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1 – 10 of over 4000Floriana Fusco, Marta Marsilio and Chiara Guglielmetti
Understanding the outcomes of co-creation (CC) in healthcare is increasingly gaining multidisciplinary scientific interest. Although more and more service management scholars have…
Abstract
Purpose
Understanding the outcomes of co-creation (CC) in healthcare is increasingly gaining multidisciplinary scientific interest. Although more and more service management scholars have pointed out the benefits of cross-fertilization between the various research fields, the literature on this topic is still scattered and poorly integrated. This study aims to summarize and integrate multiple strands of extant knowledge CC by identifying the outcomes of health CC and the determinants of these outcomes and their relationships.
Design/methodology/approach
A structured literature review was conducted per PRISMA guidelines. A total of 4,189 records were retrieved from the six databases; 1,983 articles were screened, with 161 included in the qualitative thematic analysis.
Findings
This study advances a comprehensive framework for healthcare CC based on a thorough analysis of the outcomes and their determinants, that is, antecedents, management activities and institutional context. Extant research rarely evaluates outcomes from a multidimensional and systemic perspective. Less attention has been paid to the relationship among the CC process elements.
Research limitations/implications
This study offers an agenda to guide future studies on healthcare CC. Highlighting some areas of integration among different disciplines further advances service literature.
Practical implications
The framework offers an operational guide to better shape managerial endeavors to facilitate CC, provide direction and assess multiple outcomes.
Originality/value
This is the first extensive attempt to synthesize and integrate multidisciplinary knowledge on CC outcomes in healthcare settings by adopting a systematic perspective on the overall process.
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Fiorella Pia Salvatore, Simone Fanelli, Chiara Carolina Donelli and Michele Milone
This study aims to analyze the value-based health-care model in defining a strategy to guide the evolution of health-care organizations toward a value-oriented model. To improve…
Abstract
Purpose
This study aims to analyze the value-based health-care model in defining a strategy to guide the evolution of health-care organizations toward a value-oriented model. To improve the quality of care by ensuring economic sustainability, it is necessary to redefine the concept of competition in healthcare and align it with the concept of maximizing value for patients.
Design/methodology/approach
Performance measurement is a crucial aspect of the analysis of health-care organizations. Porter developed an effective analytical technique and presented the measurement of health-care outcomes based on health conditions, the efficiency of health-care organizations and the type of service provided.
Findings
Clinical outcomes and data on the costs of care of each patient are essential to evaluate improvement in treatment value over time. Engaging in the evaluation of what happens to patients in their course of care enables the expansion of the measurement of outcomes because it measures all the health services related to it.
Originality/value
Building a health-care system based on the value and continuous improvement of care and services provided is a goal shared by many countries and international organizations. Today, the analysis of outcomes is important for making informed decisions, directing and planning clinical and organizational changes by improving the quality of care and services.
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Axel Wolf, Annette Erichsen Andersson, Ewa Wikström and Fredrik Bååthe
Value-based health care (VBHC) argues that health-care needs to re-focus to maximise value creation, defining value as the quota when dividing the outcomes important for the…
Abstract
Purpose
Value-based health care (VBHC) argues that health-care needs to re-focus to maximise value creation, defining value as the quota when dividing the outcomes important for the patient, by the cost for health care to deliver such outcomes. This study aims to explore the perception of value among different stakeholders involved in the process of implementing VBHC at a Swedish hospital to support leaders to be more efficient and effective when developing health care.
Design/methodology/approach
Participants comprised 19 clinicians and non-clinicians involved in the implementation of VBHC. Semi-structured interviews were conducted and content analysis was performed.
Findings
The clinicians described value as a dynamic concept, dependent on the patient and the clinical setting, stating that improving outcomes was more important than containing costs. The value for non-clinicians appeared more driven by the interplay between the outcome and the cost. Non-clinicians related VBHC to a strategic framework for governance or for monitoring different continuous improvement processes, while clinicians appreciated VBHC, as they perceived its introduction as an opportunity to focus more on outcomes for patients and less on cost containment.
Originality/value
There is variation in how clinicians and non-clinicians perceive the key concept of value when implementing VBHC. Clinicians focus on increasing treatment efficacy and improving medical outcomes but have a limited focus on cost and what patients consider most valuable. If the concept of value is defined primarily by clinicians’ own assumptions, there is a clear risk that the foundational premise of VBHC, to understand what outcomes patients value in their specific situation in relation to the cost to produce such outcome, will fail. Health-care leaders need to ensure that patients and the non-clinicians’ perception of value, is integrated with the clinical perception, if VBHC is to deliver on its promise.
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Felix Gradinger, Julian Elston, Sheena Asthana, Chloe Myers, Sue Wroe and Richard Byng
This integrated care study seeks to highlight how voluntary sector “wellbeing co-ordinators” co-located in a horizontally and vertically integrated, multidisciplinary community…
Abstract
Purpose
This integrated care study seeks to highlight how voluntary sector “wellbeing co-ordinators” co-located in a horizontally and vertically integrated, multidisciplinary community hub within one locality of an Integrated Care Organisation contribute to complex, person-centred, co-ordinated care.
Design/methodology/approach
This is a naturalistic, mixed method and mixed data study. It is complementing a before-and-after study with a sub-group analysis of people receiving input from the wider hub (including Wellbeing Co-ordination and Enhanced Intermediate Care), qualitative case studies, interviews, and observations co-produced with embedded researchers-in-residence.
Findings
The cross-case analysis uses trajectories and outcome patterns across six client groups to illustrate the bio-psycho-social complexity of each group across the life course, corresponding with the range of inputs offered by the hub.
Research limitations/implications
To consider the effectiveness and mechanisms of complex system-wide interventions operating at horizontal and vertical interfaces and researching this applying co-produced, embedded, naturalistic and mixed methods approaches.
Practical implications
How a bio-psycho-social approach by a wellbeing co-ordinator can contribute to improved person reported outcomes from a range of preventive, rehabilitation, palliative care and bereavement services in the community.
Social implications
To combine knowledge about individuals held in the community to align the respective inputs, and expectations about outcomes while considering networked pathways based on functional status, above diagnostic pathways, and along a life-continuum.
Originality/value
The hub as a whole seems to (1) Enhance engagement through relationship, trust and activation, (2) Exchanging knowledge to co-create a shared bio-psycho-social understanding of each individual’s situation and goals, (3) Personalising care planning by utilising the range of available resources to ensure needs are met, and (4) Enhancing co-ordination and ongoing care through multi-disciplinary working between practitioners, across teams and sectors.
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Tuija Muhonen, Sandra Jönsson and Martin Bäckström
The purpose of this paper is to explore health- and work-related outcomes of cyberbullying behaviour and the potential mediating role of social organisational climate, social…
Abstract
Purpose
The purpose of this paper is to explore health- and work-related outcomes of cyberbullying behaviour and the potential mediating role of social organisational climate, social support from colleagues and social support from superiors.
Design/methodology/approach
Altogether 3,371 respondents participated in a questionnaire study.
Findings
The results of this study indicate that social organisational climate can have a mediating role in the relationship between cyberbullying behaviour and health, well-being, work engagement and intention to quit. Contrary to earlier face-to-face bullying research, the current study showed that cyberbullying behaviour had stronger indirect than direct relationships to health, well-being, work engagement and intention to quit.
Practical implications
Communication through digital devices in work life is becoming more prevalent, which in turn increases the risk for cyberbullying behaviour. Organisations need therefore to develop occupational health and safety policies concerning the use of digital communication and social media in order to prevent cyberbullying behaviour and its negative consequences.
Originality/value
Cyberbullying behaviour among working adults is a relatively unexplored phenomenon and therefore this study makes valuable contribution to the research field.
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Lisa Wood, Nicholas J.R. Wood, Shannen Vallesi, Amanda Stafford, Andrew Davies and Craig Cumming
Homelessness is a colossal issue, precipitated by a wide array of social determinants, and mirrored in substantial health disparities and a revolving hospital door. Connecting…
Abstract
Purpose
Homelessness is a colossal issue, precipitated by a wide array of social determinants, and mirrored in substantial health disparities and a revolving hospital door. Connecting people to safe and secure housing needs to be part of the health system response. The paper aims to discuss these issues.
Design/methodology/approach
This mixed-methods paper presents emerging findings from the collaboration between an inner city hospital, a specialist homeless medicine GP service and Western Australia’s inaugural Housing First collective impact project (50 Lives 50 Homes) in Perth. This paper draws on data from hospitals, homelessness community services and general practice.
Findings
This collaboration has facilitated hospital identification and referral of vulnerable rough sleepers to the Housing First project, and connected those housed to a GP and after hours nursing support. For a cohort (n=44) housed now for at least 12 months, significant reductions in hospital use and associated costs were observed.
Research limitations/implications
While the observed reductions in hospital use in the year following housing are based on a small cohort, this data and the case studies presented demonstrate the power of care coordinated across hospital and community in this complex cohort.
Practical implications
This model of collaboration between a hospital and a Housing First project can not only improve discharge outcomes and re-admission in the shorter term, but can also contribute to ending homelessness which is itself, a social determinant of poor health.
Originality/value
Coordinated care between hospitals and programmes to house people who are homeless can significantly reduce hospital use and healthcare costs, and provides hospitals with the opportunity to contribute to more systemic solutions to ending homelessness.
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Guido Noto, Anna Prenestini, Federico Cosenz and Gustavo Barresi
Public health strategies and activities are intrinsically complex. According to the literature, this “wickedness” depends on the different interests and expectations of the…
Abstract
Purpose
Public health strategies and activities are intrinsically complex. According to the literature, this “wickedness” depends on the different interests and expectations of the stakeholders and the community, the fragmented governance of the related services and the challenges in measuring and assessing public health outcomes. Existent performance measures and management systems for public health are not designed to cope with wickedness since they are mainly focused on inputs and outputs, neglecting broader outcomes because of their long-term impact and the poor accountability of results. This research aims to tackle this shortfall by adopting a dynamic performance management (DPM) approach.
Design/methodology/approach
This research explores the case of the vaccination campaign of a Regional Health System. Through the analysis of an illustrative case study, the research discusses both opportunities and limits of the proposed approach.
Findings
This research highlights that DPM supports performance management (PM) in wicked contexts, thanks to the adoption of a system-wide perspective and the possibility of using simulation to experiment with alternative strategies and benchmarking performance results with simulated trends.
Originality/value
This article tackles a gap related to the management of wicked problems both from a theory and a practical perspective. In particular, this research suggests the adoption of DPM as an approach that may support policymakers in tackling social pluralism, institutional complexity and scientific uncertainty all at once.
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Open and distance e-learning (ODeL) practices have substantial contributions to make in achieving societal development goals. The challenge however remains with enhancing…
Abstract
Purpose
Open and distance e-learning (ODeL) practices have substantial contributions to make in achieving societal development goals. The challenge however remains with enhancing skilling, training and educating professionals who will contribute to this progress. The purpose of this paper is to illustrate how transformative education and training in global health can be undertaken through ODeL in increasing the quality, quantity and relevance of health professional education and training.
Design/methodology/approach
This paper is based on a descriptive qualitative case study of the International Health and Development Course offered by the University of the Philippines Open University and is thus limited in its scope from other courses in the program.
Findings
Transformative education and training through ODeL has the potential of increasing the quality, quantity and relevance of health professionals training. However more critical assessment of transformative learning outcomes is needed via rigorous methods of objectifying such outcomes. Achieving transformative health education and training requires rigorous engagement in constructivist-oriented experiential learning that allow learners to be accustomed to significant interactions achieved by involvement in problem-based methods accomplished through small group e-tivities in order to demonstrate applicability in the real work context.
Originality/value
The outcome of this paper is relevant to institutions in Asia that offer ODeL-based global health programs through open knowledge systems in order to produce graduates who are more responsive to the evolving health needs amid twenty-first century global health challenges.
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Shantanu Sharma, Faiyaz Akhtar, Rajesh Kumar Singh and Sunil Mehra
This study aims to assess the associations of early marriage and spousal age difference (independent of early marriage) with reproductive and sexual health and autonomy in…
Abstract
Purpose
This study aims to assess the associations of early marriage and spousal age difference (independent of early marriage) with reproductive and sexual health and autonomy in decision-making among married women before conception.
Design/methodology/approach
The present study was a part of a three-year community intervention to improve the preconception health of young married women (20–35 years) in the West Delhi district of India. The six key outcomes assessed were: knowledge of reproductive health, discussions related to sexual health, history of anemia, use of contraceptives by women, frequency of consumption of meals per day and the autonomy in decision-making for household expenditures. Unadjusted and adjusted logistic regression models were used to explore the associations between the two key predictors (early marriage or spousal age difference), sociodemographic variables and six outcomes. The results were expressed as odds ratio (OR) and 95% confidence interval (CI). A total of 2,324 women, enrolled from four wards in the district using cluster-based sampling, were interviewed.
Findings
Around 17% of women were married by the exact age of 18, and 20% were elder or just one year younger than their husbands. Women who were married early had low reproductive health knowledge (OR (95% CI): 0.48 (0.38–0.60)) and a lower probability of expressing autonomy (OR (95% CI): 0.78 (0.62–0.97)). However, women older than men or younger by just one year in the married relationship had higher reproductive health knowledge (OR (95% CI): 1.25 (1.01–1.54)) than women younger than men more than two years.
Originality/value
Under the umbrella of the preconception care domain, frontline workers should emphasize counseling girls and young women to marry late and delay the first pregnancy.
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James Brackley, Penelope Tuck and Mark Exworthy
This paper examines the contested value of healthy life and wellbeing in a context of severe austerity, exploring how the value of “Public Health” is constructed through and with…
Abstract
Purpose
This paper examines the contested value of healthy life and wellbeing in a context of severe austerity, exploring how the value of “Public Health” is constructed through and with material-discursive practices and accounting representations. It seeks to explore the political and ethical implications of constructing the valuable through a shared consensus over the “facts” when addressing complex, multi-agency problems with long time horizons and outcomes that are not always easily quantifiable.
Design/methodology/approach
The theorisation, drawing on science and technology studies (STS) scholars and Karen Barad's (2007) agential realism, opens up the analysis to the performativity of both material and discursive practices in the period following a major re-organisation of activity. The study investigates two case authorities in England and the national regulator through interviews, observations and documentary analysis.
Findings
The paper demonstrates the deeply ethical and political entanglements of accounting representations as objectivity, consensus and collective action are constructed and resisted in practice. It goes on to demonstrate the practical challenges of constructing “alternative accounts” and “intelligent accountabilities” through times of austerity towards a shared sense of public value and suggests austerity measures make such aims both more challenging and all the more essential.
Originality/value
Few studies in the accounting literature have explored the full complexity of valuation practices in non-market settings, particularly in a public sector context; this paper, therefore, extends familiar conceptual vocabulary of STS inspired research to further explore how value(s), ethics and identity all play a crucial role in making things valuable.
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