential part of patient-centred care. Yet little research, and no measurement tool, has addressed the organizational impacts of such involvement. The paper aims to discuss these issues.

The authors developed and piloted the scoresheet for tangible effects of patient participation (STEPP) to measure the instrumental use of patient input. Its items assess the magnitude of each recommendation or issue brought forward by patients, the extent of the organization’s response, and the apparent degree of patient influence on this response. In collaboration with teams (staff) from five involvement initiatives, the authors collected interview and documentary data and scored the STEPP, first independently then jointly. Feedback meetings and a “challenges log” supported ongoing improvement.

Although researchers’ and teams’ initial scores often diverged, the authors quickly reached consensus as new information was shared. Composite scores appeared to credibly reflect the degree of organizational impact, and were associated with salient features of the involvement initiatives. Teams described the STEPP as easy to use and useful for monitoring and accountability purposes. The tool seemed most suitable for initiatives in which patients generated novel, concrete recommendations; less so for broad public consultations of which instrumental use was not a primary goal.

The STEPP is a promising, first-in-class tool with potential usefulness to both researchers and practitioners. With further research to better establish its reliability and validity, it could make a valuable contribution to full mixed-methods evaluation of patient involvement.

Researchers recommend a reorganization of the medical profession into larger groups with a multispecialty mix. We analyze whether there is evidence for the superiority of these models and if this organizational transformation is underway.

We summarize the evidence on scale and scope economies in physician group practice, and then review the trends in physician group size and specialty mix to conduct survivorship tests of the most efficient models.

The distribution of physician groups exhibits two interesting tails. In the lower tail, a large percentage of physicians continue to practice in small, physician-owned practices. In the upper tail, there is a small but rapidly growing percentage of large groups that have been organized primarily by non-physician owners.

While our analysis includes no original data, it does collate all known surveys of physician practice characteristics and group practice formation to provide a consistent picture of physician organization.

Our review suggests that scale and scope economies in physician practice are limited. This may explain why most physicians have retained their small practices.

Larger, multispecialty groups have been primarily organized by non-physician owners in vertically integrated arrangements. There is little evidence supporting the efficiencies of such models and some concern they may pose anticompetitive threats.

This is the first comprehensive review of the scale and scope economies of physician practice in nearly two decades. The research results do not appear to have changed much; nor has much changed in physician practice organization.

The purpose of this study is to assess the appropriateness of applying the ISO 9001 quality standard to the residential aged‐care sector.

The study undertakes a prospective qualitative survey using the Delphi methodology. A panel of 14 experts in the field constitutes the panel.

ISO 9001 has certain shortcomings in the context of the residential aged‐care sector. There is a need to fit generic quality‐management models to the specific characteristics of the sector, and to integrate those generic quality management models with specialised models.

Managers of residential aged‐care services should ensure: that they have sufficient resources to implement quality‐management models; that all personnel are involved in the implementation; and that generic models are appropriately adapted to the specific needs of the aged‐care sector.

The paper provides an original conceptual overview of the application of a generic quality‐management system to a specific services sector.

Poor quality of services in the health-care sector of the developing countries like Bangladesh forces affluent patients to seek advanced medical treatment from abroad. The purpose of this study is to explore the outbound medical tourists’ satisfaction and loyalty on the basis of the quality of the health-care service provided by foreign medical institutions.

The medical tourists from Bangladesh who have got medical services from Indian medical institutions were taken as a sample by applying a purposive sampling technique. For the measurement of outbound medical tourists’ satisfaction, the dimensions of the HEALTHQUAL model were adopted. A self-administrated questionnaire was the major tool for collecting data from the respondents. Using partial least square-structural equation model multivariate statistical technique and with the aid of SmartPLS software, primary data collected from 218 final respondents were analyzed.

The findings of this study reveal that four dimensions of the HEALTHQUAL model, namely, empathy, tangibility, efficiency, and safety have a significant positive impact on building medical tourists’ overall satisfaction, and then the overall satisfaction also has a positive level of significance on building loyalty towards foreign medical service providers.

The findings of this study can be a helpful instrument for the developing countries to rethink and reshuffle their own existing health-care system for providing quality medical services and at the same time, the medical tourists importing countries to sharpen their existing service quality as well as to attract more medical tourists in the future.

A handful of research has been carried out, especially focused on health-care service quality measurement and the relationship of health-care service quality with satisfaction and loyalty from the perspective of developing countries outbound medical tourists. Thus, this research work will give a flavor to think of health-care service quality in a different dimension.

This article initially aims to explore the factors of every quality construct of the 5Qs model of service quality and, second, identify the significant factors affecting the total quality of e-healthcare services and its association with consumer satisfaction using a multidimensional hierarchical 5Qs model of e-healthcare service quality.

Questionnaire-oriented research was performed at three public hospitals of Punjab and Chandigarh. In total, 53 variables were covered in all quality constructs for data collection from the designated public hospitals. The respondents who agreed to have knowledge regarding e-Healthcare services and were availing these services were included in the study. The analysis comprised structural equation modeling technique using AMOS 21.

The outcomes suggest that the 5Qs model is more comprehensive and can be used to evaluate service quality perceptions using e-Healthcare services. The research identified 11 sub-dimensions for the five quality constructs of the 5Qs model, representing total quality, which is primary to consumer satisfaction. “Overall objectivity” and “technical objectivity” defined the quality of object. The quality of process of e-Healthcare services was characterized by “functionality,” “timeliness” and “responsiveness.” Quality of infrastructure was defined by “technical infrastructure,” “physical infrastructure,” “manpower skills” and “organizational infrastructure.” “Manner of interaction” and “timely interaction” defined the quality of interaction. The atmosphere was represented by only one factor. The results also suggest that quality of infrastructure, quality of interaction and quality of atmosphere play the most significant role in total quality leading to consumer satisfaction.

Theoretical implications: The multidimensional hierarchical model will help the researchers study the e-Healthcare service quality in a more organized manner, and the outcomes of this study can be linked with that of future studies for more generalized application in other public hospitals. The sub-dimensions of each quality construct of the 5Qs model can be applied in private hospitals, and the hierarchical model can be tested in different industries to measure service quality perceptions of the consumer

The outcomes of the study can be applied in various public sector hospitals to redesign the e-Healthcare services based on consumers' perception for better consumer satisfaction and quality services. This paper identifies the role of each quality construct in e-Healthcare services for improvement in the total quality, which in turn will lead to higher satisfaction for the consumers.

In this study, the original 5Qs model has been used for the first time in a new instrument to understand better and design quality e-Healthcare services. The paper explores the sub-factors of each quality construct and its significance in measuring the total quality.

As one of the five major dimensions of service quality, empathy has been and continues to be regarded as a requirement for a successful service encounter. This paper focuses on the highly customer-centric service industry of health care. The purpose of this paper is to shed light on the potential negative effects of empathy on both the physician and the patient.

Building on an in-depth review of literature and well-established service quality models, the authors propose a new model for understanding the complex role of physician empathy in the physician–patient encounter. The trait, emotional intelligence (EI), is presented as a moderator for physician empathy levels.

The Health Care Optimal Physician Empathy (HOPE) model enables further characterization and analysis of the tradeoffs between patient satisfaction and physician burnout and determining when empathy optimally works to the benefit of both the physician and the patient to maximize service quality. The HOPE model provides a systematic way to understand and determine the appropriate level of physician empathy that results in optimal outcomes for both physicians and their patients by demonstrating the tradeoffs between physician burnout and patient satisfaction.

The authors highlight the potential detrimental effects on physicians themselves, and, in turn, on service quality. The theoretical and practical implications in this paper provide insights into the development and implementation of empathy-focused interventions and best practices to optimize service quality in the physician–patient interaction. The HOPE model is the first of its kind in shedding light on the manifestation of physician empathy.