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Article
Publication date: 1 June 2007

Amy Blakemore and Clare Baguley

The current focus on psychological well‐being and the treatment of people experiencing common mental disorder in primary care is of interest to health professionals and…

Abstract

The current focus on psychological well‐being and the treatment of people experiencing common mental disorder in primary care is of interest to health professionals and economists alike (Centre for Economic Performance Mental Health Policy Group, 2006). This brings with it an important opportunity to consider how services for people living with long term medical conditions may benefit from developments in widening access to psychological therapies. The National Service Framework for Longterm Conditions (DoH, 2005a) aims to improve the quality of life for people living with chronic medical conditions. Further to this, NICE Guidelines for the Management of Chronic Obstructive Pulmonary Disease (COPD) (NICE, 2004a) specifically focuses attention on quality of life issues for COPD sufferers and the influence of co‐morbid mental disorder on the ability of individuals to optimise selfmanagement of their condition. By examining issues relating to co‐morbidity of common mental disorders within the long‐term condition of COPD this paper concerns itself with how the agenda for widening access to psychological therapies delivered through a stepped model of care and the introduction of new mental health workforce roles such as community matrons, case managers and primary care graduate mental health workers (PCGMHWs) provides an opportunity for primary care services to integrate mental health care into chronic disease management for COPD, which in turn may provide a model for the development of services for other long‐term medical conditions.

Details

The Journal of Mental Health Training, Education and Practice, vol. 2 no. 1
Type: Research Article
ISSN: 1755-6228

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Article
Publication date: 15 June 2020

Padraig Collins, Zara Walsh, Aimee Walsh, Amy Corbett, Roisin Finnegan, Sinead Murphy, Lisa Clogher, Eimear Cleary and Sinead Kearns

This paper aims to evaluate the effectiveness of a stepped-care primary care psychology service through triangulating clinical outcome data, service user satisfaction…

Abstract

Purpose

This paper aims to evaluate the effectiveness of a stepped-care primary care psychology service through triangulating clinical outcome data, service user satisfaction ratings and feedback from referrers.

Design/methodology/approach

A mixed method approach including a repeated measures design (pre- and post-clinical data on standardised psychometrics) for clinical outcomes and an online and postal survey with quantitative and qualitative elements offered to all service users and referrers to the service.

Findings

In total, 125 service users completed a full intervention with the service with 56% treatment completers demonstrating a reliable reduction in the symptoms of low mood and 49.6% in anxiety. Of those within the clinical range for depression at assessment, 66.67% achieved clinical recovery following an intervention. Of those within the clinical range for an anxiety disorder at assessment, 62.03% achieved clinical recovery following an intervention. Service users reported high levels of satisfaction with the service specifying particular interpersonal qualities of the therapists and the individualisation of service provision as crucial positive factors. Referrers similarly reported high levels of overall satisfaction with the service, specifying that the speed of response to referral and length of intervention was of greatest importance to them.

Practical implications

Stepped-care psychological interventions reduce psychological distress in treatment completers with mild to moderate symptoms of anxiety and low mood. The overall interpersonal experience may be of greater importance to service users in their evaluation of a service than clinical outcomes. In their relationship to a Psychology service, referrers value speed of response and ongoing feedback. Building a robust, highly valued service may require the triangulation of evidence from all key stakeholders.

Originality/value

This paper provides a pragmatic template of how a rigorous evaluation of a primary care psychology service requires evidence from multiple stakeholders.

Details

Mental Health Review Journal, vol. 25 no. 2
Type: Research Article
ISSN: 1361-9322

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Article
Publication date: 10 December 2009

Tom Jackson

It is widely acknowledged that there is a significant gap between the demand for psychological therapy services and the supply (Bower & Gilbody, 2005). It is also…

Abstract

It is widely acknowledged that there is a significant gap between the demand for psychological therapy services and the supply (Bower & Gilbody, 2005). It is also well‐known that the health needs of people with learning disabilities are typically greater than those of the rest of the population, and that they are more likely to experience mental health problems and psychological distress (Lindsey, 2002). Difficulties in accessing psychological therapy services and long waiting times have been commonplace in recent years (Richards et al, 2003). Current moves towards modernising the NHS have led to increased accountability and competition between health providers, and many providers of psychological services have tried to increase their accessibility, effectiveness and efficiency. Adaptations to referral pathways and service delivery models in psychological care services have made changes to how clients access services and the input they receive. Accessible services, employing collaborative and stepped care models, have been identified as effective in delivering services in ways which best meet the needs of individuals and maximise the efficient use of resources (Bower & Gilbody, 2005). In our local psychology service for adults with learning disabilities, we have attempted to develop service delivery strategies and modernise referral routes so that services can be delivered which better meet the needs of our client group by optimising accessibility, efficiency and effectiveness.

Details

Advances in Mental Health and Learning Disabilities, vol. 3 no. 4
Type: Research Article
ISSN: 1753-0180

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Article
Publication date: 9 May 2016

Gary Blau, Susan A. Chapman and Melinda Neri

The purpose of this paper is to distinguish knowledge gained vs skills learned as two learning-related training criteria; and to then test the impact of two career…

Abstract

Purpose

The purpose of this paper is to distinguish knowledge gained vs skills learned as two learning-related training criteria; and to then test the impact of two career motivation variables, home care intent and stepping stone, for explaining these training criteria beyond controlled-for variables.

Design/methodology/approach

The research used a sample of 720 personal/home care aides (P/HCAs) who filled out pre-training and post-training surveys. Training consisted of 25 modules, lasting approximately 100 hours on various P/HCA knowledge bases, with training sessions generally five to six hours/day, four to five days/week over a three to four week period. Factor analyses, correlation, and hierarchical regression analyses were used to test the hypotheses.

Findings

Results showed that these two learning outcomes, knowledge gained vs skills learned, could be differentiated and reliably measured. Subsequent hierarchical regression analyses showed additional discriminant validity for these two learning outcomes. For the two measured career motivation variables, home care intent and stepping stone, home care intent was positively related to both learning outcomes but stepping stone only had a significant positive impact on skills learned. Training delivery was significantly related only to knowledge gained, while instructor rating was significantly related only to skills learned.

Originality/value

A unique sample of P/HCA trainees was utilized to test for this previously untested learning outcome distinction. As the population ages and demand increases for P/HCAs, additional training and studies evaluating such training will be needed.

Details

Career Development International, vol. 21 no. 2
Type: Research Article
ISSN: 1362-0436

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Article
Publication date: 12 November 2020

Beata Segercrantz, Annamari Tuori and Charlotta Niemistö

Drawing on a performative ontology, this article extends the literature on health promotion in organizations by exploring how health promotion is performed in care work…

Abstract

Purpose

Drawing on a performative ontology, this article extends the literature on health promotion in organizations by exploring how health promotion is performed in care work. The focus of the study is on health promotion in a context of illness and/or decline, which form the core of the studied organizational activities. The paper addresses the following question: how do care workers working in elderly care and mental health care organizations accomplish health promotion in the context of illness and/or decline?

Design/methodology/approach

The article develops a performative approach and analyses material-discursive practices in health promoting care work. The empirical material includes 36 semi-structured interviews with care workers, observations and organizational documents.

Findings

Two central material-discursive health promoting practices in care work are identified: confirming that celebrates service users as residents and the organizations as a home, and balancing at the limits of health promotion. The practices of balancing make the limitations of health promotion discernible and involve reconciling health promotion with that which does not neatly fit into it (illness, unachievable care aims, the institution and certain organizing). In sum, the study shows how health promotion can structure processes in care homes where illness and decline often are particularly palpable.

Originality/value

The paper explores health promotion in a context rarely explored in organization studies. Previous organization studies have to some extent explored health promotion and care work, but typically separately. Further, the few studies that have adopted a performative approach to material-discursive practices in the context of care work have typically primarily focused on IT. We extend previous organization studies literature by producing new insights: (1) from an important organizational context of health promotion and (2) of under-researched entanglements of human and non-human actors in care work providing a performative theory of reconciling organizational tensions.

Details

Qualitative Research in Organizations and Management: An International Journal, vol. 16 no. 1
Type: Research Article
ISSN: 1746-5648

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Article
Publication date: 11 May 2015

Teng-Kuan Wang, Taho Yang, Chih-Yao Yang and Felix T.S. Chan

The purpose of this paper is to use lean principles and simulation optimization on solving a combined hospital emergency department (ED) layout design and staff assignment…

Abstract

Purpose

The purpose of this paper is to use lean principles and simulation optimization on solving a combined hospital emergency department (ED) layout design and staff assignment problem.

Design/methodology/approach

This study is based on value stream mapping for the design and analysis of the ED. Subsequently, the authors investigate cellular manufacturing design, which addresses the decisions of continuous steps in a cell simultaneously and considers the optimal staff assignment. A simulation based on the case study is used for these methodologies. Simulation optimization is then used to optimize the staff assignments, minimize the waiting time and maximize the service level.

Findings

The linear layout outperformed in both waiting time and service level. The patients’ average waiting time is reduced from 78 to 38 minutes. The service level increased from 54.86 to 88.55 percent. Moreover, the number of nurses was reduced from nine to six.

Research limitations/implications

First, the tests for model accuracy were performed using the actual arrival rate; however, seasonal variation should be reflected. Second, the staffing levels varied were not tracked. Third, the accuracy of individual patient treatment paths can be dynamic. Fourth, the 25 percent of delays in transferring a patient to an inpatient bed will be discussed in future studies.

Practical implications

A practical case is adopted for empirical illustrations.

Originality/value

The proposed methodology innovatively solved a practical application and the results are promising.

Details

Industrial Management & Data Systems, vol. 115 no. 4
Type: Research Article
ISSN: 0263-5577

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Article
Publication date: 1 December 2001

Waleed M. S. Al‐Shaqha and Mohamed Zairi

Institutional pharmaceutical services have widely evolved over the past 20‐30 years. Hospital pharmacy practice has changed from a profession concerned chiefly with the…

Abstract

Institutional pharmaceutical services have widely evolved over the past 20‐30 years. Hospital pharmacy practice has changed from a profession concerned chiefly with the bulk preparation and distribution of drug products to one centred on ensuring optimal drug therapy. Whereas hospital pharmacists were charged with maintaining large drug stock on nursing units, many of them now provide individualised patient therapies. The practice of hospital pharmacy has therefore become one encompassing all aspects of drug therapy, from the procurement of drugs and drug delivery devices, their preparation and distribution, to their most appropriate selection and use for each patient. Hospital pharmacy services have traditionally had little involvement at the key stages in patients’ hospital care. This leads to the conclusion that the model of clinical pharmacy practice adopted by many pharmacy department hospitals is no longer appropriate for the demands of today’s health‐care services. Reviews many new models proposed for clinical pharmacy practice including an integrated model for providing a pharmaceutical care management approach in the health‐care system. This model is a response to the failures of traditional drug therapy. It is primarily an idea about how health professionals and patient should integrate their work to obtain outcomes important to patients and clinicians.

Details

International Journal of Health Care Quality Assurance, vol. 14 no. 7
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 1 December 2003

Alison Petch

Intermediate care has featured strongly in evolving strategy for support provision for older people in England. In Scotland the concept appears to have been rejected in…

Abstract

Intermediate care has featured strongly in evolving strategy for support provision for older people in England. In Scotland the concept appears to have been rejected in favour of an emphasis on integrated care. This apparent divergence is explored in the broader context of policy variation post‐devolution and against the aspirations for a whole‐system approach.

Details

Journal of Integrated Care, vol. 11 no. 6
Type: Research Article
ISSN: 1476-9018

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Article
Publication date: 1 August 2016

Justin Drupsteen, Taco van der Vaart and Dirk Pieter Van Donk

Hospitals struggle to integrate the planning from different departments; resulting in unacceptable waiting times for patients. The literature mainly addresses general…

Abstract

Purpose

Hospitals struggle to integrate the planning from different departments; resulting in unacceptable waiting times for patients. The literature mainly addresses general, organizational factors inhibiting or enabling integration and omits important factors stemming from the care delivery process. Therefore, the purpose of this paper is to uncover operational antecedents and to assess their effect on the integration of hospital planning.

Design/methodology/approach

The study is based on a three-hospital multi-case study. The main findings stem from over 40 in-depth interviews with specialists, nurses, planners, and managers of four specialties that are all involved in the orthopedic internal supply chain.

Findings

This study identifies five critical operational antecedents: performance management, shared resources, information technology, process visibility, and uncertainty/variability. The latter two are of specific importance in a healthcare context. Three distinctive roles are identified; initiating (performance management and process visibility), facilitating (information technology), and inhibiting (shared resources and uncertainty/variability).

Practical implications

The authors address how integration can be achieved, rather than merely prescribing integration as a means to improve performance. The identification of specific operational antecedents and their role help managers to find tangible ways to effectively integrate hospital planning which increases hospital performance.

Originality/value

First, the identified operational antecedents are essential supplementary factors to more common organizational and behavioral antecedents. Second, in contrast to earlier contributions the authors show the effects of antecedents on three different stages of integration, rather than on integration in general.

Details

International Journal of Operations & Production Management, vol. 36 no. 8
Type: Research Article
ISSN: 0144-3577

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Article
Publication date: 6 July 2015

Boris T Rachev

This is a report on a recent development of an innovative coordinated care solution named the Care Coordination Centre (CCC), which targets coordinated care arrangements…

Abstract

Purpose

This is a report on a recent development of an innovative coordinated care solution named the Care Coordination Centre (CCC), which targets coordinated care arrangements for a populations expected to benefit the most. The purpose of this paper is to identify the patients who might comprise this group, and to assess the best ways to meet their health, community, and social care needs before and after introducing the coordinated care solution across care settings.

Design/methodology/approach

This is a summary of the author’s experience in the design and development of a care coordination business model for US providers and UK Clinical Commissioning Groups (CCGs) using coordinated care not only as a cost-cutting tool, but as a mechanism for creating a flexible and responsive patient-centered care. The author makes an assessment of the economic benefits of coordinated care resulting from: the shift to less costly interventions; reduction in readmissions; reduced unplanned admissions; increased time allocation efficiency of healthcare staff; and the overall reduction in per-patient costs.

Findings

The health and social care systems in the USA and the UK are facing the biggest challenges in their history. Payers, providers, governments, and communities need to work to build better coordination and integration mechanisms to manage the increasing demand on health and social care in a period of stagnant health and social care budgets. New innovative models of coordinated care have been developed in both countries, at the local economy level, as the health service systems are undergoing crucial transformation from a supply to a demand-based model. In the UK, the Trafford CCG has commissioned a new CCC, responsible for the delivery of high-quality coordinated care. The CCC is designed to function at clinical, service, and community levels across multiple providers to cover, among other tasks, chronic condition patient case management, risk stratification of preventative, elective, and unscheduled care for the whole region.

Originality/value

Insights from the work with Trafford CCG would be of considerable methodological and practical interest to researchers, policy makers, commissioners, healthcare professionals, and innovators.

Details

Clinical Governance: An International Journal, vol. 20 no. 3
Type: Research Article
ISSN: 1477-7274

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