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As hospitals are now being designed with an increasing number of single rooms or cubicles, the individual preference of patients with respect to social contact is of great interest. The purpose of this study is to gain a better understanding of the experience of patients in an outpatient infusion center.

A total of 29 semi-structured interviews were conducted, transcribed and analyzed by using direct content analysis.

Findings showed that patients perceived a lack of acoustic privacy and therefore tried to emotionally isolate themselves or withheld information from staff. In addition, patients complained about the sounds of infusion pumps, but they were neutral about the interior features. Patients who preferred non-talking desired enclosed private rooms and perceived negative distraction because of spatial crowding. In contrast, patients who preferred talking, or had no preference, desired shared rooms and perceived positive distraction because of spatial crowding.

In conclusion, results showed a relation between physical aspects (i.e. physical enclosure) and the social environment.

The findings allow facility managers to better understand the patients’ experiences in an outpatient infusion facility and to make better-informed decisions. Patients with different preferences desired different physical aspects. Therefore, nursing staff of outpatient infusion centers should assess the preferences of patients. Moreover, architects should integrate different types of treatment places (i.e. enclosed private rooms and shared rooms) in new outpatient infusion centers to fulfill different preferences and patients should have the opportunity to discuss issues in private with nursing staff.

This study emphasizes the importance of a mix of treatment rooms, while new hospital designs mainly include single rooms or cubicles.

The purpose of this study is to evaluate the determinants of health outcomes of dialysis patients, while specifically focusing on the role of dialysis process measures and dialysis practice characteristics. The dialysis industry is facing a major transition from a volume-based health care system to a value-based cost-efficient care model, in the USA. Under the bundled Prospective Payment System, the treatment-based payment model is subject to meeting quality thresholds as defined by clinical process measures including dialysis adequacy and anemia management. Few studies have focused on studying these two processes and their association with the quality of patient health outcomes.

In this study, the authors focus on identifying the determinants of patient health outcomes among freestanding dialysis clinics, using a large cross-sectional data set of 4,571 dialysis clinics in the USA. The authors use econometric analyses to estimate the association between dialysis facility characteristics and practice patterns and their association with dialysis process measures and hospitalization risk.

The authors find that reusing dialyzers and increasing the number of dialysis stations is associated with higher levels of clinical quality. This research indicates that deploying more nurses on-site allows patients to avail adequate dialysis, while increasing the supply of physicians can hurt anemia control process. In addition, the authors report that offering peritoneal dialysis and late night shifts are not beneficial practices in terms of their impact on the hospitalization risk.

While early studies of dialysis care mainly focused on the associations between practice patterns and patient outcomes, this research reveals the underlying mechanisms of these relationships by exploring the mediation effects of clinical dialysis processes on patient outcomes. The results indicate that dialysis process measures mediate the impact of the operational characteristics of dialysis centers on patient hospitalization rates.

This study offers several managerial insights for owners and operators of dialysis clinics with respect to the association between managerial and clinical practices that they deploy within dialysis clinics and their impact on clinical quality measures as well as hospitalization risk of patients. Managers can draw on this study to optimize staffing levels in their dialysis clinics, and implement innovative clinical practices.

Considering the growth in healthcare expenditures in developing and developed countries, and specifically for costly diagnoses such as dialyses, this study offers several insights related to the inter-relationships between dialysis practice patterns and their clinical quality measures.

This study makes several major contributions. First, the authors address the extant gap in the literature on the relationships between dialysis facility and practice characteristics and clinical outcomes, while specifically highlighting the role of clinical process measures as antecedents of patient hospitalization ratio, a key metric used to measure performance of dialysis clinics. Second, this study sheds light on the underlying mechanisms that serve as enablers of the dialysis adequacy and anemia management. To the best of the authors’ knowledge, this is the first study to explore these relationships in the dialysis industry. The authors’ approach provides a new direction for future studies to explore the pathways that may impact clinical quality measures in the delivery of dialysis services.

Retrospective studies of therapeutic community (TC) treatment for drug abuse found reductions in drug use, criminality, and increased work participation after treatment completion. These studies have also shown treatment benefits, even without completion, are correlated with days of stay in residential treatment. However, others have found that high rates of early leaving from TC treatment reduce the proportion of clients with positive outcomes, raise the total cost per treated client, and lower the treatment benefit-to-costs ratio. The purpose of this paper is to describe an experimental approach to raising the days in residential treatment using earlier vocational access for clients.

The current study used a random assignment design to compare earlier integration of on-site vocational training in a vocationally integrated therapeutic community to off-site vocational training initiated after one year of residence in a traditional therapeutic community.

The resulting data support the hypotheses that client expectations and early training in job skills increase rate of treatment affiliation, the proportion of clients having effective lengths of stay, and the rate of treatment completion.

Research limitations/implications include the difficulty of assuring unbiased selection and controlling treatment assignment and conditions.

Practical implications of this research project are to support practitioners striving for longer, more effective lengths of stay, while at the same time attempting to reduce treatment time and increase effectiveness.

Social Implications of this project are to encourage social support for addiction treatment and emphasize the value of paired residential treatment and vocational education.

The originality and value of this research project lies in the adoption of a working model at Phoenix House TC (in-house vocational preparation), which utilizes early in-house vocational education as a means to increase residential program participation, increase employment skills and prospects, and decrease overall length of treatment.

This study discusses that the necessary criteria and the solution approach taken to resolve the main spatial infection problems with a burn center design should be evaluated holistically to achieve spatial infection control in a burn center. The burn center design plays an important role in protecting severely burned patients from infection because the microbial flora of the hospital can affect the infection risk. In hospitals, sterilization and disinfection are the basic components of infection prevention; however, the prevention and control of infection for burn patients also requires the design of burn centers that adhere to a specific set of criteria that considers spatial infection control in addition to appropriate burn treatment methods and treatments. In this study, a burn facility converted from a burn unit into a burn center is introduced and the necessary design inputs for the transformation are discussed because there is no holistic study in the literature that delas with all the spaces that should be in a burn center and relations between spaces. This study aims to define the functional relations between each of the units and the spaces that change according to different sterilization demands in the burn center for ensuring spatial infection control. Furthermore, it aims to propose a method for ensuring continuity in the control of spatial infections.

The burn care and health facilities guidelines are examined within the framework of spatial standards, together with a comprehensive literature review. The design method was based on the spread of microorganisms and the effect of human movement on space and spatial transitions in the burn center, according to all relevant literature reviews. To determine the extent to which the differences in treatment protocols of burn care guidelines were reflected in the space, interviews were conducted with burn facility officials. The plan–do–check–act (PDCA) method is also modeled to ensure the continuity of infection control in the burn center.

The burn center design findings are classified under three main headings, namely, location of the burn center in the hospital, spatial organization and physical features of the burn center and the air flowing system. The importance of the interactions among the criteria for spatial infection control has been revealed. Due to the physical space characteristics and air flow characteristics that change according to human movement and the way microorganisms spread, it has been seen that designing the air flow and architectural aspects together has an effective role in providing spatial infection control. Accordingly, a functional relation scheme for the center has been suggested. It is also proposed as a model to ensure the continuity of infection control in the burn center.

This research presents spatial measures for infection control in burn centers for practitioners in health-care settings such as designers, engineers, doctors and nurses. The PDCA method also leads to continuity of infection control for hospital management.

This is the first study, to the best of the authors’ knowledge, to focus on developing the criteria for spatial infection control in burn center. Moreover, the aim is to create a function chart that encompasses the relationships between the units within the burn center design so that infection control can be coordinated spatially.

The purpose of this paper is to consider queuing systems where captive repeat customers select a service facility each period. Are people in such a distributed system, with limited information diffusion, able to approach optimal system performance? How are queues formed? How do people decide which queue to join based on past experience? The authors explore these questions, investigating the effect of information availability, as well as the effect of heterogeneous facility sizes, at the macro (system) and micro (individual performance) levels.

Experimental economics, using a queuing experiment.

The authors find little behavioural difference at the aggregate level, but observe significant variations at the individual level. This leads the authors to the conclusion that it is not sufficient to evaluate system performance by observing average customer allocation and sojourn times at the different facilities; one also needs to consider the individuals’ performance to understand how well the chosen design works. The authors also observe that better information diffusion does not necessarily improve system performance.

Evaluating system performance based on aggregate behaviour can be misleading; however, this is how many systems are evaluated in practice, when only aggregate performance measures are available. This can lead to suboptimal system designs.

There has been little theoretical or empirical work on queuing systems with captive repeat customers. This study contributes to the understanding of decision making in such systems, using laboratory experiments based on the cellular automata approach, but with all agents replaced by humans.

Providing public healthcare to people is a major challenge for governments. In this sector, public-funded systems are grossly inadequate in India, and excessive commercialization and exploitation by the private sector are a stark reality. The cooperative healthcare model is emerging as an alternate system in Kerala with its strong service objective to challenge the woes of private healthcare. The cooperative hospitals in the state worked round the clock to serve the poor and needy during the devastating COVID-19 pandemic. The pandemic has also badly exposed the weakness of our healthcare system in the wake of challenges posed by an increase in demand for health services, especially in rural areas. The resultant rise in the cost of treatment has put severe strains on the people at a time when even their day to day jobs were in peril. India has a strong cooperative movement and world-class institutions to serve as models in each sector. The Thrikkakara Municipal Co-operative Hospital, located at Cochin in the Kerala State of India on which this case study is written was established by the Hospital Society Ltd. in 1999, as a project under the People’s Planning Programme of the Government. Today, it has grown into a medium-sized healthcare establishment with the prime objective ‘Modern healthcare to all at affordable costs’ and cater to an average of 700 outpatients a day. This case study reveals the inception, development over years, facilities available, operations, management, public interface, and outlook for the hospital to become a modern healthcare institution to serve the people still better.

Huge gap exists between demand and supply of seeking health care leads to remain high maternal mortality in rural areas of Uttar Pradesh, India. The purpose of this paper is to make an effort in this direction.

This paper draws on Three Delays Model to understand the reasons behind poor maternal health outcomes among 964 currently married women aged 15–34, given birth in last two years preceding the survey including six case studies in poor settings of Northern India.

Receiving minimum four antenatal care and identifying the severity of obstetric complications during pregnancy was quite low (7 and 34 per cent, respectively). Major delay in seeking care in district was decision delay (average four days) followed by arranging transportation (average 4 hours) and start treatment within an hour after reaching health facility. Health services and trained human resources are mainly concentrated at towns and poor supply of drugs and equipment in labour room is always in demand at primary level in the district in area. Delays in decision making, travel and treatment compounded by ignorance of obstetric complications and poor healthcare infrastructure are the major contributing factors of maternal deaths in the district in area.

Interventions to improve timely seeking of medical care for obstetric complications may need to more effectively target husbands and family members rather than women. Strengthening of primary and secondary level facilities and timely referral to tertiary level care can play a crucial role in improving obstetric care in the district in rural areas.

In this article we introduce De Borg, a collaboration of five institutions in the Netherlands for adults with mild learning disabilities (intellectual disabilities) and severe problem behaviour. Some results are presented of the research that has taken place in the treatment units about the characteristics of our clients. We finish with recent developments in De Borg institutions, such as the creation of a common ‘vision on treatment and treatment programmes’ and the improvement of treatment programmes.

The study aims to facilitate the medical tourists visiting emerging countries for various kinds of ailments by ranking the possible destinations to avail medical treatments.

A Fuzzy Analytical Hierarchical Process (FAHP) with a mixed-method approach is applied to analyze data collected from patients and substantiate it with medical tour operators in India to gain managerial insights on the choice-making patterns of the patients.

India is a preferred emerging market location due to the low cost and high medical staff quality. India offers value for money, whereas Singapore and Thailand are preferred destinations for quality and technology.

The study will facilitate the emerging markets' governments, hospitals and medical tourists to understand the importance of various determinants responsible for availing medical treatment outside their country.

The study recommends that cost and quality care are the patients' prime focus; government policies must provide clear guidelines on what the hospitals and country environment can offer and accordingly align the marketing strategies.

This study is the first attempt to rank various factors affecting medical tourism using the FAHP approach.

Students with and at-risk for emotional and behavioral disorders (EBD) or behavioral difficulties have unique and heterogeneous needs that affect their academic, behavioral, and social skills. As such, many of these students are served in more restrictive settings (e.g., residential facilities) than their peers with other disabilities. However, there is little research to document the characteristics of students who are served outside of their neighborhood school. In this chapter, we describe a study of students with and at-risk for EBD served in a residential facility in the southeastern United States. Descriptive analyses of the behavioral, academic, and social characteristics of 18 students enrolled at the facility suggest that, on average, students scored above average for problem behaviors, below average on academic measures, and below average for social skills. Linear regression analyses suggest that age did not predict performance and that certain behavioral indices predicted student achievement on both academic and social skills measures. Limitations and implications for future research are discussed.