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Purpose: This paper aims to outline the initial pilot use of the client complexity matrix (CCM), an outcome measure developed for an NHS Adult Intellectual Disabilities Intensive Support Team (IST) in the West Midlands of England. Design/methodology/approach: A mixed method approach was used to report the results and evaluate the use of the CCM within this IST. The CCM was trialled for six months between January 2022 and June 2022. CCM scores pre and post IST intervention were analysed via t-test, and qualitative feedback from clinicians is detailed. Findings: Analysis suggests the CCM captures service success showing a significant decrease in complexity and risk post-intervention. Qualitative comments from clinicians were generally positive; however, there were requested changes regarding specific presentations, use of labels/language and for a digital version. Research limitations/implications: The tool is not co-constructed with the client. Because of this IST's caseload, the sample size was small. Only one clinician was asked to complete the CCM pre and post intervention. Future use of the measure will encourage two clinicians to complete the measure to evidence its inter-rater reliability. Each client's specific presentation was not explicitly analysed here. Practical implications: The CCM will be updated using the feedback from clinicians and from the peer review process. Research that examines the generalisability of this measure to other IST services would be beneficial. Originality/value: The CCM appears to fill a gap in outcome measurements for this IST service which looks at breadth and depth of client complexity and risk. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this paper is to empirically describe and analyze factors deemed to be relevant for the successful provision of coordinated paediatric oncology care by physicians and nurses involved. Design/methodology/approach: A qualitative case study primarily consisting of interviews. Findings: The paper's findings indicate that certain factors (i.e. distinct mission, clear treatment protocols and support from external stakeholders) relevant for the provision of coordinated paediatric oncology care have not received sufficient attention in previous research. In addition, emphasis is placed on the necessity of facilitating constructive working relationships and a bottom-up perspective when pursuing improved care coordination. Originality/value: The factors described and analyzed may act as insights for how paediatric oncology might be improved in terms of care coordination and thus facilitate care integration. In addition, the paper's findings identify factors relevant for further empirical studies in order to delineate their generalizability. [ABSTRACT FROM AUTHOR]

Purpose: Health in low-income countries has become associated with the provision of minimum guaranteed public health services though Essential Health Packages (EHPs). How far do EHPs deliver the human right to health for all? This study addresses this question through qualitative research into access to health care for vulnerable communities, using Malawi as a case study. This study shows that there are significant accountability gaps and perceptions of weak service provision in Malawi's EHP in relation to some particularly marginalised (and stigmatised) groups that limit the right to health and the promise of "health for all". Design/methodology/approach: This study extends the body of qualitative work on EHPs in general and on Malawi in particular by exploring the perceptions of key stakeholders in relation to inclusivity and the delivery of health policies to particularly vulnerable groups. To do so, this study adopted an approach based on interpretive epistemologies (Scott, 2014). This study conducted largely unstructured interviews with a range of health stakeholders, speaking to stakeholders individually, rather than through focus groups due to the potentially sensitive nature of the topic. Findings: The findings of this study are as follows: limited inclusion of civil society actors and local communities; local communities and local policymakers feel frustration with the gap between the promises of consultation in the EHP and the reality, and the difficulties of not having effective channels of communication; and exclusionary health practices for particularly vulnerable groups. Research limitations/implications: There are limitations based on the qualitative methodology, and in terms of the particularly vulnerable groups – the authors studied two such groups (people with disabilities and those who identify as LBTQ) but a wider survey of vulnerable groups is needed to extend and confirm the findings. Practical implications: Greater attention to the health rights of vulnerable groups would improve access and services, even in the context of resource restrictions. This study suggests that a deeper engagement with human rights-based approaches would pay dividends in terms of increasing access to health in Malawi, even within the constraints of the EHP process. Furthermore, without this, there is the risk that discrimination and exclusion will become more embedded in health policies, rather than progressively minimised. Social implications: Without addressing these issues, there is the risk that discrimination and exclusion will become more embedded in health policies, rather than progressively minimised. Originality/value: This paper makes an important contribution to the growing literatures on EHP in sub-Saharan Africa and Malawi in particular and to the importance of listening to stakeholder perceptions. It provides original data on stakeholder perspectives of the challenges associated with universalising health care in resource-constrained countries. To the best of the authors' knowledge, it is one of the first papers to focus on the rights of disabled and LBTQ people in relation to EHPs. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to examine how external change agents (ECAs) engaged to disseminate a national quality register (NQR) called Senior alert nationwide in the Swedish health care and elderly care sectors interpret their work. To study this, sensemaking theories are used.Design/methodology/approach This is a qualitative inductive interview study including eight ECAs. To analyze the data, a thematic analysis is carried out.Findings Well-disseminated NQRs support health care organizations’ possibility to work with quality improvement and to improve care for patient groups. NQRs function as artifacts that can influence how health care professionals make sense of their work. In this paper, a typology depicting how the ECAs make sense of their dissemination work has been developed. The ECAs are engaged in prospective sensemaking. They describe their work as being about creating future good results, both for patients and affiliated organizations, and they can balance different quality aspects.Originality/value The number of NQRs increased markedly in Sweden and elsewhere, but there are few reports on how health care professionals working with the registers interpret their work. The use of ECAs to disseminate NQRs is a novel approach. This paper describes how the ECAs are engaged in prospective sensemaking – an under-researched perspective of the sensemaking theory. [ABSTRACT FROM AUTHOR]

Purpose: Refugees and asylum seekers worldwide face numerous barriers in accessing health systems. The evidence base regarding who and what helps refugees and asylum seekers facilitate access to and the navigation of the health system in the UK is small. This study aims to address this gap by analysing 14 semi-structured, in-depth interviews with refugees and asylum seekers of different countries of origin in the UK to identify where, when and how they came into contact with the health-care system and what the outcome of these interactions was. Design/methodology/approach: Semi-structured, in-depth interviews were chosen as the key method for this study. In total, 14 individual interviews were conducted. A trauma-informed research approach was applied to reduce the risk of re-traumatising participants. Findings: The paper identifies key obstacles as well as "facilitators" of refugees' and asylum seekers' health-care experience in the UK and suggests that host families, friends and third-party organisations all play an important role in ensuring refugees and asylum seekers receive the healthcare they need. Originality/value: To the best of the authors' knowledge, this is the first qualitative study in the UK that looks at comprehensive health journeys of refugees from their first encounter with health services through to secondary care, highlighting the important role along the way of facilitators such as host families, friends and third-party organisations. [ABSTRACT FROM AUTHOR]

Purpose: The concept of personal recovery is now a key pillar of service delivery. It aims to support individuals to flourish and establish a new identity following an acute episode or diagnosis. This view of recovery is unique to each person on that journey. However, there has been a significant focus on measuring these experiences. This paper aims to explore the influence of social constructionism on the concept of recovery within an Irish context, seeking to understand the influence of language, discourse and power on service users' experiences. Design/methodology/approach: A qualitative, interpretivist methodology was adopted for this case study design. Semi-structured interviews were conducted with 12 service users. Thematic analysis was chosen as the method of analysis. Findings: Personalising recovery did not always lead to the removal of biological symptoms, but with the appropriate supports, individual's recovery journey was greatly enhanced. On the contrary, personal recovery places overwhelmingly responsibility on the individual to succeed, largely driven by neoliberal discourse. This focus on individualism and the pressure to succeed was further experienced when people sought to re-integrate into society and participate in normalised social order. Ultimately, for many service users, they viewed personal recovery as an unfulfilled promise. Research limitations/implications: It is not a representative sample of service users within an Irish context. Originality/value: To the best of the authors' knowledge, this is the first study to explore influence of social constructionism on the concept of personal recovery within a mental health service context. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper was to explore the health of trafficking survivors in Spain, which is relatively unstudied (Sweileh, 2018). Therefore, the objectives of this study are to describe the health conditions, access to health-care facilities, COVID-19 protection and health challenges in relation to the COVID-19 pandemic reported by women survivors of human trafficking in Spain. Design/methodology/approach: Due to the pandemic situation, limited research and the complexity of the issue, the authors took a qualitative approach. A cross-sectional study was carried out through interviews with women survivors of human trafficking for sexual exploitation in Spain. Prior to the interviews, the researchers conducted written interviews with social workers to understand the most important challenges that the women survivors were experiencing during confinement. As a result of these written interviews, the interview script for the survivors was modified. Findings: To sum up, the COVID-19 situation poses several challenges, including social difficulties (food insecurity; violence; terrible housing conditions; working pressure; poor sleeping habits; and cultural, linguistic and religious challenges), medical insecurity (due to lockdowns, negative experiences in care, lack of official documents, collapse of hospitals, telephone monitoring and fear of contagion), great emotional distress reported by women (anxiety, fear, sadness, post-traumatic stress disorder, stigma and substance use) and physical health problems (serious weight loss, muscle pains, dental problems and sexual and reproductive health-care limitations). Research limitations/implications: As is usual in qualitative research, rather than obtain generalizable results, the main objective was to delve deeper into under-researched or complex issues (Polit and Beck, 2010). While this report provides a timely overview marked by COVID-19 of an important population, there are some limitations. The major limitation of this research was the sample representativity, because the sample was conducted with only one non-governmental organization and only individuals who voluntarily agreed to make the interview; as such, other victim profiles may not be represented. Practical implications: The findings can provide information for detecting victims of human trafficking for sexual exploitation and contribute to understanding the pandemic's impact. Furthermore, the paper emphasizes the need to adopt measures for the recovery of victims, such as medical and psychological assistance, in accordance with the Palermo Protocol. As people transition out of the pandemic, it is crucial for Spain, along with other European countries, to guarantee that all residents, particularly the victims of human trafficking, have access to social and health-care protections during times of crisis. Social implications: As already mentioned, further investigation should be done to fill the gaps on health of human trafficking (Sweileh, 2018) and improve the recovery of victims of trafficking (García-Vázquez and Meneses-Falcón, 2023 0; Sweileh, 2018). The paper acknowledges the existing research gap in the field and emphasizes the importance of future studies to delve deeper into the challenges faced by victims, calling for a more nuanced understanding of health. Originality/value: The Coronavirus pandemic has increased and reinforced the vulnerability of sex-trafficked victims, especially creating different mental health problems. One of the biggest concerns for this group has been the difficulty of access to basic goods such as food. Furthermore, psychological distress impacted the well-being of trafficking victims, and many suffered from eating disorders. Less than half of the women who were forced to continue in prostitution did not have the means to protect themselves against COVID-19 and did not have easy situations to overcome illness. [ABSTRACT FROM AUTHOR]

Purpose: Theoretically, a health system has been described in terms of integration being the coordination of health services and collaboration amongst provider organizations. The components of an integrated health system remain inconclusive. Although senior healthcare executives establish structures and designs which facilitate the delivery of integrated care, their perspectives of a health system have not been explored. The purpose of this paper is to present senior healthcare executives' perspectives of a health system which, when combined, form a model for developing an integrated health system. Design/methodology/approach: Using a qualitative methodology and a multi-case study design, 11 presidents and 4 senior vice presidents of major healthcare organizations or systems in Ontario Canada were selected from a target population of 246 senior healthcare executives to engage in 1 h interviews each. Critical case sampling was applied in the selection of the study sample. Interviews were conducted between December 2017 and February 2018. Findings: Senior healthcare executives expressed four distinct perspectives of a health system: systems, institutional, clinical and governance. When combined, the four perspectives form an original research-based concept or model for an integrated health system. Originality/value: This paper conveys results of personal interviews with senior healthcare executives and presents a proposed model for an integrated health system based on their four distinct perspectives of a health system. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to assess the extent to which the LEADS Framework guided health-care leaders through organizational change and the COVID-19 pandemic in a western Canadian province. Design/methodology/approach: A qualitative exploratory inquiry assessed the extent to which health leaders applied competencies that aligned with the LEADS Framework. A purposeful sample of 22 health-care leaders participated in the study representing senior, mid-level and front-line health-care leaders in various health-care organizations to ensure diverse representation of leader competencies. The authors conducted semi-structured interviews to collect the data and used Braun and Clarke's (2006) six-phase approach to guide data analysis. Findings: The analysis suggests that health-care leaders found Engaging with Others and Developing Coalitions were the most critical themes of the LEADS Framework for change management and for navigating the COVID-19 pandemic. Findings reveal that during transformational change and a crisis context, leaders embrace relational approaches to adapt and improve performance in dynamic organizations. Practical implications: These findings have implications for a relational approach to improve teamwork and decrease emotional strain; a focus on mobilizing and sharing power with nurses; and educational programs to advance relational and self-management skills, shared leadership, communication, change management, human resource and talent development as critical learning components for current and future health-care leaders. Originality/value: The LEADS Framework is used to examine how health-care leaders responded to transformational change in the organization while situated in a pandemic context. [ABSTRACT FROM AUTHOR]

Purpose – This paper reviews the Lean Healthcare and Productive Ward: releasing time to care (RTC) literature and extracts the reported effects and impacts experienced by employees who implement it. The purpose of this paper is to identify and investigate the strength of the connection between the two models and explores the implications for leadership and implementation. Design/methodology/approach – This study reviewed the Lean Healthcare and Productive Ward: RTC literature using strict systematic inclusion criteria. A qualitative content analysis was used to identify key characteristics of reported employee experience, effect or impact. Themes and categories were ranked by the number of citations and presented. Findings – This study outlines the similar employee effects and impacts that exist between Lean-type improvement initiatives and the Productive Ward: RTC programme. It discusses the three top themes of: Empowerment, Leadership and Engagement and explores the opportunities for leadership. It also identifies one key difference between the two initiatives, the socio-cultural effect and impact which is strongly reported with Lean-type improvement initiatives. The socio-cultural element is discussed and presented as one of the fundamental aspects of Lean and the original Toyota production system. Originality/value – This study brings new insights for leaders involved in Lean-type improvement initiatives which are currently being imported into healthcare and provides a comprehensive list of reported employee impacts and effects of value to healthcare leaders attempting to establish an environment and culture of improvement. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to explore users' perceptions of whether the Leadership Development Impact Assessment (LDI) Toolkit is valid, reliable, simple to use and cost-effective as a guide to its quality improvement. Design/methodology/approach: The Canadian Health Leadership Network codesigned and codeveloped the LDI Toolkit as a theory-driven and evidence-informed resource that aims to assist health-care organizational development practitioners to evaluate various programs at five levels of impact: reaction, learning, application, impact and return on investment (ROI) and intangible benefits. A comparative evaluative case study was conducted using online questionnaires and semistructured telephone interviews with three health organizations where robust leadership development programs were in place. A total of seven leadership consultants and specialists participated from three Canadian provinces. Data were analyzed sequentially in two stages involving descriptive statistical analysis augmented with a qualitative content analysis of key themes. Findings: Users perceived the toolkit as cost-effective in terms of direct costs, indirect costs and intangibles; they found it easy-to-use in terms of clarity, logic and structure, ease of navigation with a coherent layout; and they assessed the sources of the evidence-informed tools and guides as appropriate. Users rated the toolkit highly on their perceptions of its validity and reliability. The analysis also informed the refinement of the toolkit. Originality/value: The refined LDI Toolkit is a comprehensive online collection of various tools to support health organizations to evaluate the leadership development investments effectively and efficiently at five impact levels including ROI. [ABSTRACT FROM AUTHOR]

Purpose: Government imperatives that drive integrated care are challenging corporate executive leadership. Conspicuous by its absence in both government's imperatives and the literature, is any reference to corporate executive leadership in transitioning a hierarchically oriented health system to a laterally integrated health system referred to, in this paper, as an integrated health system. This lack of reference to executive leadership involvement conveys either significant consequences or opportunities for corporate healthcare executives. The purpose of this qualitative, multi-case study is to explore corporate executive leadership in transitioning a hierarchically oriented health system to an integrated health system. Design/methodology/approach: Between December 2017 and February 2018, a qualitative methodology and multi-case study design facilitated one hour telephone interviews with 11 presidents and four senior vice presidents. Critical case sampling was used to select the study sample from a target population of 246 corporate healthcare executives representing Ontario's major acute healthcare organizations/systems. Findings: Corporate healthcare executives possess the requisite skills and knowledge to transition a hierarchically oriented to a laterally integrated the health system but are constrained by an undefined partnership role with government and fear of government changes. Originality/value: This paper provides corporate executive leaders with a systematic leadership approach to organizational readiness, in transitioning to an integrated health system. Features and outcomes of the approach are illustrated. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to inductively explore the context-specific preconditions for nurses' perceived organizational support (POS) in healthcare organizations.Design/methodology/approach: A qualitative interview study was performed, based on the critical incident technique (CIT), with 24 registered nurses in different specialities of hospital care.Findings: The nurses perceived three actors as essential for their POS: the first-line manager, the overarching organization and their college. The preconditions affecting the nurses' perceptions of organizational support were supportive structuring and structures at work, as well as individual recognition and professional acknowledgement.Originality/value: Previous studies of POS have mostly had a quantitative outset. In this paper, context-specific preconditions for nurses' POS are described in depth, enabled by the qualitative approach of the study. The findings may be used to guide healthcare organizations and managers aiming to foster nurses' POS, and thereby, benefit nurses' well-being and retention, as well as healthcare quality and efficiency. [ABSTRACT FROM AUTHOR]

Purpose - This paper seeks to concentrate on the question whether any parallels can be found between the industrial sector and health care services with respect to the developments that have taken place in the area of Supply Chain Management. Starting from an analysis of existing literature, it is intended that different modes of Supply Chain integration will be discussed. Also, in doing so, it is intended that the lessons learned from the studies presented in this special issue will be summarized and placed into the perspective of future research that can be considered as necessary. Design/methodology/approach - This paper adopted an exploratory, qualitative approach based on an analysis of existing literature in the area of Supply Chain Management in Health Services. Additionally, material from the case studies presented in this special issue is used to assess the current body of knowledge regarding Supply Chain Management in Health Services. Findings - Starting from a classification of existing research, five main research areas with respect to Supply Chain Management in a health care setting are defined. Additionally, it is concluded that next to studies with a mono-disciplinary focus, an interdisciplinary focus on Supply Chain Management issues in health services seems to be necessary. Originality/value - This paper contributes to both the supply chain management literature and literature in the area of healthcare management by identifying some important research areas which are linked to both fields. This paper helps both academics and managers to gain a better understanding of the complexity of supply chain management in health services. [ABSTRACT FROM AUTHOR]

Purpose: The article aims to argue that the concept of "distributed leadership" lacks the specificity required to allow a full understanding of how change happens. The authors therefore utilise the "Strategic Action Field Framework" (SAF) (Moulton and Sandfort, 2017) as a more sensitive framework for understanding leadership in complex systems. The authors use the New Care Models (Vanguard) Programme as an exemplar.Design/methodology/approach: Using the SAF framework, the authors explored factors affecting whether and how local Vanguard initiatives were implemented in response to national policy, using a qualitative case study approach. The authors apply this to data from the focus groups and interviews with a variety of respondents in six case study sites, covering different Vanguard types between October 2018 and July 2019.Findings: While literature already acknowledges that leadership is not simply about individual leaders, but about leading together, this paper emphasises that a further interdependence exists between leaders and their organisational/system context. This requires actors to use their skills and knowledge within the fixed and changing attributes of their local context, to perform the roles (boundary spanning, interpretation and mobilisation) necessary to allow the practical implementation of complex change across a healthcare setting.Originality/value: The SAF framework was a useful framework within which to interrogate the data, but the authors found that the category of "social skills" required further elucidation. By recognising the importance of an intersection between position, personal characteristics/behaviours, fixed personal attributes and local context, the work is novel. [ABSTRACT FROM AUTHOR]

Purpose: This paper explores residents' perceptions and experiences of extra care housing as an integrated model of housing with care. Design/methodology/approach: Data were collected in a longitudinal qualitative study based on four extra care housing schemes. Data from interviews with residents, care workers, managers and local commissioners were analysed thematically. Findings: The integration of housing with care enabled many older people to manage their care proactively. However, the increasing number of residents with complex health and care needs, including chronic illness, led some residents to question the ability of the model to support residents to live independently. Research limitations/implications: The study struggled to recruit sufficient residents from the specialist dementia setting who were able to communicate their consent to take part in the research. In addition, the quality of qualitative data collected in interviews with participants at this setting reduced over successive rounds of interviews. Practical implications: The study suggests the need to ensure that residents are fully informed about levels of care and support is available when considering a move into extra care housing. Originality/value: This paper provides a timely opportunity to consider extra care housing as an example of an integrated housing service, particularly in light of the current challenges facing the sector. [ABSTRACT FROM AUTHOR]

Purpose: Sexual and reproductive health (SRH) incorporates prevention of unplanned pregnancies, unsafe abortions, and sexually transmitted infections (STIs). The sourcing, understanding and application of related information are important for health and this defines sexual and reproductive health literacy (SRHL). Health care utilization rates among Asylum Seekers and Refugees (ASRs) may not be high and they are unlikely to seek sufficient SRH information and care in their host countries, leaving some needs unmet. No SRHL research related to Scotland's Asylum Seeking and Refugee Women (ASRW) exists. In this qualitative study, the purpose of this paper is to explore the SRHL-related views and experiences of adult ASRW living in Glasgow and their views on assistance required to improve their SRHL. Design/methodology/approach: In total, 14 semi-structured interviews were audio-recorded and transcribed and qualitative thematic analysis employed. Findings: Five themes and 13 sub-themes with four key findings highlighted: experience of unmet SRHL needs, similarities and differences in the source of SRH information, SRH views and behaviours influenced by cultural and religious factors, barriers and facilitators to accessing SRH information/care and developing SRHL. Research limitations/implications: This was a small scale qualitative study affording limited transferability. The work addressed a highly sensitive topic among women from conservative home country cultures. Practical implications: Routine collection of sexual and reproductive health data by the NHS should be explored for this group. NHS staff should be aware of the rights of asylum seekers, Refugees and failed asylum seekers, to NHS healthcare free at the point of delivery in Scotland (National Health Service, 2019; Scottish Government, 2018), and be well trained in the likely religious and cultural norms of these groups. Host communities should consider improving access to SRH information and care in ASRWs first languages. Social implications: The study identified weaknesses in the opportunities for social integration afforded this group and the coordination of existing social opportunities. The stigmatization of immigrants in the UK is well understood and has repercussions for many individuals and societal organizations implicated in the promotion of this. Originality/value: This paper addresses a very sensitive topic with women from conservative cultures. With few publications in this area, and none pertaining to Scotland, the paper makes a small but original contribution that might be considered a starting point for researchers and relevant services in Scotland. [ABSTRACT FROM AUTHOR]

Purpose: This aim of this study was to explore how hospital-based physicians in Sweden experienced the challenges in working conditions related to the provision of care during the initial response to the COVID-19 pandemic in 2020 when hospitals transitioned to pandemic care. Design/methodology/approach: The study has a qualitative design. Twenty-five hospital-based physicians were interviewed about their experiences from working in a hospital while healthcare organisations initially responded to COVID-19 pandemic in 2020. A thematic analysis was used to analyse the empirical material. Findings: The analysis resulted in four themes: involuntary self-management, a self-restrictive bureaucracy, passive occupational safety and health (OSH) management, and information overload. These themes reflect how the physicians perceived their work situation during the pandemic and how they tried to maintain quality care for their patients. Practical implications: The study gives valuable insights for formulating preparedness in regard to crisis management plans that can secure the provision of care for future emergencies in the healthcare services. Originality/value: This paper shows that a crisis management plans in the healthcare services should include decision structures and management, measures of risk assessment and OSH management, and the maintenance of personnel wellbeing. A prepared healthcare management can preserve quality care delivery while under crisis. [ABSTRACT FROM AUTHOR]

Purpose The concept of value is becoming increasingly fashionable in healthcare and various improvement approaches (IAs) have been introduced with the aim of increasing value. The purpose of this paper is to construct a taxonomy that supports the management of parallel IAs in healthcare. Design/methodology/approach Based on previous research, this paper proposes a taxonomy that includes the dimensions of view on value and organizational focus; three contemporary IAs - lean, value-based healthcare, and patient-centered care - are related to the taxonomy. An illustrative qualitative case study in the context of psychiatric (psychosis) care is then presented that contains data from 23 interviews and focuses on the value concept, IAs, and the proposed taxonomy. Findings Respondents recognized the dimensions of the proposed taxonomy and indicated its usefulness as support for choosing and combining different IAs into a coherent management model, and for facilitating dialog about IAs. The findings also suggested that the view of value as "health outcomes" is widespread, but healthcare professionals are less likely than managers to also view value as a process. Originality/value The conceptual contribution of this paper is to delineate some important characteristics of IAs in relation to the emerging "value era". It also highlights the coexistence of different IAs in healthcare management practice. A taxonomy is proposed that can help managers choose, adapt, and combine IAs in local management models. [ABSTRACT FROM AUTHOR]

Purpose: In Sweden, the care of older people and people with disabilities is increasingly carried out by informal carers, often family members, who are unpaid and outside a professional or formal framework. While there is an increasing awareness of the role of carers within service systems and their own needs for support, their involvement in research is underexplored. The purpose of this paper is to explore carers' views and experiences of involvement in research and development (R&D) work. Design/methodology/approach: A qualitative study was conducted, consisting of 12 individual interviews with carers from different local Swedish carer organizations. Findings: Core findings included carers' discussions of the perceived challenges and benefits of their involvement in research, both generally and more specifically, in the context of their involvement in the development of a national carer strategy. Research limitations/implications: Limitations included the relative lack of male carer participants and the convenience sample. Practical implications: Authentic carer involvement in research demands a high level of engagement from researchers during the entire research process. The provided CRAC framework, with reference to the themes community, reciprocity, advocacy and circumstantiality, may help researchers to understand and interpret carer involvement in research and provide the prerequisites for their involvement. Originality/value: There is a dearth of studies that systematically examine carer involvement in research. This paper attempts to redress this gap by providing a nuanced analysis of carer involvement in R&D work from the perspective of carers themselves. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to report on a service evaluation of a competency-based dementia training programme for clinicians to establish its value in improving their knowledge and confidence of dementia care and to explore any resulting changes to practice. Design/methodology/approach: Mixed method quantitative and qualitative data, using rating scales and focus group discussions (FGDs), were collected. Wilcoxon signed-rank test was used to analyse changes in the responses to the rating scales of knowledge and confidence and thematic analysis of FGDs was undertaken to identify staff perceptions of the impact of training on their practice. Findings: In total, 162 qualified and clinical support staff undertook the training. A significant change in knowledge and confidence scores was found on all three scales. In general, feedback on the course was positive. Seven themes, demonstrating the relevance of the training to practice, emerged from the FGDs – experiential training awareness of diagnosis, approach, understanding, communication, risk, changed practice and going forward. Practical implications: Providing competency-based dementia training for large numbers of staff can have a positive effect on the care delivered to patients with dementia. Originality/value: Healthcare organisations have a responsibility to ensure their staff have the training to provide quality care for patients living with dementia. This paper suggests this can be achieved through a collaborative, multi-disciplinary approach involving co-production and best practice guidance. [ABSTRACT FROM AUTHOR]

Purpose Collaborative inter-agency working is of paramount importance for the public protection agenda worldwide. The purpose of this paper is to disseminate the findings from a research study on the inter-agency working within adult support and protection (ASP) roles in the police, health and social care.Design/methodology/approach This realistic evaluation study with two inter-related phases was funded by the Scottish Institute for Policing Research. This paper reports on Phase 1 which identified existing gaps in the implementation of effective inter-agency practice by reviewing the "state of play" in inter-agency collaboration between the police and health and social care professionals. In total, 13 focus groups comprising representatives from Police Scotland (n=52), Social Care (n=31) and Health (n=18), engaged in single profession and mixed profession groups addressing issues including referral and information exchange.Findings On analysing context-mechanism-outcome (CMO), gaps in joint working were identified and attributed to the professionals' own understanding of inter-agency working and the expectations of partner agencies. It recommended the need for further research and inter-agency training on public protection.Research limitations/implications This unique Scottish study successfully identified the inter-agency practices of health, social services and police. By means of a modified realistic evaluation approach, it provides an in-depth understanding of the challenges that professionals face on a day-to-day basis when safeguarding adults and informed strategic recommendations to overcome the barriers to good practices in organisational working. The methods used to determine CMO could benefit other researchers to develop studies exploring the complexities of multi-causal effects of cross-boundary working. The use of the same case study in each focus group helped to neutralise bias. However, the voluntary nature of participation could have resulted in biased perceptions. The limited numbers of health professionals may have resulted in less representation of health sector views.Practical implications This paper reports on a Scottish study that focused on the coordinated and integrated practices amongst the police, health and social services' professionals who support and protect adult members of society at risk of harm and has implications for their practice.Social implications Whilst the focus of this study has been on ASP, the conclusions and recommendations are transferable to public protection issues in many other contexts.Originality/value Studies on the joint-working practices amongst police and health and social services' professionals who support and protect adult members of society at risk of harm are uncommon. This study investigated professionals' perceptions of gaps and concerns pertaining to integrated working by means of a realistic evaluation approach. It recommended the need for further research and inter-agency training on public protection. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to analyze the relationship between Latin American migrants and the Spanish healthcare system, from the users' perspective, in order to examine the socio-cultural determinants for access and attention, as well as the possible difficulties faced when attending institutional facilities. Design/methodology/approach - This work is based on qualitative ethnographic research with the Latin American community established in the region of Castile and León, Spain. Analysis was established through a thematic approach and illustrated with the testimonies of participants involved, to inspect personal meanings and interpretations, as well as specific practices regarding healthcare. Findings - The encounter between foreigners and health services is frequently expressed with negative emotions, such as feelings of fear facing a system that is perceived as designed "for others." For many Latin American immigrants in Spain, institutional healthcare is not considered their first choice for treating illness. This has been related to economic, bureaucratic, ideological and emotional factors. Originality/value - Most of the existing literature about immigrant healthcare in Spain has focused on sanitary conditions or patterns of service use from an institutional perspective and a quantitative approach. This paper highlights the perceptions of users to enrich comprehension of the rapport betweenmigrants and medical care. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to conduct a qualitative needs assessment to explore the effectiveness of Houston's refugee resettlement efforts in the areas of employment, health care and education. Design/methodology/approach: Using referral sampling, the authors identified refugee community leaders and staff members at the five refugee resettlement agencies in Houston. The authors conducted 29 qualitative interviews with these contacts from February–August 2017. Findings: Recently resettled refugees may struggle to find and maintain employment in Houston due to difficulty accessing public transportation. Refugees seeking medical care in Houston often have difficulty navigating the complexities of the health-care system and communicating with their physicians due to language barriers. Finally, refugee children may have trouble adapting to Houston public schools, sometimes because they have limited experience with formal education. This study provided insights into the challenges Houston refugees face during resettlement and these barriers can be mitigated with policies designed specifically to address them. Practical implications: The authors recommend decreasing public transportation fees for refugees, supporting programs that donate used vehicles to refugees, expanding access to English as a Second Language classes for refugee children and adults and giving refugees designated time to learn English upon arrival. Originality/value: Houston welcomes more resettled refugees than any other American city. However, few studies have explored the barriers refugees face during the resettlement process. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to investigate the extent, range and nature of literature concerning the mental health inpatient care of the young adult population (16-25 years) who have been admitted to adult mental health wards. This paper reports the findings and positions these in the context of the broader nature to adult inpatient care, evaluates the quality of the evidence and identify gaps in the literature.Design/methodology/approach This paper uses an adapted scoping review methodology, allowing for a broad search but utilised established steps that allowed for a structured, rigorous approach to be used. CINAHL, Cochrane Library, MEDLINE, PsycINFO, Google Scholar, plus a secondary hand search were conducted resulting in eight papers, of quantitative, qualitative and mixed methods papers.Findings Findings show admissions follow similar paths as to adults; admission reasons are largely unknown beyond simple descriptors; admission lengths are unknown whilst on adult wards; staff feel confident yet lack resources; young people feel the transition from CAMHS ward to adult ward can be beneficial if done sensitively; young people have positive experiences of adult wards, including factors that may not be present on CAMHS wards, e.g. role modelling by older patients; young people feel scared and vulnerable, including when excluded from decision making; however, involving young people can cause stress and be confusing if not done sensitively.Research limitations/implications The scoping review identified a limited amount of research evidence for the care of young people admitted to adult wards. The research methods used in these papers were varied and none was of a high-quality standard. All studies contained methodological gaps which detract significantly from their findings and conclusions. The studies go some way to fill the gaps in knowledge and evidence base for this group, although in doing this scoping review was to unearth more gaps in knowledge.Originality/value This scoping review collates findings from the literature regarding young people’s admissions to adult mental health wards. This sensitive and controversial area of mental health care is shown to be lacking in high-quality research. Young people are being admitted to adult wards in increasing numbers year on year in the UK, yet little research has been conducted to identify when and where treatment has been appropriate. This review provides a start to understanding what is known about admission and treatment for this group and what is not known so that these gaps may be investigated in future research. [ABSTRACT FROM AUTHOR]

Purpose: Transitional care (TC) models emerged to ensure healthcare coordination and continuity, as at-risk patients transfer between different settings or different levels of care within the same setting. TC models have been developed in many countries as well as within different healthcare service delivery models and organizations. This paper aims to focus on a TC model developed in Italy called Operating Centre for Transition (OCT), in order to (1) explore its distinctive features by establishing a framework of analysis, (2) apply the framework to study two OCTs and (3) provide recommendations on how to use the framework to evaluate and develop new OCTs in the future. Design/methodology/approach: The authors adopted a grounded theory method to develop and validate the framework of analysis. The authors employed several qualitative methods following four iterative and recursive steps: (1) desk analysis of relevant documents, (2) in-depth interviews to key informants, (3) three meetings of an expert working group and (4) application of the framework to two case studies. Findings: The framework of analysis identifies three core dimensions that are always present in any OCT: the service model, the functions and the organizational features. Moreover, for every dimension several variables that capture and understand OCTs' nature, role and development level are identified. Originality/value: The results of the study highlight the key elements of the OCT model in Italy and show that the proposed framework can be useful both to analyse existing OCTs and to support health managers and policy makers to create new OCTs or develop those already active. [ABSTRACT FROM AUTHOR]

Purpose: Nongovernmental organizations (NGOs) play a critical role in modern health-care systems complementing state organizations. The purpose of this paper is to investigate the challenges of NGOs' participation in Iran's health-care system. Design/methodology/approach: This qualitative study was conducted in 2020. Data were collected through semi-structured interviews with 26 participants: 11 managers and experts at the office of NGOs in the Ministry of Health (MOH) and universities of medical sciences and 15 chief executive officers (CEOs) of health-related NGOs in Tehran, Iran. The participants were chosen using the non-probabilistic approach of purposive sampling with maximum variation. Data analysis was performed using the thematic analysis method and MAXQDA 10 software. Findings: Challenges of NGOs' participation in Iran's health-care system are categorized into external and internal challenges. Financial issues, the process of getting permissions, lack of trust in NGOs, weak relationships with the public sector and lack of law are identified as main challenges. Building trust in NGOs, passing the NGOs' law, making people more familiar with NGOs and capacity development are the most important measures that improve the role of NGOs and resolve barriers to their participation in Iran's health-care system. Originality/value: In this study, for the first time, the challenges of NGOs' participation in Iran's health-care system are investigated by examining the views of both the public sector and NGOs. Improving the participation of NGOs in the health-care system provides Iran's MOH with the opportunity to make use of the NGOs' capacities to eliminate public health issues. [ABSTRACT FROM AUTHOR]

Purpose The civil war prompted many Tamils to flee Sri Lanka as refugees. Several researchers have documented psychological distress and trauma among Sri Lankan Tamil refugees, but the literature lacks sufficient discussion of resilience among this population. Although Sri Lankan Tamil refugees have experienced conflict and loss, they have also demonstrated positive adaptation following these challenges. The paper aims to discuss these issues.Design/methodology/approach The present study used an ecological approach, in which the effect of the environment on a person is regarded as significant, to explore resilience among Sri Lankan Tamils living in refugee camps in India.Findings Through a qualitative investigation of refugee experiences of war and camp life, the authors developed a conceptual framework for understanding individual and collective resilience among refugees.Research limitations/implications Additionally, the results of this study need to be interpreted with caution because participants were camp refugees, which may limit the applicability of these results with refugees who live in different settings.Practical implications The current research results show that intervention programs should have multiple components, including trauma intervention to address the individual and community psychological and psychiatric effects of war and migration experiences and psychosocial interventions to address individual, family, community dynamics and daily stressors.Social implications The study participants stated that Sri Lankan Tamil refugees are using their resilience traits including will power, positive talk, practical solutions, social support, religion and social networks to remake their broken souls.Originality/value Future studies need to be conducted with other refugee group to validate the findings of the paper. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to examine the trend of return migration of health professionals to Ghana and how it is impacting the delivery of health services in the country. It also highlights the challenges facing returnees to the country. Design/methodology/approach – A qualitative exploratory case study approach was employed in the study. Data gathered were analysed using the sequential model of qualitative content analysis. Findings – It was found that while push factors dominantly influence out-migration, pull factors rather dominated reasons for return migration. Other determinants of return migration include social and financial benefits to the home country, achieving goals for travelling, skills’ improvement and spousal consideration. The paper also highlights some of the challenges returnees usually encounter in the home country. Social implications – This paper makes reasonable recommendations regarding how return migration of Ghanaian health professionals might be smoother. Originality/value – The study brings to the fore, the necessity for the government to plan for health professionals, who returned to Ghana to contribute to the health system. [ABSTRACT FROM AUTHOR]

Purpose: There is a dearth of research on what constitutes effective transfer of care from children's and young people services to adult services for patients with eating disorders (EDs) in the UK. Transition has implications for continuity of care and particularly for early intervention which has the best prognosis. The purpose of this paper is to understand the experience of transition and identify facilitators and barriers to this. Design/methodology/approach: Qualitative methodology was used. Focus groups (n = 4) were held with clinicians (n = 22) working in Child and Adolescent Mental Health Services or adult ED services. Individual interviews were conducted with patients (n = 5) who had commenced/completed transition to adult services and with parents/carers (n = 6) of patients invited for interview. Findings: A number of factors may facilitate or impede transition and can be grouped into the broad themes of communication, managing the differences between services and timing of transition. Improvements in communication, clear explanation of service differences and flexibility around the timing of transitions may enhance the experience for patients and parents/carers. Research limitations/implications: The service evaluation was limited to transition between two specialist ED services in one geographical location. The findings provide the basis for a wider research study to examine which factors are most important when planning transition from the perspectives of patients, parents/carers and clinicians. Originality/value: This is the first study examining ED transitions in the UK. It provides valuable insight of the experience of service users and carers and highlights potential improvements when planning transitions for this patient group. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to explore how the clinical governance policy and its main component, patient satisfaction, turned into practice and what they look like on the ground in the centralised health system of Iran. Design/methodology/approach -- A qualitative research stance was adopted incorporating three main sources of information: face to face in-depth interviews and focus groups conducted with hospital senior managers at the teaching hospitals in Kerman city, Iran, as well as documentary analysis of key policy texts. Nine hospital senior managers were purposefully selected for face-to-face interviews as well as a purposeful sample of 15 hospital senior managers for focus groups. Findings -- The documentary analysis revealed how clinical policy has been put into practice. The interview and focus group data analysis also disclosed four key themes with respect to how policy implementers in the Iranian centralised health system perceive nationally developed policies towards clinical governance and patient satisfaction. These include: a paper exercise; opaque, ambiguous policies; unstable policies; and separation of policy making from policy implementation. Originality/value -- The study revealed a perceived mismatch between the official proposals for clinical governance and their application in practice. The findings of this research lend support to the idea that there should be no separation between policy making process and its implementation; they are inseparable and should be treated in parallel, rather than in sequence. The study further suggests more accountability of the state towards its policies and public alike as a better governance of the health system. State-level sustainability followed by allocating proper resources to implementation fields and empowering policy implementers coupled with good systems of performance control are the keys to keep patient focus a top priority. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to explore the impact of domestic abuse on the health and lives of older women.Design/methodology/approach - A qualitative research design was used and data were collected using in-depth interviews with 16 older women who had experienced domestic abuse. The interviews varied between one and two hours in length and, with the participant's permission, all of the interviews were audio recorded and transcribed verbatim. Analysis was undertaken utilising an iterative approach. In the present study all data were manually indexed and coded.Findings - The findings of this study illustrate that the consequences of domestic abuse for older women are far reaching, impacting significantly on the long-term health and emotional wellbeing of those affected. This paper also highlights that there is currently little available data regarding older women and domestic abuse within the particular context of health. This is increasingly being recognised as a significant deficit in awareness and understanding within society as a whole and, more particularly, for those responsible for support and care provision. Existing policy in this field and the implications for service development are also considered.Research limitations/implications - This is a small scale study and therefore there are limitations in terms of generalisability.Originality/value - This paper discusses the specific issues that arise for older women who have experienced domestic abuse within the particular context of health. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to present a case study of a hospital nursing unit that has evaluated and approved a two-bin "e-kanban" replenishment system based on passive high frequency radio-frequency identification (RFID) technology. Design/methodology/approach - The case study analysis is based on both qualitative and quantitative data that were collected using semi-structured interviews, on-site observations and experience from previous implementations. The data and simulation analysis presented in this paper were validated by key respondents thereby increasing their reliability. Findings - Results indicate that implementing the e-kanban RFID solution in conjunction with the redesign of the ward floor and of the roles and functions can substantially improve business and operational performance. The most important benefits for the hospital are derived from the time saved from non-value-added activities that can be transferred to patient care activities and the significant reduction of on-hand inventory at distributed storage locations. The solution is considered an alternative that requires less initial investment than RFID-enabled cabinets used in the replenishment of consignment and high-value supplies in operating rooms and cardiac catheterization laboratories. Research limitations/implications - There is a need to conduct further research on RFID supply chain management (SCM) applications in the healthcare sector as this area holds a great potential for performance improvements. Additionally, there is a need to conduct more in-depth research into the isolated impact of RFID technology in comparison to the change management and process redesign that it generates. One key limitation of this research is the case study approach based on a single case. This paper, therefore provides direction for practitioners on how to assess RFID''s potential impact in the healthcare supply chain. Originality/value - While most of the research on RFID in healthcare sector focuses on active RFID technology for asset management, this research presents a novel RFID application and contributes to our understanding of RFID''s potential in intra-organizational SCM processes. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to evaluate the longer-term impact of the 12-month Welsh clinical leadership fellowship. Design/methodology/approach: Semi-structured interviews with 10 out of 14 trainee doctors who were fellows between 2013-2016, exploring how leadership knowledge and skills were used in clinical practice, impact on patient care and influence on careers. Data, gathered in 2017 when participants had completed the fellowship between 1-3 years, were analysed thematically. Findings: All found the fellowship rewarding. The experience was felt to advantage them in consultant interviews. They gained insight into the wider influence on organisations and the complexity of issues facing senior clinicians. Although subtle, the impact was significant, equipping fellows with negotiation skills, enabling them to better influence change. Indirect impact on clinical practice was evidenced by enhanced confidence, teamworking skills and progression of improvement projects. However, the use of skills was limited by lack of seniority within teams, demands of medical training and examinations. The negativity of others towards management and leadership was also noted by some. Research limitations/implications: Small participant numbers limit generalisability. Practical implications: The fellowship is designed to equip participants with skills to lead improvements in healthcare delivery. Those more advanced in their medical training had greater opportunity and seniority to lead change and were better placed to apply the learning. This has implications for whom the training should be targeted. Originality/value: A rare study exploring the longer-term impact of a leadership programme on later clinical practice, which adds to the body of knowledge of impact and efficacy of leadership training programmes in healthcare environments. [ABSTRACT FROM AUTHOR]

Purpose Large numbers of women in prison report significant emotional and mental health problems, and there is evidence to suggest that the prison environment may exacerbate the incidence and severity of these issues (Armour, 2012). However, there has been limited exploration of the extent to which women’s mental health problems exist prior to incarceration, whether symptoms first occur in incarceration, and how incarceration affects this. The paper aims to discuss these issues.Design/methodology/approach In-depth interviews were conducted with 43 women incarcerated in three English prisons and a thematic analysis of the data was conducted. Review of official prison records provided a form of data triangulation.Findings Analysis of the data revealed that while many women who experienced mental health issues in prison had experienced these issues in the past, a number of women reported first experiencing mental health and emotional problems only after entering prison. Although these problems often recede, this demonstrates the significant impact that entering prison can have upon the mental health of women. Unusually, the data highlighted many positive experiences of support within prison. However, there was some lack of consistency in the treatment and support offered to women.Originality/value The data presented here are in many ways more positive than previous research and – as opposed to much of the existing literature that simply states the prevalence women’s issues in prison – provides insight into the lived experiences of women in prison. This paper documents how prison can present an opportunity for women to engage with treatment, but there is a need for a clearer understanding of women’s needs and consistent and appropriate support. [ABSTRACT FROM AUTHOR]

Purpose Child and family health (CAFH) services in Australia initially provide at least one nurse-home-visit following the birth of a child. Planning and referral then commences for the on-going provision of appropriate services to families. Unfortunately, services in rural and regional communities in Australia can be fragmented and poorly resourced. Little is known about CAFH nurses’ experiences of working with families in these communities. The purpose of this paper is to examine the way CAFH nurses work within a universal health service model that may be compromised by isolation, discontinuity and fragmentation.Design/methodology/approach Focus groups with 26 CAFH nurses from five rural, two regional and one urban community in New South Wales (NSW), Australia were conducted. A secondary, thematic analysis of the qualitative data were undertaken to reflect on change and continuity in the field of universal CAFH services. Analysis was driven by two key research questions: How do CAFH nurses experience their role in universal home-based CAFH services within rural and regional areas of Australia and, what unique factors are present in rural and regional areas that impact on their CAFH nursing role?Findings The experience of the CAFH nurses as presented by these data revealed a role that was family centred and concerned for the welfare of the family, yet compromised by the need to meet the disproportionately complex needs of families in the absence of a strong network of services. The opportunity to present the findings provides insight into the way in which families engage with available services in isolated communities. CAFH nurses in the study attempted to maintain service integrity by adapting to the unique context of their work.Originality/value It is important to understand the mechanisms through which CAFH nurses operate to work effectively with families referred to their service. This paper describes the way in which CAFH nurses work with families not meeting the threshold for more intensive and targeted home-visiting service delivery in rural and regional communities of NSW, Australia. [ABSTRACT FROM AUTHOR]

Purpose: Wales Applied Risk Research Network (WARRN) is a formulation-based technique for the assessment and management of serious risk (e.g. violence to others, suicide, etc.) for users of mental health services. It has been gradually adopted as the risk evaluation and safety-planning technique for all seven health boards in Wales. The purpose of this paper is to examine the opinions of WARRN as used within these health boards. Design/methodology/approach: An online survey was disseminated to NHS clinicians in secondary mental health services to evaluate their perceptions of the use and effectiveness of WARRN. Data from 486 clinicians were analysed with both quantitative and qualitative methods. Findings: Results indicated that the overall impact of WARRN on secondary mental health care was very positive, with clinicians reporting increased skills in the domains of clinical risk formulation, safety-planning and communication, as well as increased confidence in their skills and abilities in these areas. Clinicians also reported that the "common-language" created by having all NHS health boards in Wales using the same risk assessment process facilitated the communication of safety-planning. Crucially, NHS staff believed that the safety of service users and of the general public had increased due to the adoption of WARRN in their health board and many believed that lives had been saved as a result. Originality/value: WARRN is perceived to have improved clinical skills in risk assessment and safety-planning across Wales and saved lives. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to explore implementation and development of step-down intermediate care (IC) in Glasgow City from the perspective of staff. Design/methodology/approach: The study used qualitative methods. Nine key members of staff were interviewed and three focus groups were run for social work, rehabilitation and care home staff. Framework analysis was used to identify common themes. Findings: The proposed benefits of IC were supported anecdotally by staff. Perceived enablers included: having a range of engaged stakeholders, strong leadership and a risk management system in place, good relationships, trust and communication between agencies, a discharge target, training of staff, changing perception of risk and risk aversion, the right infrastructure and staffing, an accommodation-based strategy for patients discharged from IC, the right context of political priorities, funding and ongoing adaptation of the model in discussion with frontline staff. Potential improvements included a common recording system shared across all agencies, improving transition of patients from hospital to IC, development of a tool for identifying suitable candidates for IC, overcoming placement issues on discharge from IC, ensuring appropriate rehabilitation facilities within IC units, attachment of social work staff to IC units and finding solutions to issues related to variation in health and social care systems between sectors and hospitals. Originality/value: The findings of this study help the ongoing refinement of the IC service. Some of the recommendations have already been implemented and will be of value to similar services being developed elsewhere. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to describe how frequent attenders (FAs), divided into different profiles, use of primary care, emergency care and specialised medical care and which social services have been granted to them. Design/methodology/approach: The present study utilises previous research of FAs and their identification of four profiles. The data were acquired from three data registries in Finland. Analysis of the FAs (n = 56) data was undertaken using descriptive statistics methods and qualitative analysis. Findings: Patients with multiple problems used primary care, emergency care and specialized medical care frequently, and they had the highest number of appointments with doctors and nurses. Social services were required mostly social work. Visits made by patients with an impaired capacity caused by substance abuse were mainly targeted at appointments and mental health care services to a nurse in primary care. The required types of social services were often rehabilitative work experience. For mothers requiring support, the most frequently used services in primary were the child health and maternity clinic. The social services granted were mostly social work. Children and adolescents who are burdened by everyday concerns visits were mainly focused on primary to the child health and maternity clinic. Use of social services often entailed the supervision of contact sessions between parents and children's. Research limitations/implications: The study confirmed that there is a need for increase knowledge of FAs. The service needs of FAs should be understood multi-dimensionally and the research results justify the individualised integration of social and health services for FAs. Originality/value: The research results justify the individualised integration of social and health services for FAs. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to evaluate a collaborative effort between a health care organization and academic institution to strengthen organizational health literacy.Design/methodology/approach: The intervention took place at a rural, federally qualified health clinic in Missouri between May 2009 and April 2011. Qualitative interviews of key informants were conducted before (n=35) and after (n=23) the intervention to examine program implementation and success in effecting organizational change.Findings: Intervention activities helped establish a comprehensive understanding of health literacy. The project achieved moderate, fundamental and sustainable organizational change. The program successfully integrated health literacy practices into clinic systems and garnered leadership and organizational commitment, helped the workforce improve interpersonal communication and embedded practices making health education materials more accessible.Originality/value: The study points to programmatic, conceptual and methodological challenges that must be addressed for organizations to improve health literacy practices, and suggests change management strategies to advance organizational health literacy. [ABSTRACT FROM AUTHOR]

Purpose In the UK, the Identification and Referral to Improve Safety (IRIS) initiative has been developed for use within primary care to support women survivors of domestic violence and abuse (DVA). However, while evaluated nationally, less is known regarding impact of implementation at a local level. The purpose of this paper is to explore the effectiveness of IRIS within one locality in the UK.Design/methodology/approach A qualitative study using interviews/focus groups with primary care teams and women who had experienced DVA in one primary care setting in the UK. Interviews with 18 participants from five professional categories including: general practitioners, practice nurses, practice managers, assistant practice managers and practice receptionists. Focus group discussion/interview with seven women who had accessed IRIS. Data were collected between November 2016 and March 2017.Findings Five main themes were identified for professionals: Team role approach to training, Professional confidence, Clear pathway for referral and support, Focussed support, Somewhere to meet that is a "safe haven". For women the following themes were identified: Longevity of DVA; Lifeline; Face to face talking to someone; Support and understood where I was coming from; A place of safety.Practical implications IRIS played a significant role in helping primary care professionals to respond effectively. For women IRIS was more proactive and holistic than traditional approaches.Originality/value This study was designed to assess the impact that a local level implementation of the national IRIS initiative had on both providers and users of the service simultaneously. The study identifies that a "whole team approach" in the primary care setting is critical to the effectiveness of DVA initiatives. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to investigate inter-organizational designs for care–cure conditions in which low-risk patients are cared for in specialized care organizations and high-risk patients are cared for in specialized cure organizations. Performance impacts of increasing levels of integration between these organizations are analyzed.Design/methodology/approach Mixed methods were used in Dutch perinatal care: analysis of archival data, clinical research and system dynamics simulation modeling.Findings Inter-organizational design has an effect on inter-organizational dynamics such as collaboration and trust, and also on the operational aspects such as patient flows through the system. Solutions are found in integrating care and cure organizations. However, not all levels of integrated designs perform better than a design based on organizational separation of care and cure.Practical implications A clear split between midwifery practices (care) and obstetric departments (cure) will not work since all pregnant women need both care and cure. Having midwifery practices only works well when there are high levels of collaboration and trust with obstetric departments in hospitals. Integrated care designs are likely to exhibit superior performance. However, these designs will have an adverse effect on organizations that are not part of this integration, since integrating only a subset of organizations will feed distrust, low collaboration and hence low performance.Originality/value The originality of this research is derived from its multi-method approach. Archival data and clinical research revealed the dynamic relations between organizations. The caveat of some integrated care models was found through simulation. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to explore the views of people with learning disabilities on issues associated with continuity of care in the transition from full-time education to adult care and support.Design/methodology/approach Data collection was undertaken with people with learning disabilities and staff in two advocacy organisations in one area of England in 2012. In total, 19 participants attended three focus groups. Analysis focussed on continuity of care and was guided by the framework approach to qualitative analysis.Findings Teachers, social workers in children’s services and youth workers were identified as making important contributions to the transition process. Information relating to learning and social development was identified as most important to inform transition planning with less priority accorded to health, communication, and self-care and independence. Participants appeared to value principles which underpin continuity of care.Research limitations/implications This study provides insights into attributes of continuity of care valued by people with a learning disability. Possibilities of translating these attributes into practice within localities are explored. Findings could be used to inform strategic planning locally to promote service integration thereby contributing to continuity of care within transition planning.Originality/value Continuity of care in the transition planning process is highlighted in policy guidance with recognition that both practice and procedures require improvement. This research explores areas for development from the perspective of people with learning disabilities. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to investigate older people’s views and experiences of getting help from neighbours in order to consider whether such help is situated within neighbourliness and the implications for social care policy which seeks to harness help from neighbours.Design/methodology/approach A qualitative study in which 15 older people from the North of England were interviewed to explore relationships with neighbours, managing day to day life and experiences of getting help from neighbours.Findings Relationships with helper neighbours were reciprocal, dynamic and preceded the start of getting help. The help offered was not negotiated but evolved in response to changes in circumstances and was commensurate with normative views of neighbourliness, i.e. reciprocated sociability and helpfulness but also respect for privacy. Respondents were reluctant to ask for help. Underpinning such reluctance were perceptions of imposing on neighbours, suggestive of anticipated asymmetry in the give-and-take of neighbourliness.Social implications Policy makers who see the help from neighbours as an output of household production and available as a source of informal care for older people must appreciate that whether help is offered or taken up is dependent on the development of a reciprocal relationship which itself depends on observing and respecting normative boundaries, such as in relation to help giving or receiving and due respect for privacy.Originality/value There has been little research into older people’s perspectives on getting help from neighbours despite diminishing public services and neighbours viewed as a potential source of care. [ABSTRACT FROM AUTHOR]

Purpose The purpose of the paper is to examine the care transitions of older people who transfer between home, acute and sub-acute care to determine if there were common transition types and areas for improvements.Design/methodology/approach A longitudinal case study design was used to examine care transitions of 19 older people and their carers as a series of transitions and a whole-of-system experience. Case study accounts synthesising semi-structured interviews with function and service use data from medical records were compared.Findings Three types of care transitions were derived from the analysis: manageable, unstable and disrupted. Each type had distinguishing characteristics and older people could experience elements of all types across the system. Transition types varied according to personal and systemic factors.Originality/value This study identifies types of care transition experiences across acute, sub-acute and primary care from the perspective of older people and their carers. Understanding transition types and their features can assist health professionals to better target strategies within and across the system and improve patient experiences as a whole. [ABSTRACT FROM AUTHOR]

Purpose Since 1990, the Cleveland Clinic has trained physicians in team skills through various iterations of a program called Leading in Healthcare (LHC). In the present study, the authors utilize a case study approach to gain insight into the LHC curriculum, and more specifically, the team project. The purpose of this paper is to better understand the Cleveland Clinic’s position on the issue and its approach to education – specifically among physicians.Design/methodology/approach The authors utilized a case study approach with four key program architects.Findings The results of this exploratory research yielded three themes: There is a lack of formal physician education in teamwork, there is a growing trend of inter-disciplinary teams and the team project was an important component of teambuilding in LHC.Research limitations/implications A breakdown in team function adversely impacts patient care. While formal and informal participation in teams is imbedded in the role, physicians are rarely trained in leadership or teambuilding in their formal medical education – much of it is learned on the job in hidden curricula. In addition to the adverse effects of dysfunctional teams on patient care, the authors have explored another area that will be affected by a lack of education – the team experience at the administrative level. As more and more physicians take on leadership roles in healthcare, there is an additional need to build competencies around teams (e.g. team theory, cross-functional team participation and leading teams) from an administrative perspective.Originality/value This is one of only a few studies which have specifically examined the impact of a teamwork education for physicians. [ABSTRACT FROM AUTHOR]

Purpose UK fellowship schemes have been set up to address low-level engagement of doctors with leadership roles. Established in 2013, the Welsh Clinical Leadership Fellowship (WCLF) programme aims to recruit aspiring future clinical leaders and equip them with knowledge and skills to lead improvements in healthcare delivery. This paper aims to evaluate the 12-month WCLF programme in its first two years of operation.Design/methodology/approach Focused on the participants (n = 8), the authors explored expectations of the programme, reactions to academic components (provided by Academi Wales) and learning from workplace projects and other opportunities. The authors adopted a qualitative approach, collecting data from four focus groups, 20 individual face-to-face or telephone interviews with fellows and project supervisors and observation of Academi Wales training days.Findings Although from diverse specialties and stages in training, all participants reported that the Fellowship met expectations. Fellows learned leadership theory, developing understanding of leadership and teamwork in complex organisations. Through workplace projects, they applied their knowledge, learning from both success and failure. The quality of communication with fellows distinguished the better supervisors and impacted on project success.Research limitations/implications Small participant numbers limit generalisability. The authors did not evaluate longer-term impact.Practical implications Doctors are required to be both clinically proficient and influence service delivery and improve patient care. The WCLF programme addresses both the need for leadership theory (through the Academi Wales training) and the application of learning through the performance of leadership roles in the projects.Originality/value This work represents an evaluation of the only leadership programme in Wales, and outcomes have led to improvements. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to discuss health services managers’ experiences of management in a special health-care unit and development efforts from the point of view of the Lean method. Additionally, the aim is to deepen the knowledge of the managers’ work and nature of the Lean method development processes in the workplace. The research focuses on those aspects and results of Lean method that are currently being used in health-care environments.Design/methodology/approach These data were collected through a number of thematic interviews. The participants were nurse managers (n = 7) and medical managers (n = 7) who applied Lean management in their work at the University Hospital in the Northern Ostrobothnia Health Care District. The data were analysed with a qualitative content analysis.Findings A common set of values in specialized health-care services, development of activities and challenges for management in the use of the Lean manager development model to improve personal management skills.Practical implications Managers in specialized health-care services can develop and systematically manage with the help of the Lean method. This emphasizes assumptions, from the point of view of management, about systems development when the organization uses the Lean method. The research outcomes originate from specialized health-care settings in Finland in which the Lean method and its associated management principles have been implemented and applied to the delivery of health care.Originality/value The study shows that the research results and in-depth knowledge on Lean method principles can be applied to health-care management and development processes. The research also describes health services managers’ experiences of using the Lean method. In the future, these results can be used to improve Lean management skills, identify personal professional competencies and develop skills required in development processes. Also, the research findings can be used in the training of health services managers in the health-care industry worldwide and to help them survive the pressure to change repeatedly. [ABSTRACT FROM AUTHOR]

Purpose Injuries resulting from racism are largely hidden by silence. Community services to provide healing from racism are missing in at least one Canadian city. The purpose of this paper is to identify the injuries suffered by immigrants who experienced racism and discuss the development of culturally appropriate programs and tools to address injuries from racism.Design/methodology/approach Participants representing visible minorities service providers from non-profit, public-funded organizations in a major Canadian city took part in two focus groups. Data from focus groups were thematically analyzed.Findings Racism produces traumatic and persistent psychological, social and intergenerational injuries. An ostensible gap exists in services, professional education and skills to address the psycho-social effects of this complex problem. The complicity of silence in both dominant and subordinated groups contributes to its perpetuation. A dearth of screening and assessment instruments is a barrier in identifying individuals whose mental health and addiction problems may have underlying racism-related etiology. Creation of community healing circles is recommended as a preferred method over individual “treatment” to expose and deconstruct racism, strengthen ethnic identity and intergenerational healing.Research limitations/implications These qualitative findings were generated based on the perspectives of a small purposive sample (n=8) of immigrant service providers and immigrants from one Canadian city. Many of these findings are consistent with the existing literature on internalized racism and racism injuries. Generalizability to the wider population of the province and of Canada requires further research.Practical implications Practitioners in health and social care as well as educators need to understand the injuries and internalized effects of racism to provide appropriate services and leadership. Development of anti-racism professional knowledge and skills, healing circles, and assessment instruments will contribute to deconstructing racism and mitigating its injuries.Originality/value Community-driven studies exploring racism and the lack of services to address the issue are scarce. This study pulls together the experience of service providers and their insights on ways to break the detrimental silence surrounding racism. [ABSTRACT FROM AUTHOR]

Purpose: In this article, we outline our views on the appropriateness and utility of Return on Investment (ROI) for the evaluation of the value of healthcare quality improvement (QI) programmes. Design/methodology/approach: Our recent research explored the ROI concept and became the genesis of our viewpoint. We reflect on our findings from an extensive research project on the concept of ROI, involving a multidisciplinary global systematic literature review, a qualitative and Delphi study with mental healthcare leaders from the United Kingdom National Health Service. Research participants included board members, clinical directors and QI leaders. Our findings led to our conclusions and interpretation of ROI against the broad QI governance. We discuss our views against the predominant governance frameworks and wider literature. Findings: ROI is in-line with top-down control governance frameworks based in politics and economics. However, there is evidence that to be of better utility, a tool for the assessment of the value of QI benefits must include comprehensive benefits that reflect broad monetary and non-monetary benefits. This is in-line with bottom-up and collaborative governance approaches. ROI has several challenges that may limit it as a QI governance tool. This is supported by wider literature on ROI, QI as well as modern governance theories and models. As such, we question whether ROI is the appropriate tool for QI governance. A more pragmatic governance framework that accommodates various healthcare objectives is advised. Practical implications: This article highlights some of the challenges in adopting ROI as a QI governance tool. We signal a need for the exploration of a suitable QI governance approach. Particularly, are healthcare leaders to be perceived as "agents", "stewards" or both. The evidence from our research and wider literature indicates that both are crucial. Better QI governance through an appropriate value assessment tool could improve clarity on QI value, and thus investment allocation decision-making. Constructive discussion about the utility and appropriateness of ROI in the evaluation of healthcare QI programmes may help safeguard investment in effective and efficient health systems. Originality/value: The article raises awareness of QI governance and encourages discussions about the challenges of using ROI as a tool for healthcare QI governance. [ABSTRACT FROM AUTHOR]