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This chapter explores the experiences of people with complex conditions before and during the COVID-19 pandemic, their fears for imagined futures when the pandemic first appeared, their reflections on their experiences and present status, as well as plans for a post-pandemic future.

This research is based on semi-structured interviews conducted by phone, Zoom, or in-person with six participants, each interviewed twice – before and during the pandemic – who either have complex medical conditions or are mothers of a child with complex medical conditions, in the United States. Half the interviews were conducted before the pandemic and the other half during the pandemic.

The data illuminate the understanding of our participants of the COVID-19 pandemic as a disability issue, which should be analyzed with the focus of disability as an intersectional social category and that disabled people felt at higher risk due to ableism in health policies and getting their health needs met. The results demonstrated the tremendous impact of the pandemic on the lives of our participants with complex medical conditions, whether in their work, care, physical and mental health, and social relationships.

This study points to the importance of policymakers incorporating strategies to reduce ableism in health care provision, rationing, and other forms of decision-making. Services need to be designed keeping in mind the challenges of disabled people and their need for care. In addition, adequate education, and employment opportunities for disabled people must be ensured, while continuing to expand access options to disabled people that were available throughout the lockdown.

The purpose of this paper is to explore the “active ingredients” of integrated behavioral health care (IBHC) from the perspective of Karen refugee participants in an IBHC intervention.

This paper is based on in-depth, semi-structured interviews with participants (n=40) who have received an IBHC intervention for one year. These qualitative data are supplemented by descriptive quantitative data from those same participants.

This research suggested that IBHC increased awareness and access to behavioral health services, and that IBHC may be especially amenable to treating complex health conditions. The research also found that IBHC provided a point of regular contact for patients who had limited time with their primary care providers, which helped to enhance access to and engagement with health care.

IBHC has the potential to meet the complex needs of Karen resettled refugees living in an urban setting in the USA.

IBHC is a promising approach to help meet the mental health needs of refugees in the USA. There are, however, gaps in knowledge about the “active ingredients” of IBHC. This paper helps fill these gaps by studying how IBHC works from the perspective of a group of Karen refugees; these are critical perspectives, missing in the literature, which must be heard in order to better address the complex conditions and needs of resettled refugees.

Given that the workforce constitutes a principal resource of primary care, appraisal of models of care requires thorough investigation of the health workforce in all Models of Child Health Appraised (MOCHA) countries. This chapter explores this in terms of workforce composition, remuneration, qualifications and training in relation to the needs of children and young people. We have focused on two principal disciplines of primary care; medicine and nursing, with a specific focus on training and skills to care for children in primary care, particularly those with complex care needs, adolescents and vulnerable groups. We found significant disparities in workforce provision and remuneration, in training curricula and in resultant skills of physicians and nurses in European Union and European Economic Area Countries. A lack of overarching standards and recognition of some of the specific needs of children reflected in training of physicians and nurses may lead to suboptimal care for children. There are, of course, many other professions that also contribute to primary care services for children, some of which are discussed in Chapter 15, but we have not had resources to study these to the same detail.

Fundholding (the opportunity to hold a budget at practice level) has given general practitioners (GPs) purchasing power for medical services within the reformed UK National Health Service (NHS). This new purchasing power equates to financial leverage with the NHS consultants in hospitals. Argues that fundholding is presented as an opportunity for GPs to engage in a “turf battle” with the hospital consultants without this battle becoming publicly visible. Fundholding as an accounting‐based intervention masked the nature of the professional challenge which GPs launched against the consultants and, hence, allowed territorial claims to be renegotiated through the medium of contracting. This circumvented the damage to medical professional ideologies which would have ensued if intra‐professional conflicts had become overt. The empirical study which is referred to indicates that GPs are using contracts to improve processes of case management at the hospital interface (an area where consultants have failed to communicate with GPs) and to have an input into the setting of quality standards within the hospitals. The increased financial flexibility conferred through holding budgets is also enabling GPs to expand in‐house services for primary care. Theorizes the changing power relations between GPs and consultants through exploring four dimensions of intra‐professional differentiation: task specialization; client differentiation; organization of work; and career pattern. Concludes that budgets have constituted a catalyst for professional development through reconnecting the monetary bonds between the polarized professionals in British medicine. This study indicates that, as fundholding progresses, the boundary between primary and secondary care is becoming blurred; that lead fundholding GPs are being managerialized; and that the purchasing dialogue between the GPs and the Trusts is marginalizing the role of the Health Boards (bodies which had previously held sole responsibility for the co‐ordination and delivery of health care but which now have a more limited purchasing/commissioning role).

The purpose of this paper is to highlight how the management of an adult with intellectual disabilities and complex medical conditions by a multi-disciplinary and multi-agency team approach across a clinical pathway (primary, secondary and tertiary care, health, social and third sector agencies) can be used to improve the person's physical and mental health outcome.

Literature review and case report in which the paper describes the presentation of the patient with multiple complex physical health conditions, mild intellectual disability and challenging behaviour and description of the management process and the observed outcome.

The patient required input from the multi-disciplinary community intellectual disabilities team and multi-agency team including social services and community support team, admission to a specialist intellectual disabilities ward to optimise her management. She improved relatively well and was discharged to the community. On discharge she continued to receive ongoing psychiatric, psychological and community psychiatric nurse input and maintains the sustained improvement in her mental health. She no longer displays risky or challenging behaviour, her mood has improved and there is no self-harm ideation. She remains anxious at times, however, her symptoms are much improved and do not affect her daily functioning.

This case highlights the profound and enduring psychiatric and behavioural sequelae following brain malignancy and treatment and how essential a multi-disciplinary and multi-agency approach is in the successful management of complex issues. Her symptoms appeared relatively treatment resistant until she had a specialist inpatient admission. This case study also demonstrates the strengths and advantages of having specialist care pathway for such complex presentations, allowing for integrated community, secondary and tertiary care, and for the care system to work together in a coordinated and managed way.

Students with physical and health impairments represent a small but growing group of individuals with diverse educational needs. They are those students whose physical limitations or health problems interfere with school attendance or learning to such an extent that special services, training, equipment, materials, or facilities are required. Therefore, the purpose of this chapter is to discuss some of these impairments and acquaint both general and special educators with interventions for helping students with physical and health impairments succeed.

Eating and swallowing are natural processes for sustaining life. Every occasion that we celebrate involves food. Swallowing is a complex and intricate process that involves the coordination of neural control, muscles, nerves, and respiration working together for normal swallowing to occur. When a traumatic event occurs that compromises those systems, swallowing will inevitably be affected. Children who have sustained traumatic events will have devastating effects on normal development and swallowing. Some may require feeding tubes as their primary source of nutrition while others may require the assistance of a speech-language pathologist. This chapter will provide insight in conditions that impact feeding and swallowing and the role of specialists working with learners who exhibit those problems.

This paper aims to examine the time it would take to provide medical prophylaxis for a large urban population in the wake of an airborne anthrax attack and the effect that various parameters have on the total logistical time.

A mathematical model that evaluates key parameters and suggests alternatives for improvement is formulated. The objective of the model is to minimize the total logistical time required for prophylaxis by balancing three cycles as follows: the loading cycle, the shipping cycle and the service cycle.

Applying the model to two representative cases reveals the effect of various parameters on the process. For example, the number of distribution centers and the number of servers in each center are key parameters, whereas the number of central depots and the local shipping method is less important.

Various psychological factors such as mass panic are not included in the model.

There are few papers analyzing the logistical response to an anthrax attack, and most focus mainly on the strategic level. The study deals with the tactical logistical level. The authors focus on the distribution process of prophylaxis and other medical supplies during the crisis, analyze it and identify the parameters that influence the time between the detection of the attack and the provision of effective medical treatment to the exposed population.

New organization theory posits that coordination mechanisms work by generating three integrating conditions: accountability (clarity about task responsibilities), predictability (clarity about which, when, and how tasks will be accomplished), and common understanding (shared perspectives about tasks). We apply this new theory to health care to improve understanding of how accountable care organizations (ACOs) are attempting to reduce the fragmentation that characterizes the US health care system. Drawing on four organizational case studies, we find that ACOs rely on a wide variety of coordination mechanisms that have been designed to leverage existing organizational capabilities, accommodate local contingencies. and, in some instances, interact strategically. We conclude that producing integrating conditions across the care continuum requires suites of interacting coordination mechanisms. Our findings provide a conceptual foundation for future research and improvements.

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.