Anat Drach‐Zahavy, Efrat Shadmi, Anat Freund and Margalit Goldfracht
The purpose of this article is to identify and test the effectiveness of work strategies employed by regional implementation teams to attain high quality care for diabetes…
Abstract
Purpose
The purpose of this article is to identify and test the effectiveness of work strategies employed by regional implementation teams to attain high quality care for diabetes patients.
Design/methodology/approach
The study was conducted in a major health maintenance organization (HMO) that provides care for 70 per cent of Israel's diabetes patients. A sequential mixed model design, combining qualitative and quantitative methods was employed. In‐depth interviews were conducted with members of six regional implementation teams, each responsible for the care of 25,000‐34,000 diabetic patients. Content analysis of the interviews revealed that teams employed four key strategies: task‐interdependence, goal‐interdependence, reliance on top‐down standardised processes and team‐learning. These strategies were used to predict the mean percentage performance of eight evidence‐based indicators of diabetes care: percentage of patients with HbA1c < 7 per cent, blood pressure ≤ 130/80 and cholesterol≤100; and performance of: HbA1c tests, LDL cholesterol tests, blood pressure measurements, urine protein tests, and ophthalmic examinations.
Findings
Teams were found to vary in their use of the four strategies. Mixed linear models analysis indicated that type of indicator (simple process, compound process, and outcome) and goal interdependence were significantly linked to team effectiveness. For simple‐process indicators, reliance on top‐down standardised processes led to team effectiveness, but for outcome measures this strategy was ineffective, and even counter‐effective. For outcome measures, team‐learning was more beneficial.
Practical implications
The findings have implications for the management of chronic diseases.
Originality/value
The advantage of allowing team members flexibility in the choice of the best work strategy to attain high quality diabetes care is attested.
Details
Keywords
Through life stories and the unique lens of military combat service, this study analyzes how Israeli Jewish women construct their relationship to the Jewish nation-state.
Abstract
Purpose
Through life stories and the unique lens of military combat service, this study analyzes how Israeli Jewish women construct their relationship to the Jewish nation-state.
Design/methodology/approach
This qualitative study establishes a theoretical relationship between gender and the nation, including concepts such as the nation-state, the public/private divide, Jewish womanhood, and militarization in Israel. It utilizes in-depth semi-structured life story interviews with 17 Israeli Jewish women, who served in combat roles in the Israeli military.
Findings
These women demonstrate ambivalent and gendered narratives of sacrifice and success and of loyalty and resistance as they transgress and comply with the idea of the national Jewish home. They reveal a strong desire for national belonging that can be seen as an attempt to challenge the gendered public/private divide and secure their status as qualified citizens.
Social implications
Women’s integration in the military is a political issue in Israel where liberal and radical feminists, religious, bureaucratic, and other civil groups are pushing for contrasting demands. I engage in this debate by emphasizing the voices of women soldiers.
Originality/value
Instead of focusing on subjugation and marginalization owing to the unsolvable conundrum of partial military inclusion leading to (partial) political and societal exclusion, I offer an analysis of military combat service as a meaning-making practice providing a new understanding of Israeli women’s relationship to the Jewish nation-state.