Sergio Riotta and Manfredi Bruccoleri
This study formulates a new archetypical model that describes and re-interprets the patient–physician relationship from the perspective of two widespread phenomena in the…
Abstract
Purpose
This study formulates a new archetypical model that describes and re-interprets the patient–physician relationship from the perspective of two widespread phenomena in the healthcare delivery process: value co-creation (VCC) and defensive medicine (DM).
Design/methodology/approach
Grounded in the existing literature on VCC and DM, the authors designed and conducted 20 in-depth interviews with doctors (and patients) about their past relationships with patients (and doctors). After putting the recorded interviews through qualitative analysis with a three-level coding activity, the authors built an empirically informed model to classify patient–physician relationships.
Findings
The authors identified four archetypes of patient–physician relationships. Each archetype is described along with its representing characteristics and explained in terms of its consequences as they relate to VCC and DM.
Research limitations/implications
This research contributes to the literature on both VCC in healthcare and DM, in addition to the patient–physician's relationship literature.
Practical implications
Being aware of patient–physician relationship mechanics, building long-term relations with patients and investing in service personalization and patient-centred care can effectively mitigate the risks of DM behaviours on one side while increasing the likelihood of VCC actualization on the other.
Originality/value
Although strictly linked to the interactions between patients and doctors, VCC and DM are typically considered disentangled. In this research paper, the authors identified four archetypes of patient–physician relationships in relation to these two phenomena.
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Vikki A. Entwistle, Ian S. Watt and Amanda J. Sowden
The idea that patients should be informed about the benefits and risks of treatment options and involved in decisions about their care is, to many people, appealing and sensible…
Abstract
The idea that patients should be informed about the benefits and risks of treatment options and involved in decisions about their care is, to many people, appealing and sensible. However, it has important implications. This paper briefly considers two motivations for involving patients in clinical decisions and explores some of the issues raised by these. It then makes some practical suggestions for those wanting to provide information to support patient involvement. The paper emphasizes that although the provision of more good‐quality information to patients is widely accepted to be a priority, it is not always a straightforward matter and warrants critical consideration. Substantial resources may be needed if it is to be done well.
M.F. Lambert, I.S. Watt, A.M. Woodhouse, S. Balmer and M.R. Robinson
Describes and analyses the factors limiting the success of implementation of guidelines on management of heart failure using content analysis of structured interviews with nine…
Abstract
Describes and analyses the factors limiting the success of implementation of guidelines on management of heart failure using content analysis of structured interviews with nine general practitioners in Wakefield District, validated from hospital records, to generate within‐case displays. Discusses the results and conclusions.
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Nicodim Basumatary and Bhagirathi Panda
The study attempts to assess the socio-economic development in Bodoland Territorial Area District (BTAD) of Assam in North Eastern Region of India. This region is one of the most…
Abstract
Purpose
The study attempts to assess the socio-economic development in Bodoland Territorial Area District (BTAD) of Assam in North Eastern Region of India. This region is one of the most underdeveloped areas in India. The study also examines whether demographic and social characteristics in the form of social groups, number of family members, number of employed members in the family, education of the head of household, sources of income and location determine the variation in the level of socio-economic development. The authors surveyed 400 households during February to May 2018 in both rural and urban areas of BTAD to achieve the objective of the study.
Design/methodology/approach
The authors use the concept of Amartya Sen's capability approach (CA) for assessment of development and constructed an index of Multidimensional Development.
Findings
There is variation in the distribution of developmental parameters across the study area. It is found that urban locations have better achievement in the multidimensional index score, while the spread of development is not even in the rural locations. An interesting revelation of this study is that while urban areas depict better performance in income, asset, education and empowerment, they have a relatively lower score in health dimension as compared to rural areas. The study shows that level of development depends on demographic as well as social characteristics of the households.
Research limitations/implications
This study does not analyse temporal dynamics of development that is necessary to examine how development evolves because of data constraints.
Originality/value
The study provides an understanding of the socio-economic development in BTAD area in a multidimensional framework. This study is the first of its kind to assess the nature and extent of development realised in BTAD through the capability framework. The study supports more recent findings.
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Artiom Jucov, Liliana Staver and Larisa Mistrean
Introduction: Lately, various tendencies to approach personalized medicine (PM) have developed. However, their result is a mutual application of technology without considering the…
Abstract
Introduction: Lately, various tendencies to approach personalized medicine (PM) have developed. However, their result is a mutual application of technology without considering the essence of this field. The comprehensive approach to the concept of PM reveals some aspects that need to be dealt with for a successful implementation.
Aim: Identifying possible ways of implementing PM through person-centered care, with an overall positive economic impact, improved medical services, and customer satisfaction.
Methods: The research carried out represents a retrospective descriptive cross-sectional study. Qualitative and quantitative methods were used.
Findings: PM plays an increasingly important role in the political agenda of different countries, to approve an effective method of prevention, diagnosis, and treatment of various diseases. The postponement of its implementation by the authorities and the lack of public policies lead to the unjustified expenditure of public money and contribute to halting the development of the medical system through managerial inefficiency.
The originality of the study: Different approaches to PM and its implementations are analyzed in the context of the challenges of the contemporary economy.
Implications: The research is carried out in the Academy of Economic Studies of Moldova within the state research programs.
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Carlos J. Torelli, Sharon Shavitt, Young Ik Cho, Allyson L. Holbrook, Timothy P. Johnson and Saul Weiner
The purpose of this paper is to investigate cultural variations in the qualities that White Americans and Hispanic Americans believe power-holders should embody, and the…
Abstract
Purpose
The purpose of this paper is to investigate cultural variations in the qualities that White Americans and Hispanic Americans believe power-holders should embody, and the situations in which these norms influence consumer satisfaction.
Design/methodology/approach
Two experimental studies (n1=130 and n2=121) and one field study (n=241) were conducted with White American and Hispanic participants. Results were analysed using ANOVA and regression.
Findings
White Americans are predisposed to apply to power-holders injunctive norms of treating others justly and equitably, whereas Hispanics are predisposed to apply injunctive norms of treating others compassionately. These cultural variations in the use of injunctive norms were more evident in business or service contexts in which power was made salient, and emerged in the norms more likely to be endorsed by White American and Hispanic participants (Study 1), their approval of hypothetical negotiators who treated suppliers equitably or compassionately (Study 2), and their evaluations of powerful service providers in a real-life, on-going and consequential interaction (Study 3).
Research limitations/implications
This research suggests key implications for our theoretical understanding of the role of social norms in carrying cultural patterns, as well as for cross-cultural theories of consumer satisfaction with service providers.
Practical implications
Marketers should pay attention to signals of fairness (compassion) in their services, as perceptions of fairness (compassion) by White American (Hispanic) consumers can boost satisfaction ratings. This is particularly important in service encounters that might be characterized by power differentials, such as those in health care and financial services.
Originality/value
As consumer markets grow more culturally diverse, it is important for marketers to understand how distinct notions of power impact the attitudes and behaviors of consumers from different cultures. This research investigates the implications of distinct power concepts for multi-cultural consumers’ evaluations of service providers, an important and under-researched area with implications for global service management.
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The purpose of this paper is to explore how discourse theories can contribute to the concept of identity formation within a patient- or person-centered care (PCC) orientation, to…
Abstract
Purpose
The purpose of this paper is to explore how discourse theories can contribute to the concept of identity formation within a patient- or person-centered care (PCC) orientation, to enable more critical engagement with PCC in older people.
Design/methodology/approach
This is a conceptual paper.
Findings
This paper concludes that the discourse literature has important insights for understanding identity formation in older people as operationalized in the context of PCC in three particular ways: accounting for multiplicity in patients’ identity; exploring “the devolution of responsibility” to address shifts in performing identities in clinical encounters; and attending to a “crisis of positioning” to engage empowerment discourse within a PCC philosophy.
Originality/value
Whilst a notion of patient identity is at the heart of PCC, the concept remains inconsistent and underdeveloped. This is particularly problematic for the quality of care in older adults, as PCC has become increasingly synonymous with care of older people. Discourse theories of identity formation can be used to critically engage with identity within the context of PCC, so as to develop more nuanced understandings of “the person” or “the patient,” with the potential to improve research into care for aging and older adults.
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Kieran Mervyn, Nii Amoo and Rebecca Malby
Public sectors have responded to grand societal challenges by establishing collaboratives – new inter-organizational partnerships to secure better quality health services. In the…
Abstract
Purpose
Public sectors have responded to grand societal challenges by establishing collaboratives – new inter-organizational partnerships to secure better quality health services. In the UK, a proliferation of collaboration-based healthcare networks exists that could help to enhance the value of investments in quality improvement programs. The nature and organizational form of such improvements is still a subject of debate within the public-sector literature. Place-based collaboration has been proposed as a possible solution. In response, the purpose of this study is to present the results and findings of a place-based collaborative network, highlighting challenges and insights.
Design/methodology/approach
This study adopted a social constructionist epistemological approach, using a qualitative methodology. A single case study was used and data collected in three different stages over a two-year period.
Findings
The study finds that leadership, data-enabled learning through system-wide training and development, and the provision of an enabling environment that is facilitated by an academic partner, can go a long way in the managing of healthcare networks for improving quality.
Research limitations/implications
Regardless of the tensions and challenges with place-based networks, they could still be a solution in maximizing the public value required by government investments in the healthcare sector, as they offer a more innovative structure that can help to address complex issues beyond the remit of hierarchical structures. This study is limited by the use of a single case study.
Practical implications
Across countries health systems are moving away from markets to collaborative models for healthcare delivery and from individual services to population-based approaches. This study provides insights to inform leaders of collaborative health models in the design and delivery of these new collaborations.
Social implications
As demand rises (as a result of increasing complexity and demographics) in the western world, health systems are seeking to redefine the boundaries between health service provision and community self-reliance and resilience. This study provides insights into the new partnership between health institutions and communities, providing opportunities for more social- and solidarity-based healthcare models which place patients and the public at the heart of change.
Originality/value
The city place-based network is the first of such organizational form in healthcare collaboration in the UK.
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Terry J. Boyle and Kieran Mervyn
Many nations are focussing on health care’s Triple Aim (quality, overall community health and reduced cost) with only moderate success. Traditional leadership learning programmes…
Abstract
Purpose
Many nations are focussing on health care’s Triple Aim (quality, overall community health and reduced cost) with only moderate success. Traditional leadership learning programmes have been based on a taught curriculum, but the purpose of this paper is to demonstrate more modern approaches through procedures and tools.
Design/methodology/approach
This study evolved from grounded and activity theory foundations (using semi-structured interviews with ten senior healthcare executives and qualitative analysis) which describe obstructions to progress. The study began with the premise that quality and affordable health care are dependent upon collaborative innovation. The growth of new leaders goes from skills to procedures and tools, and from training to development.
Findings
This paper makes “frugal innovation” recommendations which while not costly in a financial sense, do have practical and social implications relating to the Triple Aim. The research also revealed largely externally driven health care systems under duress suffering from leadership shortages.
Research limitations/implications
The study centred primarily on one Canadian community health care services’ organisation. Since healthcare provision is place-based (contextual), the findings may not be universally applicable, maybe not even to an adjacent community.
Practical implications
The paper dismisses outdated views of the synonymity of leadership and management, while encouraging clinicians to assume leadership roles.
Originality/value
This paper demonstrates how health care leadership can be developed and sustained.