Search results

The Patient-Centered Medical Home (PCMH) has become a dominant model of primary care re-design. This transformation presents a challenge to many care delivery organizations. The purpose of this paper is to describe attributes shaping successful and unsuccessful practice transformation within four medical practice groups.

As part of a larger study of 25 practices transitioning into a PCMH, the current study focused on diabetes care and identified high- and low-improvement medical practices in terms of quantitative patient measures of glycosylated hemoglobin and qualitative assessments of practice performance. A subset of the top two high-improvement and bottom two low-improvement practices were identified as comparison groups. Semi-structured interviews were conducted with diverse personnel at these practices to investigate their experiences with practice transformation and data were analyzed using analytic induction.

Results show a variety of key attributes facilitating more successful PCMH transformation, such as empanelment, shared goals and regular meetings, and a clear understanding of PCMH transformation purposes, goals, and benefits, providing care/case management services, and facilitating patient reminders. Several barriers also exist to successful transformation, such as low levels of resources to handle financial expense, lack of understanding PCMH transformation purposes, goals, and benefits, inadequate training and management of technology, and low team cohesion.

Few studies qualitatively compare and contrast high and low performing practices to illuminate the experience of practice transformation. These findings highlight the experience of organizational members and their challenges in practice transformation while providing quality diabetes care.

This study examines chronic illness, disability and social inequality within an exposure-vulnerabilities theoretical framework.

Using the National Survey of Drug Use and Health (NSDUH), a preeminent source of national behavioral health estimates of chronic medical illness, stress and disability, for selected sample years 2005–2014, we construct and analyze two foundational hypotheses underlying the exposure-vulnerabilities model: (1) greater exposure to stressors (i.e., chronic medical illness) among racial/ethnic minority populations yields higher levels of serious psychological distress, which in turn increases the likelihood of medical disability; (2) greater vulnerability among minority populations to stressors such as chronic medical illness exacerbates the impact of these conditions on mental health as well as the impact of mental health on medical disability.

Results of our analyses provided mixed support for the vulnerability (moderator) hypothesis, but not for the exposure (mediation) hypothesis. In the exposure models, while Blacks were more likely than Whites to have a long-term disability, the pathway to disability through chronic illness and serious psychological distress did not emerge. Rather, Whites were more likely than Blacks and Latinx to have a chronic illness and to have experienced severe psychological distress (both of which themselves were related to disability). In the vulnerability models, both Blacks and Latinx with chronic medical illness were more likely than Whites to experience serious psychological distress, although Whites with serious psychological distress were more likely than these groups to have a long-term disability.

Several possibilities for understanding the failure to uncover an exposure dynamic in the model turn on the potential intersectional effects of age and gender, as well as several other covariates that seem to confound the linkages in the model (e.g., issues of stigma, social support, education).

This study (1) extends the racial/ethnic disparities in exposure-vulnerability framework by including factors measuring chronic medical illness and disability which: (2) explicitly test exposure and vulnerability hypotheses in minority populations; (3) develop and test the causal linkages in the hypothesized processes, based on innovations in general structural equation models, and lastly; (4) use national population estimates of these conditions which are rarely, if ever, investigated in this kind of causal framework.

Social Work education has seen some changes since my first paper on how The Archers could be used to enhance a student's understanding of service user experiences (Burrows, 2016). Social Work students still, however, need to understand the difficulties that their future service users may experience; learning is developed through lectures, seminars and workshops, and most of all through practice experience, but a real challenge for educators is how to show students the constant lived reality of families and communities who have complex difficulties. A visit to a household only gives a snapshot of their life, and service users may be guarded in their behaviour during a professional visit. My original paper considered the educational value of the ‘fly-on-the-wall’ perspective of The Archers, in catching unguarded moments and drawing attention to issues in the community. From the impact of rural poverty and unaffordable housing, through issues of mental health, hospital discharge, to adult survivors of child sexual abuse and the tangled webs of modern slavery, these issues will resonate with any social worker, in Adult, Children and Families or Mental Health fields. These are not just issues in a rural setting; professionals in more urban settings will recognise these as things the families and individuals they work with must deal with from time to time.

Reducing Level of Alcohol in Inks ‐ A medium‐sized US ink manufacturer recently needed to reduce the level of alcohol in its bases for water‐based inks. Ciba Geigy Pigments Division's Inks Technical Centre developed an improved formulation, containing half the alcohol of the previous one and 40 per cent more pigment to allow the ink producer to meet VOC limits and increase production efficiency, at no additional cost.

This paper aims to provide a study on knowledge management, facilitating new product innovation by intrapreneurial companies.

The methodology includes the empirical study which was conducted based on detailed questionnaire and data collection of 319 respondents from heavy engineering auto companies, such as Maruti, Honda and others. The data were analyzed to find the influence of knowledge management on new product development. Structural equation modeling method, critical path analysis and reliability were checked by Cronbach’s alpha.

The findings suggest that the innovation of a new product is critical for the companies. Also, it is very important for the companies to have knowledge management systems such as intelligence generation and dissemination process to facilitate information sharing among the various departments. Responsiveness to the market needs would be based on how authentic the customer data are and to what extent the company is able to share these data with research and product development departments to motivate new products for fulfilling these needs of the customers. This kind of process would enable the company to drive the next level of innovation within the company.

The present study has several implications for managers and researchers. The model proposed in the study suggests the adoption and implementation of knowledge management for product innovation. The study findings also suggest that developing better methods to share knowledge and intelligence among the employees about the customers’ data would be a very critical success factor for new product innovation.

This paper also suggests that the researchers can study this model with respect to inter-disciplinary and inter-country study to become competitive using new product innovation.

The study contributes toward development of theory on creating innovation facilitated by knowledge management for enhancing innovation.

Health service effectiveness continues to be limited by misaligned objectives between policy makers and frontline clinicians. While capturing the discretion workers inevitably exercise, the concept of “street-level bureaucracy” has tended to artificially separate policy makers and workers. The purpose of this paper is to understand the role of social-organizational context in aligning policy with practice.

This mixed-method participatory study focuses on a locally developed tool to implement an Australia-wide strategy to engage and respond to mental health services for parents with mental illness. Researchers: completed 69 client file audits; administered 64 staff surveys; conducted 24 interviews and focus groups (64 participants) with staff and a consumer representative; and observed eight staff meetings, in an acute and sub-acute mental health unit. Data were analyzed using content analysis, thematic analysis and descriptive statistics.

Based on successes and shortcomings of the implementation (assessment completed for only 30 percent of clients), a model of integration is presented, distinguishing “assimilist” from “externalist” positions. These depend on the degree to which, and how, the work environment affords clinicians the setting to coordinate efforts to take account of clients’ personal and social needs. This was particularly so for allied health clinicians and nurses undertaking sub-acute rehabilitative-transitional work.

A new conceptualization of street-level bureaucracy is offered. Rather than as disconnected, it is a process of mutual influence among interdependent actors. This positioning can serve as a framework to evaluate how and under what circumstances discretion is appropriate, and to be supported by managers and policy makers to optimize client-defined needs.

To justify an increase in information technology (IT) spending and to understand utilization of limited organizational resources on IT, the correlation between IT and business performance has been of great interest to business managers. However, business managers face issues and challenges in finding out how and to what extent IT is able to deliver the intended benefits. The purpose of this paper is to examine IT evaluation issues and challenges faced by information systems (IS) researchers, IS specialists, and business managers.

This paper begins by reviewing the disparate discussions in past literature on IT evaluation issues and challenges. It then provides a synthesis of the disparate discussions by identifying eight issues and challenges in IT evaluation.

The eight issues and challenges identified are: evaluation scope, evaluation timing, unit of analysis, level of analysis, different perspectives, different dimensions, different measures, and underpinning theoretical frameworks. It concludes with some suggestions on ways to improve IT evaluation practices.

This paper posits that before a pragmatic IT evaluation approach can be developed, it is necessary to first understand the issues and challenges faced by IS researchers, IS specialists, and business managers in IT evaluation. Having identified the eight issues and challenges, this paper provides pointers on what needs to be considered when conducting IT evaluation.

The aim of this study is to explore and discuss key challenges associated with having stakeholders take part in co-designing a health care intervention to increase mobility in older medical patients admitted to two medical departments at two hospitals in Denmark.

The study used a qualitative design to investigate the challenges of co-designing an intervention in five workshops involving health professionals, patients and relatives. “Challenges” are understood as “situations of being faced with something that needs great mental or physical effort in order to be done successfully and therefore tests a person's ability” (Cambridge Dictionary). Thematic content analysis was conducted with a background in the analytical question: “What key challenges arise in the material in relation to the co-design process?”.

Two key challenges were identified: engagement and facilitation. These consisted of five sub-themes: recruiting patients and relatives, involving physicians, adjusting to a new researcher role, utilizing contextual knowledge and handling ethical dilemmas.

The population of patients and relatives participating in the workshops was small, which likely affected the co-design process.

Researchers who want to use co-design must be prepared for the extra time required and the need for skills concerning engagement, communication, facilitation, negotiation and resolution of conflict. Time is also required for ethical discussions and considerations concerning different types of knowledge creation.

Engaging stakeholders in co-design processes is increasingly encouraged. This study documents the key challenges in such processes and reports practical implications.

Nanotechnology as an emerging area if adequately harnessed could revolutionise food packaging and food processing industry worldwide. Although several benefits of nano-materials or particles in food packaging have been suggested, potential risks and health hazards of nano-materials or particles are possible as a result of migration of their particles into food materials. The purpose of this review therefore assessed nanotechnology and its applications in food packaging, consumer acceptability of nano-packaged foods and potential hazards and safety issues in nano-packaged foods.

This review takes a critical assessment of previous literature on nanotechnology and its impact on food packaging, consumer health and safety.

Applications of nanotechnology in food packaging could be divided into three main divisions: improved packaging, which involves mixing nano-materials into polymers matrix to improve temperature, humidity and gas barrier resistance of the packaging materials. Active packaging deals with direct interaction between nano-materials used for packaging and the food to protect it as anti-microbial or oxygen or ultra violet scavengers. Smart packaging could be used to sense biochemical or microbial changes in foods, as well as a tracker for food safety, to prevent food counterfeit and adulteration. The review also discussed bio-based food packaging which is biodegradable. Bio-based packaging could serve as veritable alternative to conventional packaging which is non-degradable plastic polymers which are not environmental friendly and could pose a threat to the environment. However, bio-based packaging could reduce material waste, elongate shelf life and enhance food quality. However, several challenges are envisaged in the use of nano-materials in food packaging due to knowledge gaps, possible interaction with food products and possible health risks that could result from the nano-materials used for food packaging.

The increase in growth and utilisation of nanotechnology signifies wide use of nano-materials especially in the food sector with arrays of potential benefits in the areas of food safety and quality, micronutrients and bioactive ingredients delivery, food processing and in packaging Active studies are being carried out to develop innovative packages such as smart, intelligent and active food packaging to enhance effective and efficient packaging, as well as balanced environmental issues. This review looks at the future of nano-packaged foods vis-à-vis the roles played by stakeholders such as governments, regulatory agencies and manufacturers in looking into consumer health and safety issues related to the application of nano-materials in food packaging.