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1 – 9 of 9Rod Sheaff, Joyce Halliday, Mark Exworthy, Alex Gibson, Pauline W. Allen, Jonathan Clark, Sheena Asthana and Russell Mannion
Neo-liberal “reform” has in many countries shifted services across the boundary between the public and private sector. This policy re-opens the question of what structural and…
Abstract
Purpose
Neo-liberal “reform” has in many countries shifted services across the boundary between the public and private sector. This policy re-opens the question of what structural and managerial differences, if any, differences of ownership make to healthcare providers. The purpose of this paper is to examine the connections between ownership, organisational structure and managerial regime within an elaboration of Donabedian’s reasoning about organisational structures. Using new data from England, it considers: how do the internal managerial regimes of differently owned healthcare providers differ, or not? In what respects did any such differences arise from differences in ownership or for other reasons?
Design/methodology/approach
An observational systematic qualitative comparison of differently owned providers was the strongest feasible research design. The authors systematically compared a maximum variety (by ownership) sample of community health services; out-of-hours primary care; and hospital planned orthopaedics and ophthalmology providers (n=12 cases). The framework of comparison was the ownership theory mentioned above.
Findings
The connection between ownership (on the one hand) and organisation structures and managerial regimes (on the other) differed at different organisational levels. Top-level governance structures diverged by organisational ownership and objectives among the case-study organisations. All the case-study organisations irrespective of ownership had hierarchical, bureaucratic structures and managerial regimes for coordinating everyday service production, but to differing extents. In doctor-owned organisations, the doctors’, but not other occupations’, work was controlled and coordinated in a more-or-less democratic, self-governing ways.
Research limitations/implications
This study was empirically limited to just one sector in one country, although within that sector the case-study organisations were typical of their kinds. It focussed on formal structures, omitting to varying extents other technologies of power and the differences in care processes and patient experiences within differently owned organisations.
Practical implications
Type of ownership does appear, overall, to make a difference to at least some important aspects of an organisation’s governance structures and managerial regime. For the broader field of health organisational research, these findings highlight the importance of the owners’ agency in explaining organisational change. The findings also call into question the practice of copying managerial techniques (and “fads”) across the public–private boundary.
Originality/value
Ownership does make important differences to healthcare providers’ top-level governance structures and accountabilities and to work coordination activity, but with different patterns at different organisational levels. These findings have implications for understanding the legitimacy, governance and accountability of healthcare organisations, the distribution and use power within them, and system-wide policy interventions, for instance to improve care coordination and for the correspondingly required foci of healthcare organisational research.
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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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Sheena Asthana and Joyce Halliday
This paper considers intermediate care as part of a whole‐systems approach to care. It argues that this perspective allows a wider appreciation of the potential benefits of…
Abstract
This paper considers intermediate care as part of a whole‐systems approach to care. It argues that this perspective allows a wider appreciation of the potential benefits of intermediate care, and that this would also be a welcome feature in future research studies. The paper draws on an evaluation of intermediate care in Cornwall and outlines the central role of intermediate care co‐ordination in the whole system. The example of residential rehabilitation is then used to examine how an individual service relates to the system as a whole. Finally, factors that may also influence local systems such as partnership working and rurality are considered; these are seen as important considerations for any other authorities which might seek to replicate the Cornwall approach to intermediate care.
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Susan Richardson and Sheena Asthana
Given pressures both to share and to protect personal information in inter‐agency service provision, this article reviews the ways in which policy and legal influences shape…
Abstract
Given pressures both to share and to protect personal information in inter‐agency service provision, this article reviews the ways in which policy and legal influences shape interorganisational information exchange and highlights key developments in government guidance that are designed to promote better information sharing.
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The Children Act 2004 provides for the establishment of information‐sharing databases. This has provoked some controversy, particularly the inclusion of ‘flags of concern’. This…
Abstract
The Children Act 2004 provides for the establishment of information‐sharing databases. This has provoked some controversy, particularly the inclusion of ‘flags of concern’. This article argues that the Government needs to tread carefully to achieve the right balance between confidentiality and information‐sharing.
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To provide a selective bibliography in the emerging area of library content personalization for the benefit of library and information professionals.
Abstract
Purpose
To provide a selective bibliography in the emerging area of library content personalization for the benefit of library and information professionals.
Design/methodology/approach
A range of recently published works (in the period 1993–2004), which aim to provide pragmatic application of content personalization rather than theoretical works, are discussed and sorted into “classified” sections to help library professionals understand more about the various options for formulating content as per the specific needs of their clientele.
Findings
This paper provides information about each category of tool and technique of personalization, indicating what is achieved and how particular developments can help other libraries or professionals. It recognises that personalization of library resources is a viable way of helping users deal with the information explosion, conserving their time for more productive intellectual tasks. It identifies how computer and information technology has enabled document mapping to be more efficient, especially because of the ease with which a document can be indexed and represented with multiple terms, and confirms that this same functionality can be used to represent a user's interests, facilitating the easy linking of relevant sources to prospective users. Personalization of library resources is an effective way for maximizing user benefit.
Research limitations/implications
This is not an exhaustive list of developments in personalization. Rather it identifies a mix of products and solutions that are of immediate use to librarians.
Practical implications
A very useful source of pragmatic applications of personalization so far, that can guide a practicing professional interested in creating similar solutions for more productive information support in his/her library.
Originality/value
This paper fulfils an identified need for a “review of technology” for LIS practitioners and offers practical help to any professional exploring solutions similar to those outlined in this paper.
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