Search results

The institutional conditions of primary care provision remain understudied in low- and middle-income countries. This study analyzes how primary care doctors cope with medical uncertainty in municipal clinics in urban India. As street-level bureaucrats, the municipal doctors occupy two roles simultaneously: medical professional and state agent. They operate under conditions that characterize health systems in low-resource contexts globally: inadequate state investment, weak regulation and low societal trust. The study investigates how, in these conditions, the doctors respond to clinical risk, specifically related to noncommunicable diseases (NCDs).

The analysis draws on year-long ethnographic fieldwork in Pune (2013–14), a city of three million, including 30 semi-structured interviews with municipal doctors.

Interpreting their municipal mandate to exclude NCDs and reasoning their medical expertise as insufficient to treat NCDs, the doctors routinely referred NCD cases. They expressed concerns about violence from patients, negative media attention and unsupportive municipal authorities should anything go wrong clinically.

The study contextualizes street-level service-delivery in weak institutional conditions. Whereas street-level workers may commonly standardize practices to reduce workload, here the doctors routinized NCD care to avoid the sociopolitical consequences of clinical uncertainty. Modalities of the welfare state and medical care in India – manifest in weak municipal capacity and healthcare regulation – appear to compel restraint in service-delivery. The analysis highlights how norms and social relations may shape primary care provision and quality.

The learning objectives have been prepared following Bloom’s taxonomy (Bloom et al., 1956). After completing the case study, the students will be able to identify and recall the prerequisites necessary for establishing a pathology laboratory. (knowledge); analyze the micro- and macroenvironmental factors considered by Mr Sabihul Haque in the development of the strategic plan for Healthcare Laboratories (HCL) (knowledge and application); explain the key components of the Porter’s value chain and their significance in the operation of HCL (comprehension and evaluation); use the TOWS analysis to map the internal strengths, weaknesses, opportunities and threats of HCL (application and synthesis); and analyze the challenges faced by protagonist in managing HCL and generate suggestions for addressing the challenges (analysis and synthesis).

HCL, an enterprise established in 2018 in Sahdeo Khap, Gaya, Bihar, India, aims to provide high-quality pathological diagnostic services in semi-urban and rural areas. This health-care initiative is pioneering, offering pathology services to make high-quality, low-cost diagnostic services accessible in rural India. In rural settings, numerous health-care hurdles make it challenging for individuals to access the care they need. Since its inception, HCL has expanded its reach to connect more areas, facilitating diagnostic services for people in remote regions. The establishment of laboratories in semi-urban areas aims to reduce patient travel time, costs and health risks by bringing services directly to their doorstep. Haque, the chief executive officer of the lab, grappled with multiple challenges, including selecting an appropriate location for the lab, recruiting and retaining skilled workforce, managing logistics supply, collaborating with local health-care providers, dispelling the stigma among the population that superior services are only available in cities and enhancing health literacy in rural communities. Following numerous meetings with Ms Ummati Naiyyer, head of operations, they worked collaboratively to address these challenges, developing a blueprint and future plan to operate services in rural areas. This case study provides insights into the obstacles faced by HCL striving for success in rural areas. It elucidates the beneficial application of the Porter’s value chain, along with an analysis of macro- and microenvironmental factors. Unique challenges such as societal stigma and mistrust are specifically emphasized. Students engaging with this case study will enhance their problem-solving skills through brainstorming and providing recommendations, contributing to potential solutions for HCL’s difficulties.

The teaching notes for the HCL case is designed to enhance the learning experience of undergraduate and graduate students within the context of the course. This case study serves as a valuable teaching tool, allowing students to apply theoretical knowledge to real-world scenarios in the health-care industry. The notes provide a framework for instructors to facilitate discussions, encourage critical thinking and promote a deeper understanding of key concepts related to establishing diagnostic laboratories in rural areas.

Teaching notes are available for educators only.

CSS3: Entrepreneurship.

While the main emotional labor strategies are well-documented, the manner in which professionals navigate emotional rules within the workplace and effectively perform emotional labor is less understood. With this contribution, I aim to unveil “the good, the bad and the ugly” of emotional labor as a dynamic theatrical performance.

Focusing on three geriatric long-term care units within a French public hospital, this qualitative study relies on two sets of data (observation and interviews). Deeply rooted within the field of study, the chosen methodological approach substantializes the subtle hues of the emotional experience at work and targets resonance rather than generalization.

Using the theatrical metaphor, this research underlines the role of space in the practice of emotional labor in a unique way. It identifies the main emotionalized zones or emotional regions (front, back, transitional, mixed) and details their characteristics, before unearthing the nonlinearity and polyphonic quality of emotional labor performance and the versatility needed to that effect. Indeed, this research shows how health-care professionals juggle with the specificities of each region, as well as how space generates both constraints and resources. By combining static and dynamic prisms, diverse instantiations of hybridity and spatial in-betweens, anchored in liminality and trajectories, are revealed.

This research adds to the current body of literature on the concept of emotional labor by shedding light on its highly dynamic and interactional nature, revealing different levels of porosity between emotional regions and how the characteristics of each type of area can taint others and increase/decrease the occupational health costs of emotional labor. The study also raises questions about the interplay of emotional labor performance with the level of humanization/dehumanization of elderly people. Given the global demographics about an aging population, this gives food for thought at a social level.

This paper aims to discover and analyze the challenges hampering blockchain technology’s (BT’s) implementation in the Indian health-care sector. A total of 18 challenges have been prioritized and modeled based on an extensive literature search and professional views.

An integrated multi-criteria decision-making approach has been used in two phases. Best worst method (BWM) is used in the first phase to prioritize the challenges with sensitivity analysis to validate the findings and eliminate a few challenges. In the second phase, interpretive structural modeling is applied to the remaining 15 challenges to obtain relative relationships among them with cross-impact matrix multiplication applied to classification analysis for their categorization.

The study’s results reveal that limited knowledge and expertise, cost and risk involved, technical issues, lack of clear regulations, resistance to change and lack of top management support are the top-ranked or high-intensity challenges according to the BWM. Interpretive structural modelling findings suggest that the lack of government initiatives has been driving other challenges with the highest driving power.

This work has been conducted in the Indian context, so careful generalization of the results is needed.

This work will give health-care stakeholders a better perspective regarding blockchain’s adoption. It will help health-care stakeholders, service providers, researchers and policymakers get a glimpse of the strategies for eradicating mentioned challenges. The analysis will help reduce the challenges’ impact on blockchain’s adoption in the Indian health-care sector.

The adoption of BT is a novel concept, especially in developing countries such as India. This is one of the few works addressing the challenges to BT adoption in the Indian health-care sector.

Regarding how the public regulation of human services is perceived within welfare organizations and how the latter cope with it, the role of emotions (as mediators between structure and agency) proves highly relevant while often being hidden beneath the surface. This article shows how a specific approach to such regulation – here: managerialism – may impact on “emotional regimes” at the organizational and individual level, affecting the attainment of organizational goals and workers' health.

The article primarily draws on multiple qualitative case studies across two welfare sectors (four organizations) in Germany (continuing education/active inclusion; long-term care). The study research was conducted between 2020 and 2022 and based on 36 interviews with caseworkers and managers, focus group interviews and expert dialogues at industry level.

The results suggest that the managerialist regulation of welfare services breeds complex and ambiguous emotional regimes. Business-like management techniques elicit various emotions, affecting the motivational basis of human service work. While the experience of hard challenges may raise positive feelings, coping patterns often put strain on organizations and staff alike. In the short run, related emotional regimes tend to make service delivery proceed smoothly, yet in the long run they may have corrosive effects and problematic repercussions on macro-level developments.

The study highlights the role of emotions in publicly regulated human service settings by intermingling macro- and micro-level processes and thereby broadens the perspective of welfare state research as it reveals the impact of (managerialist) regulation on the dynamic organizational chemistry of such settings.

Sharing patient health information (PHI) among hospitals has been much slower than the adoption of health record systems. This paper aims to investigate if privacy regulation (PR) or security measures (SMs) influence hospitals’ use of health information exchange (HIE) to share PHI with other providers (e.g. physicians, labs, hospitals). The study specifically focuses on how multiple PRs can impede and a strong national security infrastructure (NSI) can support HIE.

The study uses secondary data from a multi-national and multi-hospital survey administered by the European Union. The multi-level structure of the cross-sectional panel data is used to test the influence of both hospital-level (e.g. PR) and national-level variables (e.g. NSI) on HIE. A total of nine types of HIE, three types of PRs, nine SMs and other relevant control variables are considered. This study uses a two-level random intercept generalized linear model to test the hypothesis proposed in the study.

The study finds that national-level PRs (NLPR) have the strongest positive influence on HIE in comparison to regional (RLPR) and hospital-level (HLPR) PRs. Moreover, the study finds evidence that the presence of RLPR and HLPR, on average, decreases the positive impact of NLPR by 264%. The SMs also have a significant and positive impact on HIE. Adoption of an additional SM can increase the odds of engaging in a certain type of HIE between 21% and 61%. On the other hand, a strong NSI can also amplify the positive impact of SM on certain types of HIE.

This study extends prior research on the role of PRs in enabling HIE by considering the complexities brought up by adopting multiple PRs. NLPRs have the strongest impact on HIE in comparison to RLPRs or HLPRs. Moreover, public infrastructure initiatives such as those related to secure communications can also complement SMs adopted by the providers by encouraging HIE.

General Data Protection Regulation (GDPR) of the European Union (EU) was passed to protect data privacy. Though the GDPR intended to address issues related to data privacy in the EU, it created an extra-territorial effect through Articles 3, 45 and 46. Extra-territorial effect refers to the application or the effect of local laws and regulations in another country. Lawmakers around the globe passed or intensified their efforts to pass laws to have personal data privacy covered so that they meet the adequacy requirement under Articles 45–46 of GDPR while providing comprehensive legislation locally. This study aims to analyze the Malaysian and Saudi Arabian legislation on health data privacy and their adequacy in meeting GDPR data privacy protection requirements.

The research used a systematic literature review, legal content analysis and comparative analysis to critically analyze the health data protection in Malaysia and Saudi Arabia in comparison with GDPR and to see the adequacy of health data protection that could meet the requirement of EU data transfer requirement.

The finding suggested that the private sector is better regulated in Malaysia than the public sector. Saudi Arabia has some general laws to cover health data privacy in both public and private sector organizations until the newly passed data protection law is implemented in 2024. The finding also suggested that the Personal Data Protection Act 2010 of Malaysia and the Personal Data Protection Law 2022 of Saudi Arabia could be considered “adequate” under GDPR.

The research would be able to identify the key principles that could identify the adequacy of the laws about health data in Malaysia and Saudi Arabia as there is a dearth of literature in this area. This will help to propose suggestions to improve the laws concerning health data protection so that various stakeholders can benefit from it.

Various health systems are challenged by a multifaceted crisis of increased service demand and workforce shortages. The effects are devastating and may end up in decreased access to care, poor quality of patient care and extreme demands on the workforce. The introduction of the physician assistant (PA) profession provided an avenue to address such challenges in several countries. In Germany, the integration of PAs has been proceeding slowly.

To understand the integration of the profession in Germany, we conducted 15 expert interviews to reveal how the PA profession is perceived among healthcare experts as well as the barriers and facilitators of integration in inpatient care.

Our results highlight a generally positive perception of PAs, particularly in terms of workload relief and bridging the gap between healthcare professionals. Nonetheless, barriers include resistance from healthcare workers unfamiliar with the PA role, while workforce shortages and collaborative teamwork facilitate integration.

These findings lay the groundwork for potential integration-enhancing strategies in Germany.

This study examines the effect of occupational stress on turnover intention of employees working in the banking industry. The authors examine the mediating effects of service climate and emotional regulations of the employees in the relationship between occupational stress and intention to leave the organization.

This study followed stratified sampling technique for data collection from employees of ten commercial banks based on the banks' financial performance of top 5 and bottom 5 out of 27 banks. Data were collected at 2 stages, first from 465 employees for occupational stressors and second from 408 employees among the participants in the first stage for turnover intention, service climate and emotional regulation. Harman’s one-factor test was conducted to examine the common method bias. Confirmatory factor analysis (CFA), regression analysis and Preacher and Hayes Process Macro approach were used to examine mediation effect.

Three factors, namely workload (WL), role ambiguity and growth opportunity expectations were identified as the occupational stressors in the banking industry, predicting a positive relation of overall occupational stress to the intention to turnover. Service climate and the employees’ emotion regulation ability mediate the relationship between stress and turnover intention. Results also revealed no significant role of control variables in predicting occupational stress and turnover intention.

This study implies that the WL, role ambiguity and growth opportunity expectations of the employees cause stress in employees which may lead to have turnover intention. In order to get success in competitive environment, managers of banking industry can address stressors by enhancing service climate and formulating policies and programs to strengthen the emotion regulation which is evidence to strengthen the reciprocity approach of social exchange theory in employees’ commitment.

This study contributes to the social exchange theory and attempts to fulfill the gaps in empirical research on personnel psychology, human capital\ and organization management in developing countries.