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Purpose: The authors compare perspectives on external evaluation of health service provision between Norway and the USA. External inspection and accreditation are examples of internationally wide-spread external evaluation methods used to assess the quality of care given to patients. Different countries have different national policy strategies and arrangements set up to do these evaluations. Although there is growing attention to the impact and effects on quality and safety from external evaluation, there is still a gap in knowledge to how structures and processes influence these outcomes. Accordingly, the purpose of this article is to describe the structures and processes in external evaluation designed to promote quality improvement in Norway and the USA with attention to comparison of enablers and barriers in external evaluation systems. Design/methodology/approach: Data collection consisted of documentary evidence retrieved from governmental policies, and reviews of the Joint Commission (the US), international guidelines, recommendations and reports from the International Society for Quality in Health Care, and the World Health Organization, and policies and regulations related to Norwegian governmental bodies such as the Ministry of Health and Care Services, the Norwegian Directorate of Health, and the Norwegian Board of Health Supervision. Data were analyzed inspired by a deductive, direct content analytical framework. Findings: The authors found that both accreditation and inspection are strategies put in place to ensure that healthcare providers have adequate quality systems as well as contributing to the wider risk and safety enhancing management and implementation processes in the organizations subjected to evaluation. The US and the Norwegian external regulatory landscapes are complex and include several policymaking and governing institutions. The Norwegian regulatory framework for inspection has replaced an individual blame logic with a model which "blames" the system for inadequate quality and patient harm. This contrasts with the US accreditation system, which focuses on accreditation visits. Although findings indicate an ongoing turning point in accreditation, findings also demonstrate that involving patients and next of kin directly in adverse event inspections is a bigger part of a change in external inspection culture and methods than in processes of accreditation. Research limitations/implications: The message of this paper is important for policymakers, and bodies of inspection and accreditation because knowledge retrieved from the comparative document study may contribute to better understanding of the implications from the different system designs and in turn contribute to improving external evaluations. Originality/value: Although there is a growing attention to the impact and effects on quality and safety from external evaluation, the implications of different regulatory strategies and arrangements for evaluation on quality and safety remain unclear. [ABSTRACT FROM AUTHOR]

Purpose -- This paper aims to, by looking at the electronic medical record (EMR) from three points of view, bring light to the dynamics that are essential and are currently missing in the USA. The traditional paper medical record has worked for physicians, management and patients since the beginning of practice. Yet the development of the EMR did not begin with all the essential elements of the traditional record that were working, but instead shreds out important aspects of the patient. Design/methodology/approach -- Triangulation between three studies -- medical, information technology and management studies. Findings -- An efficient EMR has to take into consideration more than just one area of study. The dynamics between departments and users of the EMR need an integrated process that includes the necessary pieces of all involved. This hole has not been addressed in academic literature. Research limitations/implications -- The paper triangulates three areas -- medicine, management and information management. Most research on the EMR focuses only on one or two of these areas' concerns. Looking at the three sides of the EMR is important to get a solid understanding of the dynamics that can occur relaying a patient's story through various departments and uses. Practical implications -- There is a depth, space and volume crucial to the comprehensive nature of medicine. With a perspective or dimension, necessary dialogues can be addressed and more intuitive tacit knowledge from medical expertise can be made available. A prototype, filling the holes of the observed elements in this paper, is possible by using digital objects and including more information than the data of the day. Bringing accountability to the patient, more expertise to the fingertips of the physician and available data for management purposes area are the key ingredients for an effective EMR. Social implications -- With a comprehensive EMR that works more effectively for those who input the data, the patient's story can be documented with more detailed efficiency. Filling the holes of the observed elements in this paper all support better healthcare and long-term results for the health of society. Originality/value -- The paper triangulates three areas -- medicine, management and information management. Most research on the EMR focuses only on one or two of these areas' concerns. Looking at the three sides of the EMR is important to get a solid understanding of the dynamics that can occur relaying a patient's story through various departments and uses. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to present a historical overview of the health service sector in India. The development in the healthcare sector from the late eighteenth century into current times is examined from the prism of the role played by British and US healthcare systems in influencing change in the Indian setup.Design/methodology/approach Online databases searched were PubMed and JSTOR, using the search terms, “Indian health service system in transition”, “British influence on the Indian healthcare setup” and “American neo-liberal influence on Indian healthcare sector”. The authors then examined titles and abstracts of selected articles for short-listing relevant articles. Reference lists of selected articles were examined for further locating related studies. While this constituted the secondary literature for the current paper, reports by governmental and non-governmental organisation reports on the Indian health service system too were utilised as primary data sources.Findings Influenced by the British and later by the American healthcare system, the Indian healthcare network has undergone numerous changes. In the present era, the Indian healthcare system is increasingly veering towards the American model of healthcare delivery. Health is increasingly being conceived of as a commodity to be traded in the market, with the state’s role curtailed towards provisioning for and facilitating access of the weakest sections of the society through a means-tested insurance system. This has happened without adequate checks and balances on the private sector to ensure that the needs of the people accessing the system are adequately met.Social implications By tracing the development of the health service sector in India and the motives that guide such change, the paper depicts how the thrust of the system has altered from one providing universal healthcare services to the people, irrespective of their ability to pay, at the time of independence to commercialisation in present times. With the marketisation of healthcare, the focus has shifted from serving people to profiting from the provisioning of healthcare.Originality/value The paper throws light on the underlying inadequacies of the Indian healthcare setup and the need for more active participation by the government in this sector in the future if it aims to make healthcare more equitably accessible to its vast population. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to analyze the main global transformations of the healthcare sector and their underlying causes and effects. Design/methodology/approach: The study focuses on several important trends including the increasing life expectancy and aging, the rise of non-communicable diseases, the risks of pandemics, medication expenditure, the globalization of healthcare and technological innovations such as digitization, robotic and nanomedicine. Findings: The analysis indicates that the world populations will be much older in the near future and the healthcare sector will witness significant growth opportunities. The aging populations will put more pressure on healthcare systems and increase the incidence of non-communicable diseases. In a globalized world, the risks of global pandemics are expected to increase. The surge in the medication expenditure will put much pressure on healthcare systems, insurers, patients, employers and providers. The healthcare sector is characterized by its above-average growth in the USA and much of the developed world. Therefore, the share of healthcare in gross domestic product will continue to rise. The digitization and globalization of healthcare may involve major disruptions in the location and the type of care. New materials particularly nanoparticles will be used to enhance the precision, quality and efficacy of diagnostics, medications and treatments. Originality/value: The paper touches on several areas including demographic, clinical, financial, managerial and technological transformations and examines their implications for the healthcare sector. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to provide an overview of rural older veterans in the USA and discuss how the US Department of Veterans Affairs (VA) is increasing access to health care for older veterans in rural areas.Design/methodology/approach This is a descriptive paper summarizing population and program data about rural veterans.Findings VA provides a variety of health care services and benefits for older veterans to support health, independence, and quality of life. With the creation of the Veterans Health Administration Office of Rural Health (ORH) in 2006, the needs of rural veterans, who are on average older than urban veterans, are receiving greater attention and support. ORH and VA have implemented several programs to specifically improve access to health care for rural veterans and to improve quality of care for older veterans in rural areas.Originality/value This paper is one of the first to describe how VA is addressing the health care needs of older, rural veterans. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to make readers aware of the extensiveness of healthcare fraud in the USA and how it involves and affects the government, healthcare providers, insurance companies, patients and the public. In addition, recommendations are made that may help control this pervasive type of fraud.Design/methodology/approach A range of different journal publications, information from government health institutions and law enforcement websites, healthcare fraud cases and healthcare laws are used as a basis to provide information about how fraudsters are committing healthcare fraud and how to prevent this fraud from occurring.Findings Despite increased funding and prosecution efforts by the government, healthcare fraud continues to be a major threat to the US economy and public. While healthcare fraud will never be eradicated, specific efforts can be deployed to help rein in these complex fraud schemes.Practical implications The paper provides a useful resource of information on healthcare fraud for healthcare providers, insurance companies, patients and the public that may help combat healthcare fraud and prevent financial losses.Social implications Every dollar saved from combating fraud could be used to improve access to more or better health services and can, thereby, save lives.Originality/value This paper provides recommendations regarding healthcare fraud that could help prevent this large drain on the US economy. [ABSTRACT FROM AUTHOR]

Purpose: Self-direction–also known as participant direction, personalization and self-directed care–is a service delivery model that enables people to manage their personal budget and purchase services and supports tailored to their needs based on a person-centered plan. This paper, the outcome of an international learning exchange on self-direction, describes approaches across four countries' successful strategies, unresolved questions and recommendations to enhance self-direction globally. Design/methodology/approach: The findings are a product of discussions at the 2019 International Initiative for Mental Health Leadership and International Initiative for Disability Leadership Exchange on Advances in Self-Direction. Participants included people who are self-directing, providers and caregivers who support people who are self-directing, advocates, fiscal agents and public managers who administer self-direction from the United States, England, Australia and New Zealand. Findings: In all four countries, people who self-direct exercise high levels of choice and control and are able to individualize their services and supports to promote a good life in the community. The exchange also revealed challenges and possible solutions to improve and expand self-direction. Practical implications: The results of the meeting provide guidance for public managers, providers and advocates for initiating and expanding self-direction. Originality/value: This international meeting was a unique opportunity to compare self-direction across four different countries and across multiple perspectives, including people with disabilities, caregivers, providers and administrators. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to identify the primary executive leadership skills required to promote the effectiveness of Medicare Shared Savings Program Accountable Care Organizations (MSSP ACOs) and to create a new substantive theory describing these skills. The author identifies that MSSP ACO is a relatively new value-based care delivery (VBCD) structure in the USA that links clinicians' compensation to their clinical outcomes. The research question concerns what primary executive leadership skills are essential in the VBCD era. Design/methodology/approach: This single, embedded, exploratory case study is based on interviews, a focus group discussion and archival record data of MSSP ACO executives in the Northeast, Midwest, South and West of the USA. Findings: The findings represented seven major categories or the primary executive leadership skills required to succeed in the VBCD environment. Each category or skill included five subcategories or concepts supporting the leadership skills essential for reaching VBCD goals. The categories and subcategories gave rise to a new substantive theory – the Accountable Healthcare Leadership Theory of Five Ps: promoting partnership between providers, patients and payers. Research limitations/implications: The empirical generalizability of the results was limited by its essence as a single, embedded, exploratory case study of 18 MSSP ACO executives in 4 regions of the USA. The strength of this study, however, lies in its potential for making analytic generalizations for identifying theoretically meaningful leadership skills essential for success in the VBCD era. Originality/value: The author has developed and validated a new theory describing the primary executive leadership skills required to succeed in the VBCD environment. [ABSTRACT FROM AUTHOR]

Purpose -- This paper aims to discuss key provisions of the Affordable Care Act (ACA) and the obstacles faced by the federal government in achieving its goal. The ACA is designed to provide most Americans with an access to affordable health care. Design/methodology/approach -- Using data obtained from government sources, case law and current literature, the paper first discusses the history and background of the ACA. It evaluates the law's current status, the benefits it achieved and the legal, economic, political and social challenges that lie ahead. Findings -- Although the Supreme Court upheld most of the ACA's provisions, opponents at the federal and state level are still attempting to overturn or undercut it. The ACA itself is so complicated that it has generated confusion among employers, consumers and even those who are charged with enforcing it. The extent to which the ACA can be successfully implemented is unclear, and adjustments must be made as the federal government struggles to implement key components. Originality/value -- This paper should be of interest to academics, health-care and legal professionals, and to anyone who needs clarification and analysis of a still-evolving law that is certain to have an impact on most Americans. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to present the three critical changes needed to reform the US health care system -- these changes will drive cascades of other beneficial changes. These three changes include the use of transparent market prices, alignment of incentives and systematic assessment and ratings of quality. Design/methodology/approach -- The paper used an analysis based on the literature on the comparison between non-market and market systems. The current US health care system is similar to the Soviet economic system, and the paper proposes moving it gradually to where it can respond to market-based signals. Findings -- The US health care system needs to adopt transparent and real pricing, independent quality assessment of health provider organizations and portable electronic patient records. These changes will lead to continuing cascades of innovation and improvement. Research limitations/implications -- The recommended changes will be opposed by vested interest groups, and so will be easier with regulatory guidance and encouragement. It would also be useful to protect against "regulatory capture" by interested parties during the change process. Practical implications -- Health care in the USA will gradually become better and cheaper. Health organizations will become more transparent. Regulators would have to set up and supervise private quality ratings agencies. Social implications -- Social implications of this paper include greater labor mobility and higher productivity, as well as increased competitiveness of the USA. Originality/value -- In spite of numerous writings on the subject, this issue has not been analyzed in this way. This paper is unique in the way in which it layouts the process of movement to a market-based system for the US health care system. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to examine relationships between internationally educated nurses’ (IENs’) performance in a registered nurse competency assessment process and the outcomes of their nursing registration applications. Assessments of nursing practice competencies, IEN applicant characteristics and registration outcomes were explored.Design/methodology/approach This is a secondary statistical analysis of a subset of IEN application data from a previous study in combination with assessment data from an additional database. Application data between 2008 and 2011 were analyzed using univariate/bivariate analyses and regression models to explore the relationship of performance in the assessment process and outcomes of the registration process.Findings Competency categories IEN applicants had difficulties with (from least to most) were Professional Responsibility and Accountability, Ethical Practice, Self-Regulation, Service to the Public, Knowledge-Based Practice: Specialized Body of Knowledge and Knowledge-Based Practice: Competent Application of Knowledge. IENs educated in the UK and USA had the highest scores and odds of meeting competencies. Applicants educated in India and Asia had lower scores and odds ratios. All national entry-to-practice examination and registration eligibility competencies were significantly related to registration outcomes. Applicants passing the exam had higher competency scores while applicants ineligible for registration had lower competency scores.Research limitations/implications Limitations include integrity of data extracted from active databases, IEN motivation to complete the RN registration process and conversion of assessment scales for research analysis.Originality/value Results inform regulation policies that improve IEN registration processes and may be informative to regulators, assessment centers, educational institutions and IENs. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to survey current nutrition/foodservice-related healthcare professionals to determine their level of knowledge about dysphagia, and their perceptions of dysphagic patients and their needs. Design/methodology/approach – A data collection instrument in the form of a questionnaire was developed to obtain an idea of the perceptions and knowledge-level of diet/foodservice-related healthcare workers about dysphagia. Subjects included foodservice workers, including food preparers and food deliverers at a large healthcare facility in the Southwestern United States. A total sample size of n=51 surveys was collected and analyzed. Findings – Given the means from this sample group, healthcare foodservice workers are lacking in some areas of knowledge concerning dysphagia patients, and their dietary needs. Education and training seem indicated, as the number of patients suffering from some degree of dysphagia is only going to increase as the US population ages. Originality/value – Millions of Americans currently suffer from at least some degree of dysphagia. This number is expected to increase as the Baby Boomer generation reaches retirement age. The USA will be populated by more elderly people than ever before, and will thus host more individuals suffering from swallowing impairment. This paper adds insights to the subject. [ABSTRACT FROM AUTHOR]

Purpose -- Ascension Health has developed a leadership formation program and decision-making process specifically designed to tap into the inner spiritual strengths of its religiously pluralistic workforce in order to foster leadership that is more effective in initiating organizational cultural changes necessary for making successful quality improvements vital for the transformation of healthcare. This paper aims to focus on this initiative. Design/methodology/approach -- The paper is a case study, describing how Ascension Health designed a quantified measurement tool used to test the degree to which key characteristics of its mission, vision and values are implemented in its policies, practices and outcomes. Applying principles of decision-making theory from Lonergan, Harrison and Nutt, Ascension Health also created an organizational discernment process designed to habitualize best practices of decision making that support the organization's mission and transformational goals. Findings -- The authors describe how their organization's interventions have strengthened the practical wisdom of its leaders, helping it to improve on its faith-based mission and transformational goals. Case examples are included to illustrate the transformational effects of these interventions. Practical implications -- Applying formation practices that engage a spiritually diverse workforce and adopting disciplined processes of decision making can be adapted to any complex organization willing to dedicate itself to the inner transformation, participation and empowerment of its leaders and associates. Originality/value -- The formation program, decision-making approach and measurement tool are all original. Business leaders and leadership development programs will find the experience of Ascension Health to be a valuable reference for their own organizational change initiatives. [ABSTRACT FROM AUTHOR]

Purpose - Responding to demand fluctuations is a difficult problem in the marketing of services. This problem is particularly difficult in the delivery of health care, as it requires a complex network of facilities, equipment and trained personnel. This paper aims to examine how health care organizations are deploying volume flexible strategies in response to these changing demand patterns. Design/methodology/approach - This research used interviews with hospital administrators and a survey of administrators at academic medical centers in the USA to identify the use of internal and external volume flexible strategies, their impact on the creation of volume flexible capability, and their impact on performance outcomes. Findings - The results show that there is a positive relationship between the use of internal volume flexible strategies, volume flexible capability, patient satisfaction, and organizational performance. Research limitations/implications - Although the measures used in this study were adequate for this exploratory research study, they require further development to improve their reliability as well as to capture additional dimensions of the constructs examined. Practical implications - The results validate the impact of these strategies and indicate that internal volume flexible strategies are positively related to patient satisfaction and organizational performance. Originality/value - Although health care organizations have implemented these strategies, little is known about their use or the impact that they have on satisfaction and performance - this work addresses this gap. [ABSTRACT FROM AUTHOR]

Purpose – Healthcare is an ever-growing segment of the American economy. Transparency facilitates better decision-making and better outcomes measures. The purpose of this paper is to present the human and economic results of increasing transparency. Design/methodology/approach – The ASIMP Working Group on Healthcare Transparency represents a diverse yet conscilient group of practitioners, researchers, regulators, economists, and academics. Given the need for re-envisioning healthcare to include more accountability, evidence of efficacy and transparency, this integrative medicine (ASIMP) working group is suitable to address the above purpose. Findings – Substantial opportunity exists to reduce morbidity and mortality, suffering and excess death, unnecessary costs and risks. Greater transparency facilitates the transition to safer, more effective, more humane healthcare. Research limitations/implications – This paper starts from a need to improve clinical outcomes and value for resources devoted. Best efforts of a national working group are presented. The implications of the report, when tested, will determine the enduring value of this work. Practical implications – Consumers and business, administrators and practitioners can improve care at lower cost by increasing transparency. This will accelerate the diffusion of effective approaches that are not yet in widespread use despite replication of efficacy. Originality/value – This is the first time an integrative approach has been compared with conventional healthcare models, particularly with regard to the role of transparency in heaithcare management. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to examine the silences and silencing in the workplace and elsewhere related to women's experiences of perinatal loss. Design/methodology/approach - Qualitative data from in-depth interviews with 13 women who experienced perinatal losses between 1965 and 1999 are interpreted using Foucault's concepts of power/knowledge as pervasive in social relationships. Findings - Women who experienced perinatal loss were physically divided from others in hospitals. Hospital practices changed over time. Knowledge about perinatal loss has been scientifically classified in medicine, psychology, and related fields. This knowledge has changed between 1965 and 1999. Perinatal loss is rarely mentioned in organizational and professional literatures outside of health care. In addition to experiencing silencing from others, women silenced themselves about their perinatal losses. Research limitations/implications - Data were collected from interviews with women from the Great Lakes region of the USA. Further research should include a greater number of parents from a wider geographic area. Practical implications - Dividing practices and silences collect a toll in depression, severed relationships, derailed careers, and missed opportunities for development. As people begin to speak with one another about perinatal loss, their voices contribute to a fully human work community and polyphonic organizations. Originality/value - This paper makes a contribution to knowledge about perinatal loss and its impact on women's careers and grief in the workplace from a postmodern perspective. [ABSTRACT FROM AUTHOR]

Purpose - Implicit bias is the application of an unconscious attitude or belief; in the clinical setting, a provider's perception of a patient, based upon perceived race or ethnicity, is hypothesized to affect clinical decisions, provider-patient interactions and patient health. The purpose of this paper is to provide a brief synopsis of and critique the relevant works over the past 15 years while highlighting the strengths of this body of literature. Design/methodology/approach - A MEDLINE search, from 2000 to 2015, using the terms "implicit bias," "unconscious bias" and "aversive racism" was performed. US-based studies investigating the effect of racial or ethnic implicit bias on the clinical encounter or patient outcomes were assessed. In total, 15 articles were eligible for review. Findings - Despite well-reasoned hypotheses that racial/ethnic bias negatively affects patient care, this review found mixed results. Largely, studies showed that US-providers hold an anti-black implicit bias negatively affecting patient-provider communication and patient satisfaction. But studies have not shown that this bias consistently negatively affects diagnosis and treatment regimens of black patients in comparison to white patients. There is a significant dearth of implicit bias literature addressing the care of other patient groups of color. Originality/value - This review of the recent literature challenges the black-white dichotomy of most implicit bias research in the USA and highlights the lack of patient-oriented outcome research in this field. Furthermore, it demonstrates that regardless of the effect of implicit bias on patient outcomes, focus on eliminating implicit bias is insufficient to improve the health of people of color. [ABSTRACT FROM AUTHOR]

Purpose: Patient-centric exchanges, a major type of Health Information Exchange (HIE), empower patients to aggregate and manage their health information. This exchange model helps patients access, modify and share their medical information with multiple healthcare organizations. Although existing studies examine patient engagement, more research is required to investigate patients' attitudes and willingness to play an active role in patient-centered information exchange. The study's main objective is to develop a model based on the belief-attitude-intention paradigm to empirically examine the effects of patients' attitudes toward engagement in care on their willingness to participate in patient-centric HIE. Design/methodology/approach: The authors conducted an online survey study to identify the antecedents and consequences of patients' attitudes toward engagement in care. To empirically test the research model, the authors collected data from a national sample (n = 357) of individuals in the United States. The data were analyzed using structural equation modeling (SEM). Findings: The proposed model categorizes the antecedents to patients' attitudes toward engagement in patient-related and healthcare system factors. The results show that patient-related factors (perceived health literacy and perceived coping ability) and health system factors (perceived experience with the healthcare organization and perceived patient-provider interaction) significantly shape patient attitude toward care management engagement. The results indicate that patients' attitudes toward engaging in their healthcare significantly contribute to their willingness to participate in medical information sharing through patient-centric HIE initiatives. Moreover, the authors' findings also demonstrate that the link between patient engagement and willingness to participate in HIE is stronger for individuals who perceive lower levels of privacy and security concerns. Originality/value: The authors validate the proposed model explaining patients' perceptions about their characteristics and the healthcare system significantly influence their attitude toward engaging in their care. This study also suggests that patients' favorable attitude toward engagement can bring patient-centric HIE efforts onto a path to success. The authors' research attempts to shed light on the importance of patients' roles in adopting patient-centric HIE initiatives. Theoretical and practical contributions of this study are noticeable since they could result in a deeper understanding of the concept of patient engagement and how it may affect healthcare services in an evolving digital world. The authors' findings can help healthcare organizations provide public citizen-centric services by introducing user-oriented approaches in healthcare delivery systems. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to describe factors associated with incarceration as well as the association between recent incarceration and HIV-related sexual risk behaviors, access to insurance, healthcare utilization (emergency department (ED) and hospital use), antiretroviral therapy (ART) prescription, and viral suppression. Design/methodology/approach Using 2009-2010 data from a cross-sectional, nationally representative three-stage sample of HIV-infected adults receiving care in the USA, the authors assessed the demographic characteristics, healthcare utilization, and clinical outcomes of HIV-infected persons who had been recently incarcerated (detention for>24 hours in the past year) using bivariate analyses. The authors used multivariable logistic regression to examine associations of recent incarceration with insurance status as well as clinical and behavioral outcomes. Findings An estimated 22,949 (95 percent confidence interval (CI) 19,062-26,836) or 5.4 percent (CI: 4.7-6.1) of all HIV-infected persons receiving care were recently incarcerated. Factors associated with recent incarceration were age <50 years, being a smoker, having high school diploma or less, being homeless, income at or below the poverty guidelines, having a geometric mean of CD4 count <500 cells/ μL, and using drugs in the past 12 months. Results from multivariable modeling indicated that incarcerated persons were more likely to use ED services, and to have been hospitalized, and less likely to have achieved viral suppression. Originality/value Recent incarceration independently predicted worse health outcomes and greater use of emergency services among HIV-infected adults currently in HIV care. Options to improve the HIV continuum of care, including pre-enrollment for healthcare coverage and discharge planning, may lead to better health outcomes for HIV-infected inmates post-release. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to present the results of exploratory research designed to develop an awareness of healthcare behaviors, with a view toward improving the customer satisfaction with healthcare services. It examines the relationship between healthcare providers and their consumers/patients/clients.Design/methodology/approach: The study uses a critical incident methodology, with both effective and ineffective behavioral specimens examined across different provider groups.Findings: The effects of these different behaviors on what Berry (1999) identified as the common core values of service organizations are examined, as those values are required to build a lasting service relationship. Also examined are categories of healthcare practice based on the National Quality Strategy priorities.Research Limitations/implications: The most obvious is the retrospective nature of the method used. How accurate are patient or consumer memories? Are they capable of making valid judgments of healthcare experiences (Berry and Bendapudi, 2003)? While an obvious limitation, such recollections are clearly important as they may be paramount in following the healthcare practitioners' instructions, loyalty for repeat business, making recommendations to others and the like. Further, studies have shown retrospective reports to be accurate and useful (Miller et al., 1997).Practical Implications: With this information, healthcare educators should be in a better position to improve the training offered in their programs and practitioners to better serve their customers.Social Implications: The findings would indicate that the human values of excellence, innovation, joy, respect and integrity play a significant role in building a strong service relationship between consumer and healthcare provider.Originality/value: Berry (1999) has argued that the overriding importance in building a lasting service business is human values. This exploratory study has shown how critical incident analysis can be used to determine both effective and ineffective practices of different medical providers. It also provides guidelines as to what are effective and ineffective behaviors in healthcare. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this article is to alert those in positions of trust and authority that there is an urgent need for improvement throughout the entire health profession credentialing process to fix defects at every stage, from employer responsibilities all the way up to licensing board responsibilities and government oversight. Design/methodology/approach -- This paper takes the form of a narrative review. Findings -- The assumption that layers of safeguards prevent dangerously incompetent or impaired practitioners from continuing to practice in American hospitals is, unfortunately, just that -- an assumption. While the vast majority of healthcare professionals uphold the standards of their professions, a recent public health vulnerabilities report reveals serious defects throughout those safeguard layers and widespread harm that results from actions of relatively few determined miscreants who manage to evade them. This not only undermines public trust, but underscores ways in which governing boards, hospital executives and directors have found themselves liable for failings of their institution's quality assurance provisions. That vulnerability report is the result of investigation into one healthcare worker whose narcotic thefts and drug tampering resulted in thousands of patients exposed, dozens infected with hepatitis C, across several states and multiple missed opportunities to constrain. Originality/value -- Findings of the Maryland state investigation, coupled with other documents, show that long-recognized ethical and legal responsibilities are not being met effectively. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this study is to explore the determinants of consumer's propensity to choose non-conventional treatment protocols using control theory as the theoretical framework. Design/methodology/approach -- Data were collected from a consumer panel using a self-administered questionnaire. The sample consisted of 350 US-based "Baby Boomer" consumers. Findings -- The results of this study indicate that consumers' health locusof control self-efficacy, and neuroticism impact their propensity to use nonconventional treatments. Contrary to previous studies, consumers' health value was not a significant moderator except in the case of internal health locus of control. Practical implications -- The findings of this study provide guidance to public policy makers, health care providers, and managers of the conventional and non-conventional pharmaceutical industries. Specially, the results reify the importance of the collaborative efforts of public policy makers and health care practitioners alike to proactively inform consumers of the issues underlying unsupervised use of non-conventional medications. The results suggest greater governance is needed to control the marketing of non-conventional medications. Overall, this research provides prescriptive guidance for marketers of both non-conventional and conventional treatments, suggesting how better promotional and integrated communications may effectively serve their target markets. Originality/value -- The paper examines an unexplored yet rapidly growing consumption behavior in the USA: the unprecedented use of nonconventional treatments. Evaluation of this consumer trend has largely focused on demographic factors relative to adopters (and non-adopters). Control theory affords a conceptual foundation for exploring individual-level factors that have been overlooked in previous empirical studies. [ABSTRACT FROM AUTHOR]

The challenges facing today's Mexican migrant population, almost a third of the US migrant population, are formidable. Such high representation offers not only challenges, but also increased political representation and large networks of social support. Complex relationships established through such networks provide Mexican migrants with avenues of access to communities, opportunities and services. Following a working definition of community and the concept of social capital, this paper examines health care availability for Mexican migrants in the United States. Because Mexican women are traditionally responsible for the health of their families, a case study is used to illustrate how knowledge and information gained through women's social networks gives Mexican women in the US critical decision-making power with regard to health care. Greater acknowledgement of women as the brokers of health-preserving information networks is key to recognising their significance as stakeholders in community health care. Future policy developers should recognise the importance of understanding such specific contextual issues, because they create a health care system that is responsive to individual and community needs. [ABSTRACT FROM AUTHOR]

Purpose - Healthcare is both the largest (17 + percent) and the most rapidly growing (three plus times the consumer product index (measure of inflation) and half a percent of gross domestic product each year) segment of the US economy. The purpose of this paper is to focus on outcome successes that illustrate application of a previously reported health equation. The health equation allows an organized and more transparent assessment of healthcare outcomes. Design/methodology/approach - The approach includes "end use/least cost" techniques that identifies healthful care as a big Unmet need (BUN) and equally attractive business opportunity in identifying health promotion that improves outcome at lower net costs. Findings - Opportunity exists to reduce costs while also reducing adverse events, healthcare morbidity and morality. Transparency is essential to find what works more effectively to yield desired outcomes. Metrics and measures, particularly more precise tools to assess true outcome in promoting health or managing ill health, are given priority as they allow quantified and, often econometric, outcome opportunities in the midst of current uncertainties. Practical implications - This paper is for consumers and businesses, managers and administrators, professionals and allied health professionals. The successes described herein illustrate fundamental opportunities driving change and innovation within healthcare and in our society. Originality/value - Attention is called to opportunity areas that can fund out of savings the transition from the authors' current "sickness care" system to a healthful care, proactive prevention approach to delivering care. Novel application of transparency and end use/least cost can help guide choices to achieve healthier outcomes. [ABSTRACT FROM AUTHOR]

Purpose - Healthcare organizations have addressed current error issues by adopting quality programs, which usually include strategic human resource management (HRM). However, little research has focused on the determinants of successful quality programs at healthcare organizations. The purpose of this paper is to examine the centrality of strategic HRM for addressing healthcare errors, error reduction barriers, quality management processes and practices, quality program results, and competitive advantage. Design/methodology/approach - The methodology of this study involves the analysis of questionnaire data from the quality and/or risk directors of 587 US hospitals by factor analysis and regression analysis. Findings - The findings focus on highly statistically significant relationships of strategic HRM with antecedent healthcare error sources, error reduction barriers, and quality management processes and practices, as well as the strategic HRM consequences of perceived quality program results and sustainable competitive advantage. Research limitations/implications - The limitations of perceptual data and common method variance are checked. Future research could investigate international effects. Practical implications - The practical implications are that hospital errors can be successfully addressed with effective strategic HRM, quality management processes, and quality management practices. Originality/value - The original contribution of this paper is the centrality of strategic HRM as a determinant of successful quality programs at healthcare organizations. [ABSTRACT FROM AUTHOR]

Policy makers and practitioners argue that electronic exchange of clinical data across the healthcare system is a key component of improving health service delivery in the United States. Provider administrators, however, question the strategic value of participation in health information exchanges (HIEs) and remain reluctant to participate. Existing research fails to adequately illuminate the potential value derived from HIEs by participating organizations. This paper addresses this gap by developing a conceptual model informed by the complementary theoretical perspectives of the relational view and systems theory to specify both a provider organization's internal conditions and the HIE structure necessary for both financial accrual and quality improvement. This two-sided model can assist policymakers as they attempt to encourage HIE development, as well as provider and HIE leadership that seek to benefit from HIEs. The propositions developed from this model can also help guide researchers as they evaluate the impact of HIEs. [ABSTRACT FROM AUTHOR]

Institutional logics and collective identities are closely intertwined: logics shape the emergence and evolution of identities, which in turn play a crucial role in mediating the influence of the logics themselves. Though there exists a significant body of research on the intersection of the two phenomena, relatively little attention has been given to changes in the strength, content, and permanence of particular logic-identity associations. In this paper we explore empirically the question of whether and how a logic and identity may become severed, through an inductive case study of the development of the hospitalist identity in health care in the United States. Based on this study, we propose a set of mechanisms through which the distancing of a logic and an identity may occur. We also discuss potential counterfactual outcomes, in order to build theory regarding the longitudinal relationship between logics and identities. [ABSTRACT FROM AUTHOR]

Purpose - Latinos comprise 12.5 percent of the overall population in the USA, and are the fastest-growing minority, among which the Mexican-origin population makes up about 66 percent. Undocumented Latino immigrants are a small, yet important group within the immigrant population. The purpose of this paper is to review the literature and discuss the most important factors that prevent immigrants from accessing health care. Design/methodology/approach - Literature review was conducted from the library database. A total of 50 items of literature related to the subject were reviewed. Findings - Border states have the highest concentration of Mexican-origin people. The concentration of immigrants in the border has unique health and economic implications due to the vital role they have in US society, contributing both to the economy and diversity of the USA. Despite their important role, they disproportionately lack health insurance, and receive fewer health care services than US-born citizens. This lack of insurance puts a burden on the nation's economy, and their health status deteriorates as they become more prone to chronic health conditions, and their complications due to lack of primary medical attention. Originality/value - Tailored public health interventions that address the health needs of Latino immigrants in the USA need to be based on reliable data and statistics in order to effectively place resources, and to track achievements and flaws. [ABSTRACT FROM AUTHOR]

At the end of 1997, one quarter of the American public used health maintenance organizations. This paper reports findings on physicians’ perspectives on the role of managed care in their professional practices. The research data come from mailed surveys to physicians who are selected from the Cigna Directory of Physicians practicing in the State of Ohio. Subjects were asked to explain what managed care meant to them, and how long they have been practicing medicine. Questions also focused on professional autonomy, quality of care and career aspirations for the future. The results from the study suggest that managed care has had a negative impact on how physicians practice medicine. Several of our respondents reported that they are playing the role of a “double agent” and feel a sense of frustration in doing so. The degree of antipathy toward managed care differs between primary care physicians and specialists. [ABSTRACT FROM AUTHOR]

Considers the monitoring of productivity in the health care environment in the United States. Development of a labor standard; Factors to be considered in determining standard; Setting a volume indicator; Reporting of results; Methods improvement as one approach to discovering the flaws in the work flaw; Obstacles to productivity improvement.

Purpose - This paper aims to discuss the problems faced by US consumers as insurance companies use brand names as a heuristic tool to identify medical profligacy, penalizing consumers with higher co-payments or even refusing funding support for new and necessary medications. Design/method/approach - Anecdotes and descriptive reviews of the literature describe the basis for the problem. The paper looks at the use of brand names in the pharmaceutical industry in comparison with generic versions. It gives a brief history of brand name development. Findings - The paper finds that, for the pharmaceutical companies, or any company, a brand name allows them to escape from the confines of generic demand with the price and distribution power from brand demand. Furthermore the easier name can speed adoption of a new product. However, the price spread between new brand name drugs and older ones with non-branded competition gives rise to unfounded presumptions on all brand names. Practical implications - Brand names can have value for both consumers and physicians, but it might be desirable for the US health care system to put an end to a brand's exclusive use beyond the innovation's patent protection. Originality/value - The paper provides concluding recommendations of a broad regulatory solution that pharmaceutical companies would probably oppose. [ABSTRACT FROM AUTHOR]

Reports on strategies for the success of health and social care in the U.S. from 2006 to the next ten years. Role and responsibilities of health care professionals in the industry; Obstacles that could hinder the success of health care industry in the U.S.; Risk of continuing gap between the strategies and the front-line practitioners.

Purpose – The purpose of this study is to benchmark the use of process improvement techniques among US health care organizations that won the Malcolm Baldrige National Quality Award. Design/methodology/approach – The applications from 13 Baldrige award winning health care organizations were researched to determine which process improvement techniques were used most frequently to guide their operations. Findings – The results from this study identify several best practices in process improvement techniques. Furthermore, the study pinpoints in which aspect of performance that a process improvement technique is most likely to be used. Research limitations/implications – Only applications from organizations winning the Baldrige award have been studied. The identity and application for organizations that do not win the award are not released to the public. Statistical analysis of the data is limited to the relatively small number (13) of award winners. Practical implications – The results clearly show that there are certain process improvement techniques used by a majority of the Baldrige winners. It is not possible to guarantee that the use of these same techniques by other health care organizations will result in performance improvement, only that the winners used the techniques and have achieved a high level of performance. The results identify processes for further benchmarking studies. Originality/value – The process improvement techniques identified in this study have been used by successful health care organizations. This information may be useful to other health care organizations when deciding on which process improvement techniques to pursue in order to improve their own performance. While the Baldrige award process has driven benchmarking efforts, this study uses the Baldrige process to identify benchmarking opportunities for process improvement in health care organizations. [ABSTRACT FROM AUTHOR]

The article assesses the efforts to control fraud in the home health care industry in the United States. It examines the problems that criminal justice officials confronted in their attempts to control the home health care fraud and abuse. Attention is given to the history of the home health care industry in the United States, the types of fraud found in the health care field in general and the officials who are given the duty of controlling health care fraud. It suggests that the problems fraud control officials face in their response to home health care offenders are similar to those confronted in the response to white-collar offending, but also similar to those confronted in the response to many conventional offenses.

This study investigates the applicability of a modified SERVQUAL instrument as a means of measuring residents' perceptions of long-term health-care service quality in the USA and UK. The results confirm a stable, four-factor structure that is similar to previously defined service quality dimensions and is invariant across the countries studied. [ABSTRACT FROM AUTHOR]

Examines the impact of genetic testing and therapy on health care in the United States. Potentials of genetic testing and therapy in the creation of advancements in health care; Possible effects on health care in terms of distribution, access and economy; Potential failure of genetic advancements in meeting ethical and legal standards.

Examines theory and research on Occupational Stress Management (OCM) and suggestions made for biopsychosocioecological transactional model proposed by Rudolf Moos. Distinguishing feature of the model; Estimation of the cost of occupational stress on U.S. health care expenditures; Assessment of the OSM programmes offered to employees; Difference in the perception of 'stress' between the management and labor unions; Possible adoption of a 'triangulation' approach. INSETS: Managing Health at Work -- Case Example;The Converse Rubber Case;High-Tech Employees' Health.

The article discusses health care costs, which has expanded beyond the technical domains of accountancy and entered the realms of public discourse. The article analyses this discourse through an examination of all the stories published in The New York Times between 1 April 1992 and 1 May 1993, which contained the phrase "health care costs". The article describes the current discourse and examines how antagonistic social interests strive to inscribe the concept of health care cost with conflicting meanings and ideological accents. Health care costs in the United States totaled $940 billion in 1992, up 12 per cent from 1991. Spending on health care accounted for more than 14 per cent of the nation's total economic output. The article catalogues the multiplicity of meanings conveyed by the words, "health care costs" and describes how the meaning of the term changes from one context to another within contemporary discourse. The quote illustrates the extent to which the term "health care costs" has, in common usage, become identified with the cost of employee health benefits paid by US business. A significant portion of the contemporary discourse on health care costs is devoted to employee health care benefits. "Health care cost" is a symbolic form whose meaning is shaped in popular discourse as much as in the technical spheres of accounting education, research and practice.

The article aims to promote concern and debate about the penetration of accounting and financial management in the health care sectors of several Anglo-Saxon countries - the United States, United Kingdom and New Zealand. Questions may be raised in several ways for example by highlighting how accounting concepts such as "costs" are not neutral notions but rather are sites for struggles of divergent interests or by commenting on how accounting may change or be changed by different organizational and societal rationalities. Concern may also be raised by questioning the effects of accounting change in terms wider than the purely instrumental and thereby arguing that its global spread is grounded more in faith than "factual" evidence regarding its efficacy. Accounting-led initiatives are not merely techniques to control costs and promote efficiency, they have a profound constitutive role to play in shaping medical practice. The spread of accounting-led health care cost control and reform initiatives around the globe is often a matter of faith. These initiatives are constituted within the rhetoric of rationality, efficiency and free market economics with very little evidence of their ability to achieve even these goals.

Compares the contemporary community hospital and the traditional agricultural commons in the United States. Identification of four principal attributes of common field agriculture; Matching with contemporary arrangements in the management of community hospital facilities; Commonality of changes in social values that transformed agriculture to the values changing health care.