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41 – 50 of over 1000Robin Miller, Kerry Allen, Catherine Mangan and Jon Glasby
The purpose of this paper is to explore the delivery of preventative services for older people from third sector organisations (TSOs) and the extent to which current commissioning…
Abstract
Purpose
The purpose of this paper is to explore the delivery of preventative services for older people from third sector organisations (TSOs) and the extent to which current commissioning arrangements enables the aspirations of policy to be achieved.
Design/methodology/approach
Semi-structured interviews with key-contacts within a sample of TSOs which had been identified by directors of Adult Social Services as delivering one of the top three preventative interventions in their local authority area.
Findings
There was evidence of considerable trust between local authorities and TSOs and as a consequence TSOs were given autonomy to develop holistic and integrated models of delivery that supported rather than diverted the TSOs’ core missions. Both sectors found it difficult to set target outcomes and connected performance frameworks for preventative services. As a consequence a major element of the commissioning cycle is not being completed and TSOs cannot be confident that they are using their resources as effectively as possible.
Research limitations/implications
This study was based in one English region, and would benefit from being extended to other English regions and home nations.
Practical implications
Universities, policy makers, commissioners and the third sector need to work together to develop common outcome frameworks for preventative services and to gather consistent data sets that can be more easily synthesised to give a “realistic” understanding of the impact of different interventions and delivery models.
Originality value
The paper contributes to the limited evidence bases of commissioning of TSOs and preventative services.
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Robin Miller and Steve Appleton
– The purpose of this paper is to explore integration and complexity through the evaluation of a case study service which supports multiply excluded homeless people.
Abstract
Purpose
The purpose of this paper is to explore integration and complexity through the evaluation of a case study service which supports multiply excluded homeless people.
Design/methodology/approach
A mixed methods theory based evaluation. Data gathering included semi-structured interviews with external stakeholders, analysis of referral and outcome data, focus groups with frontline staff members and managers, and interviews with people living in the service.
Findings
The service was highly rated by its stakeholders due to its ability to meet the immediate needs of many individuals and to facilitate access and engagement with community and specialist resources. However, not every individual responded to the support that was an offer, and a number were unable to access the service due to the nature of their needs or a lack of capacity in the service. Whilst the service was able to engage community and specialist services this often appeared to be within the parameters set by these services rather than flexibly around the needs of the individual.
Research limitations/implications
The research is based in one case study service and findings may not be transferable to different local contexts and providers. However, the findings are consistent with previous studies.
Practical implications
It is possible for commissioners to intervene in the complexities that multiply excluded homeless people experiences through the introduction of a new service. However, this is unlikely to address all of the gaps and fragmentation that people in these circumstances face. It is therefore important that partners are sensitive to such limitations and have a shared willingness to respond to continuing gaps and shortfalls.
Social implications
Despite specific national policies people continue to experience multiple exclusion homelessness which suggest that more still needs to be done to prevent people from this extremely disadvantaged social circumstance. Whilst specialist services can provide excellent support the response is still fragmented for some people meaning that work to better integrate their responses must continue.
Originality/value
The paper contributes to the evidence base of support models for multiple excluded homeless people and the factors that can enable a housing support service to respond to such needs. It also provides comment on the relevance of the concept of complex adaptive systems to the study of integration.
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Improvements in organisational culture are a common recommendation of enquiries into system failure and an aspiration of policy. The purpose of this paper is to explore an…
Abstract
Purpose
Improvements in organisational culture are a common recommendation of enquiries into system failure and an aspiration of policy. The purpose of this paper is to explore an initiative to change culture in a low-secure service through the introduction of a self-advocacy group.
Design/methodology/approach
An independent evaluation was carried out by a university research team. A theory-based methodology was deployed with qualitative data gathered through observations, interviews and focus groups.
Findings
Culture change was reported by senior managers and clinicians in relation to the transparency of the service, decision making regarding resources, and engagement of patients in redesign. Self-advocacy group members reported a different relationship with senior management which in turn enabled greater influence in the organisation. Achieving these impacts relied on independent and skilled external facilitation, support from senior managers, and a calm and democratic atmosphere in the meetings. Ward staff were kept at an arms-length from the group and were less certain that it had made any difference to the way in which the ward operated.
Research limitations/implications
The research was only based in one organisation and the impacts of the initiative may vary with a different local context. Research in a wider sample of organisations and culture change initiatives will provide greater insights.
Practical implications
Self-advocacy groups can lead to organisation culture change alongside benefits for individual group members but require funding, external and independent facilitation, and organisational endorsement and support.
Originality/value
This paper adds to the limited literature regarding culture change in secure services and services for people with a learning disability in general and also to the understanding of the impact of self-advocacy groups.
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Ross Millar, Weiyan Jian, Russell Mannion and Robin Miller
The purpose of this paper is to explore recent healthcare reform in China. Reflecting on the current literature, the viewpoint argues that greater attention should be paid to…
Abstract
Purpose
The purpose of this paper is to explore recent healthcare reform in China. Reflecting on the current literature, the viewpoint argues that greater attention should be paid to healthcare reform in China as a public policy process, particularly one that is built on policy experimentation.
Design/methodology/approach
The viewpoint argues that while recent efforts to understand the impact of reform have brought significant understanding of key issues and processes, such interest tends to focus on pragmatic concerns rather than pose wider theoretical and methodological questions about the nature and pace of reform.
Findings
The authors suggest that the lens of public policy is particular relevant and insightful given what has been documented elsewhere regarding China’s unique policy process characterised by “policy experimentation”. The authors discuss how a policy experiment perspective can provide a useful heuristic for understanding healthcare reform in China.
Originality/value
The viewpoint concludes by outlining possible applications of this approach and looks forward at the emerging research agenda in this area.
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With the advent of Clinical Commissioning Groups, the English health system has abolished more managerially led Primary Care Trusts and given greater responsibilities to groups of…
Abstract
Purpose
With the advent of Clinical Commissioning Groups, the English health system has abolished more managerially led Primary Care Trusts and given greater responsibilities to groups of local general practitioners (GPs). As with all major changes, this brings both opportunities and risks, and the authors know relatively little about what impact this might have on relationships between the NHS and local government. Against this background, the purpose of this paper is to report key findings from a scoping review commissioned by the National Institute of Health Research School for Social Care Research in order to summarise learning from recent literature.
Design/methodology/approach
The paper is based on a review of the literature on older people’s services and the relationship between general practice and adult social care, published in the UK from 2000 onwards.
Findings
Despite the longstanding nature of the issues at stake, the review identified only nine relevant studies. These were of mixed quality, and tended to focus on lessons learned from the late 1990s/early 2000s rather than more recent reforms. Overall, these studies suggest similar barriers to those identified in previous policy contexts, and there is a strong sense of relationships starting from a low base (hence the title of our title of “new conversations between old players”).
Research limitations/implications
This review is based on literature on older people’s services published since 2000 – so only provides a snapshot of the issues at stake. However, it confirms the relatively limited nature of the evidence base and the need for new research to help shape future policy and practice.
Originality/value
Despite the central contribution of GPs, the authors still know relatively little about the relationship between general practice and adult social care. Reviewing previous literature (however, limited) is crucial to current attempts to develop more effective joint working at local level.
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Catherine Mangan, Robin Miller and Carol Ward
The purpose of this paper is to report on the findings of the first stage of a project seeking to improve interprofessional working between general practice and adult social care…
Abstract
Purpose
The purpose of this paper is to report on the findings of the first stage of a project seeking to improve interprofessional working between general practice and adult social care teams. It develops the current evidence base through findings from focus groups and reflects on the implications of the findings for interprofessional collaboration.
Design/methodology/approach
The project involved running seven focus groups with general practice staff and adult social work teams to explore their perceptions and understanding of each other.
Findings
The focus groups highlighted that the negative aspects of interprofessional working outweighed the positives. Negatives included perceptions of different value bases, a lack of knowledge about each others’ roles and responsibilities which resulted in resorting to stereotypes, poor interprofessional communication and a sense of an unspoken professional hierarchy with general practitioners (GPs) at the top leading preventing a culture of appropriate challenge.
Research limitations/implications
The research has only been conducted with four GP practices and three social work teams that had expressed an interest in improving their interprofessional working. Therefore the findings may not be generalisable.
Practical implications
The case study suggests that there is a lack of effective interprofessional working between social care teams and general practice. With the current health and social care agenda focused on integration, this suggests there should be a greater focus on this area.
Originality/value
This paper illustrates that despite many years of policy makers promoting better integration, the quality of the interprofessional collaboration between social care teams and general practice remains poor.
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Terese Ching and Brian H. Kleiner
Suggests that the practice of law is one of the most regressive profesions in breaking down the white male‐dominated stereotype. State that the hiring practice does not reflect…
Abstract
Suggests that the practice of law is one of the most regressive profesions in breaking down the white male‐dominated stereotype. State that the hiring practice does not reflect the demographics of law school graduates and that women and minorities often leave the career in the first three years. Explores the current level of discrimination and harassment as well as the steps the legal community has taken to reduce future occurrences. Examines the areas of illegal bias involving race, gender, age and sexual orientation.
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Todd M. Alessandri, Diane M. Lander and Richard A. Bettis
Strategy is ultimately aimed at creating shareholder value. We examine the relationship among intrinsic (DCF) value, market value, and the value of growth options using a “perfect…
Abstract
Strategy is ultimately aimed at creating shareholder value. We examine the relationship among intrinsic (DCF) value, market value, and the value of growth options using a “perfect foresight” model. Our findings suggest that Kester's (1984) initial assessment of growth option values may not hold under alternative valuation models. We highlight important issues in the valuation of growth options related to market expectations, modeling assumptions and estimation methods. The findings suggest that the firm's growth option value depends on three factors, each of which impacts investor expectations: (1) the macroeconomic environment; (2) the industry in which the firm participates; and (3) firm specific factors.