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The purpose of this paper is to address a gap in operations management empirical research through the use of diffusion of innovation (DOI) theory to develop further insight into patient flow and bed management, a problem that has been taxing healthcare organizations across the world.

The study used an action research (AR) approach and was conducted over an 18-month period within an acute hospital in the north east of England. Data were generated through enacting AR cycles, interviews, participant observation, document analysis, diaries, meetings, questionnaires and statistical analysis.

The research conducted within this study has not only led to practical outcomes for the hospital in terms of the successful adoption of a new patient flow system but has also led to new knowledge about the determinants of diffusion for technological and process innovations in healthcare organizations which are complex and highly political.

AR is not suited to all organizations and is most appropriate within those that are culturally attuned to participative and democratic ways of working. The results from this study are not generalizable but some similar organizations may see merits in this approach.

The AR approach has supported the hospital in adopting the new system, PFMS. This system is helping to improve the quality of patient care, providing facilities to support the work of clinicians, aiding timely discharge of well patients back into the community and saving the hospital money in terms of not needing to open emergency “winter” wards.

From an operations management perspective this work has demonstrated the potential to bring theory, in this case DOI theory, and practice closer together as well as show how academic research can impact organizations. Local-H intends to continue developing its AR approach and take it into other systems projects.

The aim of this paper is to use an innovation decision process to examine CRM technology adoption in small to medium-sized enterprises and its intrinsic link to the nature of the organisation and the individuals within it.

A survey was administered to SMEs in Southern California to measure the organisational characteristics, specifically management characteristics, employee characteristics, IT resources and firm characteristics. The perception of CRM, decision to adopt CRM, and extent of CRM implementation were also measured. Previously validated instruments were used where required. The data were analysed using multivariate and logistic regression.

The results indicate that management's innovativeness affects the firm's perception of CRM systems, but age, education and gender do not. The decision to implement a CRM system is influenced by management's perception of CRM, employee involvement, the firm's size, its perceived market position, but not the industry sector. However, the number and types of CRM features implemented are affected by management's perception of CRM, employee involvement, the firm's size, the industry sector, but not its perceived market position.

This study is specific to Southern California and the sample size is relatively small, although sufficient for this analysis. The study should be replicated in more diverse geographic settings with a larger sample.

The study provides evidence of the need for management to be supportive of innovation and technology, to evaluate the available resources (IT knowledge, skills, infrastructure) within the organisation, to recognise the importance of employees' contributions, and to be aware of the features appropriate to their company's size and industry sector before undertaking CRM technology adoption.

The findings from this study extend the understanding of CRM adoption in SMEs and help in building a greater understanding of the factors associated with such adoption. It will be of great value to owners/managers in SMEs who are considering adopting CRM.

The customer relationship management (CRM) technology adoption process in small- and medium-sized enterprises (SMEs) is an under-researched area and the purpose of this paper is to extend the knowledge and offer greater understanding of the CRM adoption process through an empirical study in the USA.

In this study it is hypothesized that the likelihood of CRM technology being adopted is dependent on management characteristics, organizational characteristics and management's perception of CRM technology. To investigate the proposed model a survey of SMEs in the retail, manufacturing and services sectors was conducted in Southern California, USA.

The results indicate that management characteristics significantly influence a firm's perception of CRM technology specifically innovativeness and positive attitude to CRM. Organizational characteristics such as the employee, information technology (IT) resources, a firms’ innovativeness influence the likelihood that CRM technology will be adopted and the extent to which CRM technology will be implemented.

First, the industries focused on were in retail, manufacturing and services. Second, the sample was geographically specific to Southern California. Third, the sample size in this study was relatively small, although it is within the testable range. Finally, only one respondent was surveyed from each firm.

Management regardless of gender, age or education level, must be supportive, innovative and have a positive attitude towards the new IT application, as positive perception will likely to lead to decision to adopt. In addition, there must be innovation within the organization and the firm must have the ability to absorb knowledge and to use it. There must be an availability of IT resources, both infrastructure and skills to support the change.

The results of this study have implications for CRM adoption in SMEs. More importantly, they suggest a framework which demonstrates the necessary linkage between organizational characteristics and CRM adoption process.

The purpose of this paper is to address the call for more public sector empirical studies on benefits realisation (BR), to contribute to the literature on BR as a dynamic capability (DC) within the context of IT-enabled innovation in a public sector context and to highlight the challenges facing organisations if they adopt a BR competence and capability framework.

The empirical research conducted within this paper is an exploratory survey. Exploratory surveys are particularly useful when investigating a little known phenomenon and can help to uncover or provide preliminary evidence of association among concepts. This survey was a census of all National Health Service acute hospital trusts in England.

The study indicates that most hospitals that participated in the survey have a basic approach to BR and have yet to develop a more mature approach that would provide the strong micro-foundations of a BR capability.

The BR framework that has been the basis of the survey is interesting in terms of its components but is limited with regards to the micro-foundations of a benefits realisation capability within an organisation. The research suggests that organisations in the public sector need to focus much more on staff development and recruitment in the area of BR to ensure that they have the appropriate skills sets for a rapidly changing environment.

The paper proposes a framework for BR capabilities and IT-enabled change, and suggests that although the concept of maturity is valuable when considering the micro-foundations of BR, DCs change and respond to stimuli within the external and internal environment and must be renewed and refreshed regularly.

Age-difference in couple relationships in Mexico and Latin America has been a field of study predominantly approached by demographers and sociodemographers. In Western Europe and North America, the tendency is similar yet sociologists and anthropologists have contributed important knowledge to this discussion. The results of both groups of studies show that in most societies men marry and cohabitate with women younger than them and that in a rather small percentage women are older than men. The discussion on the reasons for which men prefer younger women or women prefer older men when marrying and cohabitating go from psychological to economic grounds. This study aims to contribute to the discussion on the reasons for which this pattern persists by study examining the narratives of 81 Mexican heterosexual men and women from three generations. This is done from a qualitative and sociological standpoint that approaches the age differences from the subjectivity and intimacy of the interviewees aiming to understand (i) the meanings of the age-gap and age discrepancy, (ii) the role of schooling and social class in the significance of the age-gap and age-discrepancy relationships, and (iii) the gender inequality in age-gap relationships. The data show that amid a vigorous and strong trend of unions between older men and younger women where great gender inequalities may persist, there are signs of cultural change that show the discomfort and stigma of such differences. This, rather than being a contradiction, reveals how schooling and social origin affect the resignification of the difference, and moreover, suggests that the power relations in the couple are more equitable.

Organisations spend a lot of money, time and resources on enterprise system (ES) implementation and often they do not realise the expected benefits from these complex systems. There is a gap in the literature in providing sufficient insight into the implementation process or how an ES might influence or contribute to a culture change. The purpose of this paper is to address the gap in the ES literature around culture by exploring the implementation that was undertaken within a large UK university.

This paper contributes to the higher education (HE) and ES literature through an in-depth study of an ES, Strategic Information Technology Services (SITS) implementation within a university in the UK. The study was undertaken over a three-year period where one of the authors was embedded within the organisation.

Using a cultural analysis framework, the extensive rich data were analysed and the outcomes indicate that SITS has had a huge influence on the culture of the university; the technology’s rigid structure has imposed many changes that had not been anticipated.

ES have recently emerged in the HE sector where they are intended to support the management of student data and provide strategic management information. Although there are many studies which have explored important aspects of the implementation of ES, one area that appears to have been under-researched is how these systems are implicated in culture change within organisations. The results of this study will enable managers as well as IT specialists to gain rich insights into an ES implementation in the HE sector and to use this knowledge for future implementations.

Discusses the NHS Executive′s information management and technology (IM&T) strategy and its relationship to the 1991 reforms. Examines the recommendation for large acute hospitals to adopt integrated hospital information support systems (HISS). Reports that a recent census of these hospitals, undertaken by the authors, suggests that the implementation of the strategy′s recommendations has been slow at the local level. Attempts to diagnose the factors that are impeding implementation, using the evidence provided by the census. Identifies four main problem areas: the lack of success of past IM&T initiatives undermines confidence in the current strategy; the strategy is poorly aligned with other policy initiatives; the legacy of discrete, proprietary information systems within hospitals makes the creation of an integrative information environment difficult to accomplish without massive investment in new systems; and there are implicit contradictions between the following: the absence of a comprehensive post‐implementation evaluation of the economic, technological and cultural feasibility of HISS at any of the three HISS pilot sites; the strategy′s advocacy of HISS as the way forward for large acute hospitals; the requirement for a comprehensive business case to support any substantial investment in IM&T. Concludes that a massive rethink of policy is required, with a much greater emphasis on research, development and independent evaluation.

This chapter examines the associations between gender, social support, and health outcomes for individuals living with HIV disease. We include social integration and social isolation as structural measures of social support as well as perceived social support and social conflict as functional measures of social support. We include both mental health and physical health outcomes, which are too often studied in isolation of each other.

Data are from the Coping with HIV/AIDS in the Southeast (CHASE) study; this study reports on baseline data from 611 participants collected from 2001 to 2002. We first examined differences by gender and race, and then used blocked linear regression to determine the additive effects of the social support variables on both mental and physical health outcomes while controlling for potential confounders.

There were notable differences in the significance and strength of social support variables in health outcome models for men and women. Unlike men, social conflict was the strongest predictor of greater psychological distress and poorer physical health-related quality of life among women.

While the results from this study contribute to a greater understanding of gender differences in the relationships between social support and health outcomes, the data used for this study are limited to those living with HIV/AIDS in the Southeast.

Our findings suggest that social conflict may be more detrimental for the health of women than men.

The race concordance hypothesis suggests that matching patients and health providers on the basis of race improves communication and patients’ perceptions of health care, and by extension, encourages patients to seek and utilize health care, which may reduce health disparities. However, relatively few studies have examined the impact of race concordance on the utilization of health services. This chapter is grounded on Andersen’s Emerging Model of Health Services Utilization (Phase 4) and extends that model to include race concordance.

The data were collected from a stratified random sample of adult beneficiaries enrolled in North Carolina Medicaid’s primary care case management delivery system in 2006–2007. Propensity score matching techniques were used to sort respondents on their propensity for race concordance and indices were constructed to generate key control variables. Poisson regression was used to examine the impact of race concordance on the utilization of primary care and emergency room care, under the assumption that race concordance would increase the use of primary care and decrease the use of emergency care for minority patients.

While blacks (compared to whites) used less primary care and had more emergency care visits, race concordance was not a statistically significant predictor of either primary care or emergency room use. However, patients’ satisfaction with their primary care providers was associated with significantly fewer primary care and emergency care visits while trust in one’s provider was associated with more primary care visits.

The study findings suggest that the central premises of the race concordance hypothesis require further study to confirm the assumption that better patient – primary care provider relationships result in less utilization of more costly and resource-intensive forms of health care.

The study makes a valuable contribution by expanding the relatively small body of literature dedicated to exploring the impact of race concordance on health services utilization. Additionally, by virtue of researching the experience of Medicaid enrollees, the study controls for health insurance status.