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Improving the performance of health care organizations is now perceived as essential in order to better address the needs of the populations and respect their ability to pay for the services. There is no consensus on what is performance. It is increasingly considered as the optimal execution of four functions that every organization must achieve in order to survive and develop: reach goals; adapt to its environment; produce goods or services and maintain values; and a satisfying organizational climate. There is also no consensus on strategies to improve this performance. The paper aims to discuss these issues.

This paper intends to analyze the performance of primary health care organizations from the perspective of Kauffman’s model. It mainly aims to understand the often contradictory, paradoxical and unexpected results that emerge from studies on this topic.

To do so, the first section briefly presents Kauffman’s model and lays forward its principal components. The second section presents three studies on the performance of primary organizations and brings out the contradictory, paradoxical and unexpected results they obtained. The third section explains these results in the light of Kauffman’s model.

Kauffman’s model helps give meaning to the results of researches on performance of primary health care organizations that were qualified as paradoxical or unexpected. The performance of primary health care organizations then cannot be understood by only taking into account the characteristics of these organizations. The complexity of the environments in which they operate must simultaneously be taken into account. This paper brings original development of an integrated view of the performance of organizations, their own characteristics and those of the local environment in which they operated.

This study examined the provision of high‐tech home care by Quebec primary care organizations (CLSCs). Four technologies were selected: IV antibiotic therapy, oxygen therapy, parenteral nutrition, and peritoneal dialysis. A postal survey was sent to all CLSCs and a response rate of 69 percent was obtained; 57 percent of CLSCs have been involved in the provision of services related to three of the high‐tech interventions. The most frequently used sources of information are written material provided by manufacturers or by hospitals. CLSCs relied heavily on peer‐to‐peer training and training provided by manufacturers and hospitals. Formal agreements with hospitals regarding patient flow management were established; aspects related to the “content” of care were much less formalized. CLSCs have integrated high‐tech home care to a substantial extent. Our findings raise quality‐of‐care issues. The interface with hospitals needs to be reinforced and emphasis given to the appropriate use of technology.

The paper aims to contribute to the debate concerning the use of knowledge translation for implementing co-production processes in the healthcare sector. The study investigates a case study, in which design was used to trigger knowledge translation and foster co-production.

The paper employs a case study methodology by analysing the experience of “Oncology in Motion”, a co-production program devoted to the recovery of breast cancer patients carried on by the IRCCS C.R.O. of Aviano, Italy.

Results show how design could help to translate knowledge from various stakeholders with different skills (e.g. scientists, physicians, nurses) and emotional engagement (e.g. patients and patients' associations) during all the phases of a co-production project to support breast cancer patients in a recovery path. Stewardship theory is used to show that oncology represents a specific research context.

The paper highlights the vast practical contribution that design can have in empowering knowledge translation at different levels and in a variety of co-production phases, among different stakeholders, facilitating their engagement and the achievement of the desired outcomes.

The paper contributes to the literature on knowledge translation in co-production projects in the healthcare sector showing how design can be effectively implemented.

Racial and ethnic minorities utilize less healthcare than their similarly situated white counterparts in the United States, resulting in speculation that these actions may stem in part from less desire for care. In order to adequately understand the role of care-seeking for racial and ethnic disparities in healthcare, we must fully and systematically consider the complex set of social factors that influence healthcare seeking and use.

Data for this study come from a 2005 national survey of community-dwelling Medicare beneficiaries (N = 2,138). We examine racial and ethnic variation in intentions to seek care, grounding our analyses in the behavioral model of healthcare utilization. Our analysis consists of a series of nested multivariate logistic regression models that follow the sequencing of the behavioral model while including additional social factors.

We find that Latino, Black, and Native American older adults express greater preferences for seeking healthcare compared to whites. Worrying about one’s health, having skepticism toward doctors in general, and living in a small city rather than a Metropolitan Area, but not health need, socioeconomic status, or healthcare system characteristics, explain some of the racial and ethnic variation in care-seeking preferences. Overall, we show that even after comprehensively accounting for factors known to influence disparities in utilization, elderly racial and ethnic minorities express greater desire to seek care than whites.

We suggest that future research examine social factors such as unmeasured wealth differences, cultural frameworks, and role identities in healthcare interactions in order to understand differences in care-seeking and, importantly, the relationship between care-seeking and disparities in utilization.

This study represents a systematic analysis of the ways individual, social, and structural context may account for racial and ethnic differences in seeking medical care. We build on healthcare seeking literature by including more comprehensive measures of social relationships, healthcare and system-level characteristics, and exploring a wide variety of health beliefs and expectations. Further, our study investigates care seeking among multiple understudied racial and ethnic groups. We find that racial and ethnic minorities are more likely to say they would seek healthcare than whites, suggesting that guidelines promoting the elicitation and understanding of patient preferences in the context of the clinical interaction is an important step toward reducing utilization disparities. These findings also underscore the notion that health policy should go further to address the broader social factors relating to care-seeking in the first place.

The purpose of this paper is to draw attention to the discursive construction of multimorbidity. The study illustrates how the social reality of multimorbidity and the agency of patients are discursively constructed in scientific articles addressing care for people with multiple chronic conditions.

The study is based on the postmodern assumptions about the power of talk and language in the construction of reality. Totally 20, scientific articles were analysed by critically oriented discourse analysis. The interpretations of the findings draw on the agency theories and principals of critical management studies.

Four discourses were identified: medical, technical, collaborative and individual. The individual discourse challenges patients to become self-managers of their health. It may, however, go too far in the pursuit of patients’ active agency. The potential restrictions and consequences of a “business-like” orientation must be paid careful attention when dealing with patients with multimorbidity.

The data consisted solely of scientific texts and findings therefore serve as limited illustrations of the discursive construction of multimorbidity. In future, research focusing for example on political documents and practice talk of professionals and patients is needed.

The findings highlight the power of talk and importance of ethical considerations in the development of care for challenging patient groups.

By identifying the prevailing discourses the study attempts to cast doubt on the taken-for-granted understandings about the agency of patients with multimorbidity.

Regional health care planning deals with the regional healthcare resource location‐allocation problem posed to each public healthcare administration. Up to date, the models designed to support this kind of decision failed in their application. We found that the main reason is that often these models restrict the problem to a unique aspect (such as “covering of the territory” or “technique efficiency”), leaving outside a set of very important other dimensions, even if these are usually subjective and difficult to formalise. In this paper we present a method to identify formally these dimensions, by assigning measurable attributes to each of them. At a different level, we propose a hierarchical formulation of the overall objective of the regional healthcare resource planning for the facility systems; in this hierarchy, each leaf term corresponds to a formal evaluation criterion.

This paper aims to report on a new form of project insurance in the UK construction designed to improve collaborative working among project participants. It aims to examine the interprofessional collaborative endeavour under the new insurance arrangements, drawing on a structuration model of interdisciplinary collaboration developed in the field of healthcare studies.

The research employed a longitudinal, action research approach with participant observation. A novel element included a project facilitator as part of the action research team. Qualitative and quantitative data were collected using semi-structured interviews with close scrutiny of the documented project record.

Project structure emerges as a more important element in the collaboration process than is typically recognised in practice-based studies; the analysis revealing the interplay of structure, the socialising processes of participants and how facilitation helps develop interdependence among project participants. The analysis provides a basis for understanding collaboration on the trial project.

The project provides a unique context for the examination of collaboration under the new project insurance arrangements. The results have implications for the study of collaboration in highlighting the important relationship between project structure, collaboration and facilitation.

Understanding how interdependency is developed through structure, the socialising processes of collaborators and facilitation has important implications for those concerned with designing project arrangements and managing collaborative processes.

The paper reports on the first full trial of new project insurance arrangements in the UK. It highlights the significance of project structure, and the interplay between collaborators’ emerging practices and facilitation.

The study aims to assess the impact of disruptive frugal digital technology and small and medium-sized enterprises' (SMEs') innovation performance on the food sector in Masvingo urban, Zimbabwe. A descriptive research design was used, and quantitative data were obtained using a questionnaire survey on 50 restaurant employees and 100 customers. The empirical findings demonstrated that the performance of SMEs was significantly improved by social media, cloud computing, virtual reality (VR), augmented reality (AR), and robotics. The study concludes that disruptive digital technologies (social media, cloud computing, AR, VR and robots affect the performance of SMEs by improving food production, streamlining information transfer, and utilizing cutting-edge technical applications. This chapter recommends that the government, through those in charge of formulating policy, educate and encourage the adoption of disruptive digital technology. The application of social media, cloud computing, VR, AR, and robotics will increase local food producers' access to the market. Digitalization will have a significant effect on Zimbabwe's local food system in the future.

The purpose of this paper is to investigate service quality, patient satisfaction and loyalty in Bangladesh’s healthcare sector. It identifies healthcare quality conformance, patient satisfaction and loyalty based on demographics such as gender, age and marital status. It examines the differences between public and private healthcare sectors regarding service quality, patient satisfaction and loyalty.

The authors distributed 450 self-administered questionnaires to hospital patients resulting in 204 useful responses (45.3 per cent response rate). Data were analysed based on reliability analysis, exploratory factor analysis, independent samples t-tests, ANOVA and discriminant analysis using SPSS version 23.

Findings indicate that single patients perceive tangibles, reliability, empathy and loyalty higher compared to married patients. Young patients (⩽20 years) have a higher tangibles, empathy and loyalty scores compared to other age groups. The authors observed that private hospital patients perceive healthcare service quality performance higher compared to patients in public hospitals.

The authors focussed solely on the Bangladesh health sector, so the results might not be applicable to other countries.

The findings provide guidelines for enhancing service quality, patient satisfaction and loyalty in the Bangladesh healthcare sector and other countries.

The aim of this paper is to identify factors (i.e. age, gender, ethnicity, type of medical facility, geographical location, etc.) associated with physicians' prescribing behavior when treating influenza in the USA. The study aims to examine why the number of antiviral prescriptions remains substandard.

Data were obtained from the National Ambulatory Medical Care Survey for each influenza season between the years of 2005-2008. Bivariate analyses and two models of multivariate logistic regression analyses (one with no fixed effect and the other including year as a fixed effect) were used to analyze the data.

The results from this study revealed that among family practice physicians, 40.5 percent prescribed antiviral medications to patients presenting with influenza while 59.5 percent prescribed another form of medication. Antibiotics comprised 41.3 percent of the prescriptions for treatment of influenza. Multivariable logistic regression analyses revealed that race (White; p=0.023), type of health setting (private solo/group practice; p=0.041), employment status (owner; p=0.046), and metropolitan location (metropolitan statistical area; p=0.032) were all significantly associated with prescribing antivirals. Patients' expected source of payment (private insurance) and geographical location (Midwest) of health facility were marginally associated with prescribing antivirals.

By identifying factors associated with physicians' prescribing practices of antiviral medications, a more timely diagnosis and treatment of influenza can occur. Efforts should be targeted to improve physician education and awareness of the illness. Interventions may be implemented to improve the prescribing of antiviral medications and potentially inappropriate prescribing.