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Purpose: COVID-19 generated extensive fear and anxiety across the globe. This study aims to explore the psychological dynamics of students during COVID-19 lockdown, its impact and students' management strategies. Design/methodology/approach: This paper collected data from 891 students in Islamabad (Pakistan) using an online survey consisting of the generalized anxiety disorder scale and items on academic variables. After measuring the anxiety levels, this paper interviewed 20 students diagnosed with severe anxiety. The objective was to seek a deeper understanding of the impact of COVID-19 and students' management. Findings: This paper found students with different anxiety levels. Most students had no anxiety; however, 8.2% of students had severe anxiety. These students reported psychological, social and physical problems during the interview. The students shared their activities and avoidance behavior to manage their anxiety levels. Originality/value: The study helped in understanding the psychological dynamics during the pandemic and students' management strategies. Some students express their inability to cope with their problems. This paper recommends the intervention of clinical practitioners, policymakers and researchers to work for the mental health of such students. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to identify and understand the barriers and enablers to the implementation of youth peer support in a clinical mental health service. The development of a lived experience workforce in mental health is a key component of policy at both the state and the federal level in Australia. Implementing a peer workforce within existing clinical services, however, can be a challenging task. Furthermore, implementing peer support in a youth mental health setting involves a further degree of complexity, involving a degree of care for young people being invited to provide peer support when they may be still early in their own recovery journey. Design/methodology/approach: This paper reports on a formative evaluation of the beginning stages of implementation of a youth peer workforce within an existing clinical mental health service in Melbourne. Findings: The project found that it was feasible and beneficial to implement youth peer support; however, significant challenges remain, including lack of appropriate training for young people, uncertainty amongst clinical staff about the boundaries of the peer role and the potential for "tokenism" in the face of slow cultural change across the whole service. Originality/value: Very little evaluation has yet been undertaken into the effectiveness of implementing peer support in youth mental health services. This paper offers an opportunity to investigate where services may need to identify strengths and address difficulties when undertaking future implementation efforts. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to present an analysis of a "county lines" safeguarding partnership in a large city region of England. A critical analysis of current literature and practice responses to "county lines" is followed by the presentation of an analytical framework that draws on three contextual and social theories of (child) harm. This framework is applied to the partnership work to ask: are the interconnected conditions of criminal exploitation of children via "county lines" understood?; do interventions target the contexts of harm?; and is social and institutional harm acknowledged and addressed? Design/methodology/approach: The analytical framework is applied to a data set collected by the author throughout a two-year study of the "county lines" partnership. Qualitative data collected by the author and quantitative data published by the partnership are coded and thematically analysed in NVivo against the analytic framework. Findings: Critical tensions are surfaced in the praxis of multi-agency, child welfare responses to "county lines" affected young people. Generalising these findings to the child welfare sector at large, it is proposed that the contextual dynamics of child harm via "county lines" must be understood in a broader sense, including how multi-agency child welfare practices contribute to the harm experienced by young people. Originality/value: There are limited peer-reviewed analyses of child welfare responses to "county lines". This paper contributes to that limited scholarship, extending the analysis by adopting a critical analytic framework to a regional county lines partnership at the juncture of future national, child welfare responses to "county lines". [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to explore contemporary metaphors used in career literature pertaining to career development in an international context. Design/methodology/approach – Qualitative interviews with thirty-seven skilled self-initiated expatriates in one geographical location were conducted and used for data analysis. Findings – The metaphor of a "river" more aptly captures the career development directions and influences experienced by skilled self-initiated expatriates. Originality/value – The paper provides an analysis of career development influences which impact on the career direction of self-initiated expatriates. It provides useful information and recommendations for career (international career) academics and practitioners with regards to career development influences to be considered with regards to skilled self-initiated expatriates. [ABSTRACT FROM AUTHOR]

Purpose: Health literacy (HL) is considered an important prerequisite for informed, self-determined health decisions. HL research among older migrants is scarce, but especially important, as older people face great challenges regarding management of chronic illnesses and, therefore, are in need of adequate healthcare. Therefore, this paper aims to report HL in the domain of healthcare (HL-HC) among older migrants in Germany stratified by different countries of origin. Design/methodology/approach: Data were collected by a quota sample in North Rhine-Westphalia, Germany. Computer-assisted personal face-to-face interviews were conducted in German, Russian and Turkish. For this analysis, a subsample of 192 first-generation migrants aged 65–80 years from Turkey, Poland, Greece or Italy was drawn from the main sample (n = 1,000). HL-HC was assessed using a sub-index of health literacy survey European questionnaire 47. Data analyses comprised descriptive statistics, bivariate and multivariate analyses. Findings: Overall, 68.6% of the older migrants have limited HL-HC, and mean HL-HC scores vary significantly among different countries of origin. There is great variation in reported difficulties for the single HL-HC tasks by migrant groups. In multiple regressions, country of origin, not German as main language, low functional HL and low social status are significantly associated with lower HL-HC. Practical implications: Interventions should be aimed at smaller target groups and should consider language issues and possible differences related to countries of origin into account. Both individual skills and system-related aspects need to be addressed. Originality/value: This paper presents first data on HL-HC among older migrants in Germany and its determinants, stratified by different countries of origin. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to clarify the relationship between characteristics that contribute to health care access issues and individual behavior seeking health care. It proposes the different contexts of why African American and Hispanic men are not accessing health care. The study findings provided the target audience with past and present literature to contribute to the future resolution of racial and ethnic health care disparity, as well as health care access. Design/methodology/approach: The paper opted for a descriptive case study using a one-on-one face-to-face semi-structured approach of a case study, including 10 depth interviews representing African American and Hispanic men who are experiencing health care access issues. The data were complemented by archival data analysis, description of personal accounts of the African American and Hispanic men and articles pertaining to racial and ethnic health disparities. Findings: The paper provides insights into how change is brought about the improvement of health care for all races and ethnicity. It suggests that leaders act as "integrating forces" on two levels: integrating the important elements of improved health care coupled with communication, language and health care cost and mediating between the health care structures and the individual. Originality/value: This paper fulfills an identified need to study the characteristics that contribute to health care access issues among African American and Hispanic men. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to explicate one of the major findings of a research study seeking to understand how Indonesian people with diabetes learn about their disease. The one key finding discussed in this paper is how families influence the learning and self-management processes adopted by Indonesian people with diabetes. Design/methodology/approach: A grounded theory methodology was adopted to investigate how Indonesian people with diabetes learn about their disease. Twenty-eight semi-structured interviews were undertaken with Indonesian people living with diabetes, families of people living with diabetes, healthcare professionals and other healthcare providers. Data was analysed by using constant comparative analysis during three coding stages. Findings: The study explicated the basic social process of how people with diabetes in Indonesia learn about their disease through a generated theory "Learning, choosing, and acting: self-management of diabetes in Indonesia". This study found family engagement was integral to Indonesian people living with diabetes who were self-managing their disease. Families assisted with seeking information, providing recommendations, selecting and implementing actions, appraising implemented actions, and informing others about their experiences. By acknowledging that family is involved in this process, the healthcare professional can adequately provide health education to both the person with diabetes and their families. Involving families in health education is crucial as family can influence decision making made by people with diabetes in a proper or improper way. Thus, clinicians need to also skilfully recognise difficulties these people encounter by monitoring their self-management progress and by working closely with them and their family members. Originality/value: This is the first study conducted in Indonesia that specifically investigates the process of how people with diabetes learn about their disease. The involvement of families in this process is a central finding of the study. Families can enhance the overall health and well-being of the person with diabetes, aid in early recognition of aberration to health status and trigger the initiation of interventions to re-establish homeostasis if they are actively engaged and supported by health professionals. [ABSTRACT FROM AUTHOR]

Purpose: The incidents of elder victimisation and cases of victimisation, in general, are increasing fast in the society. These incidents have had negative impact on the sense of well-being and way of life of the older people. Therefore, fear of crime is being considered as a most concerning psycho-social problem amongst the older people in contemporary time. The purpose of this study is to understand the impact of crime rate on the well-being of the older people and examine the linkage between psychological factors and fear of crime amongst the older people. Design/methodology/approach: The present study is based on the mixed method approach and an exploratory research designed applied to conduct the study. The field survey has been done from October 2012 to January 2013 on a sample of 220 older people of rural and urban areas of Lucknow in the state of Uttar Pradesh through purposive sampling. For the study, researcher has interviewed 137 male older people and 83 female older people through interview schedules and case studies. The data have been analysed through descriptive and narrative analysis. Findings: The study finds that those older people have direct or indirect experience of victimisation, they have anxiety and feel insecurity that someone can victimise them. The study also finds that the happiness of older people is more affected due to anxiety and phobia and have higher level of feeling of fear of crime in their neighbourhood and home. The study also finds whenever anti-social elements are active in the neighbourhood and they commit crimes, fear of crime and anxiety grasp the older people to a large extent causing a fracture in their psychological well-being. Originality/value: This work is the original work of researcher. This paper is related to the researcher's PhD dissertation work. This paper talks about how the psychological well-being of older people affects due to nature of crime in neighbourhood, phobia of crime and anxiety due to criminal activities. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to present new findings to organizations that acknowledge difficulties in implementing and succeeding with project partnering.Design/methodology/approach The investigation is based on a case study where empirical evidence has been collected via semi-structured interviews of 54 professionals within the construction industry.Findings Based on the research the authors were able to identify three main dimensions vital for project partnering success: 1. who related to participant selection; 2. what related to task clarification; and 3. way related to partnering means. These dimensions give rise to what the authors have termed a 3W (Who, What, Way) model on how to succeed with project partnering in practice. The third dimension, way related to partnering means, was found to consist of the four subdimensions: 3a. partnering attitude; 3b. a collaborative culture; 3c. a holistic perspective; and 3d. an accurate handover.Originality/value The authors found 318 papers focusing on partnering, in these only 19 focused on how to succeed with project partnering. The authors have complemented the limited research on how to succeed with project partnering with 54 interviews of professionals. The majority of the existing research has focused on challenges. This paper contributes to the research gap by presenting a 3W model on how to succeed with project partnering. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is twofold: to identify how horizontal leaders (within project teams) execute their leadership task in the context of balanced leadership; and to pinpoint scenarios that can occur when horizontal leaders are identified and empowered by the vertical leader (senior or project managers) and a project task is handed over to them to lead. This research is based on the concept of balanced leadership, which conceptualizes leadership as a dynamic, situation-dependent transition of leadership authority from a vertical leader (like a project manager) to a horizontal leader (a project team member) and back again, in order to contribute positively to a project’s success. Balanced leadership consists of five events (nomination, identification, empowerment, horizontal leadership and its governance, and transition). This paper focuses on the fourth event, and its specific aspect of leadership distribution between horizontal and vertical leader. This event begins when a team member(s) accepts the empowerment to assume the role of horizontal leader. This paper explicitly links the leadership style of the vertical leader based on Frame’s (1987) leadership styles and the nature of decisions taken by both the vertical and horizontal leaders to deliver the project.Design/methodology/approach The method used for this paper is the qualitative phase of a sequential mixed methods (qualitative-quantitative) study. Data were collected through case studies in four different countries, using a maximum variety sampling approach. Data collection was through interviews of vertical leaders (senior leaders who were often sponsors of projects or members of senior management or project managers) and horizontal leaders (team leaders or members) in a variety of industry sectors. Data analysis was done through initial coding and constant comparison to arrive at themes. Thematic analysis was used to gain knowledge about the split of leadership and decision-making authority between the horizontal and vertical leader(s).Findings The results show that for Canadian and Australian projects, a combination of autocratic and democratic leadership styles were used by vertical leaders. In the case of Scandinavian projects, a democratic leadership style has been observed. Linked to these leadership styles, the horizontal decision making is predominantly focused on technical decisions and to daily task decisions to deliver the project. Delegation occurs most of the time to one specific team member, but occasionally to several team members simultaneously, for them to work collaboratively on a given issue.Research limitations/implications The paper supports a deeper investigation into a leadership theory, by validating one particular event of the balanced leadership theory, which is based on Archer’s (1995) realist social theory. The findings from this paper will guide organizations to facilitate an effective approach to balancing the leadership roles between vertical and horizontal leaders in their projects. The findings can also be used to develop horizontal leaders to take up more responsibilities in projects.Originality/value The originality lies in the new leadership theory called balanced leadership, and its empirical validation. It is the first study on the leadership task distribution between vertical and horizontal leadership in projects. Its value is new insights, which allow practitioners to develop practices to find and empower the best possible leader at any given time in the project and academics to develop a more dynamic and, therefore, more realistic theory on leadership as it unfolds in projects. [ABSTRACT FROM AUTHOR]

Purpose High-profile critical incidents involving multiple witnesses, particularly terrorist attacks, have increased over the years. The purpose of this paper is to describe the components of a witness interview strategy for this type of investigation. Central to these cases is a need for a triage system which deals with a large number of witness/victim interviews that must be conducted fast time.Design/methodology/approach This paper was developed based on the experience of the authors who provide practical advice and support to these types of investigations and a dialogue with police interview advisers involved in developing this type of strategy.Findings A witness interview strategy for critical incidents involving multiple witnesses should be set within a framework that covers initial contact with the witnesses, the interview process and post-interview processes.Practical implications It is important that a witness interview strategy is developed for any critical incident involving multiple witnesses to ensure that what could otherwise be a chaotic process is effectively managed.Originality/value No other papers have been published that consider the development of witness interview-strategies for multiple-witnesses in critical incidents. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to gather the perspectives of individuals accessing an early intervention in psychosis service (EIPS), in order to inform service development.Design/methodology/approach Individual interviews (n=9) and one focus group (n=7) were conducted. Discussions focused on open questions pertaining to service users’ (SU’s) experiences of accessing the EIPS. The results were analysed using inductive thematic analysis.Findings Inductive thematic analysis was used and three main themes were generated: consistency and communication, facilitating therapeutic relationships between EIPS staff and SU’s; pushing boundaries, relating to the importance of services taking a graded approach to developing therapeutic relationships and (re)engaging in activities; and normalising and validating experiences of psychosis. Participants emphasised the importance of relationships with EIPS staff and fellow SUs and highlighted how SUs can feel fearful and vulnerable when staff are not accessible or they view their care as inconsistent. Participants further emphasised the need for practitioners to balance an approach that de-stigmatises psychotic experiences whilst validating distress.Practical implications Consistency of support from EIPSs can be as important as flexibility. Clinicians should carefully consider the balance between validating and normalising distressing experiences associated with psychosis. Offering social activities with other SUs can facilitate therapeutic relationships and recovery but the results suggest that this should be facilitated in a graded way.Originality/value The paper addresses current need in the literature to understand the experiences of people using services in order to improve the quality of the services provided. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to explore the attitudes and beliefs of doctors towards medication error reporting following 15 years of a national patient safety agenda. Design/methodology/approach This is a qualitative descriptive study utilising semi-structured interviews. A group of ten doctors of different disciplines shared their attitudes and beliefs about medication error reporting. Using thematic content analysis, findings were reflected upon those collected by the same author of a similar study 13 years before (2002). Findings Five key themes were identified: lack of incident feedback, non-user-friendly incident reporting systems, supportive cultures, electronic prescribing and time pressures. Despite more positive responses to the benefits of medication error reporting in 2015 compared to 2002, doctors at both times expressed a reluctance to use the hospital's incident reporting system, labelling it time consuming and non-user-friendly. A more supportive environment, however, where error had been made was thought to exist compared to 2002. The role of the pharmacist was highlighted as critical in reducing medication error with the introduction of electronic prescribing being pivotal in 2015. Originality/value To the authors' knowledge, this is the first study to compare doctors' attitudes on medication errors following a period of time of increased patient safety awareness. The results suggest that error reporting today is largely more positive and organisations are more supportive than in 2002. Despite a change from paper to electronic methods, there is a continuing need to improve the efficacy of incident reporting systems and ensure an open, supportive environment for clinicians. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to present the findings of an early stage, exploratory case study of a proposed housing with care initiative (the Crichton Care Campus (CCC)). This sought the perspectives of a range of key stakeholders on the proposed model and how it might be best realised. The analyses of these findings show their relevance to debates on integrated housing with care, and reflect on the methodology used and its potential relevance to similar projects.Design/methodology/approach The study used a transactive planning approach, where grounded views are sought from a variety of stakeholders. A purposive sample identified informants from relevant health, social care and housing organisations and nine semi-structured interviews were conducted. These were transcribed and data analysis was undertaken on an “interactive” basis, relating care theory to empirical expressions.Findings The authors identify two contrasting orientations – inclusive “community-oriented” and professional “service-oriented”. This distinction provides the basis for a rudimentary conceptual map which can continue to be used in the planning process. Two significant variables within the conceptual map were the extent to which CCC should be intergenerational and as such, the degree to which care should come from formalised and self-care/informal sources. The potential to achieve an integrated approach was high with stakeholders across all sectors fully supporting the CCC concept and agreeing on the need for it to have a mixed tenure basis and include a range of non-care amenities.Originality/value This paper offers originality in two respects. Methodologically, it describes an attempt to undertake early stage care planning using a needs led transactive methodology. In more practical terms, it also offers an innovative environment for considering any approach to care planning that actively seeks integration – based on an acknowledgement of complexity, a variety of perspectives and possible conflicts. The authors propose that the concepts of “community-orientation” and “service-orientation” are used as a helpful basis for planning negotiations, making implicit divergences explicit and thus better delineated. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to illustrate the hostility many young women who are also mothers experience within their everyday lives.Design/methodology/approach The paper will draw on qualitative research, incorporating a narrative approach, to illustrate the hostility many young mothers experience on a daily basis. The research design included a focus group, semi-structure interviews and participant observations.Findings The paper reports the findings of a study that explored the experiences of young women who are also mothers. The author presents the findings that indicate that many young women, who are also young mothers, experience hostile reactions and interactions as part of their everyday lives.Research limitations/implications The small sample size means that this study cannot be generalised, but it does contribute to the growing body of qualitative evidence in relation to young mothers.Practical implications The findings suggest that there needs to be more recognition and acknowledgement of the hostility young women experience. Such hostility could have deleterious consequences on the young women, their parenting ability and also on the children.Originality/value This paper documents the experiences of young women who are also mothers and how they experience hostility as a daily occurrence. The hostility ranged from verbal to non-verbal and how they felt they were being treated, inferences about their sexuality to stereotyping. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to explore the “active ingredients” of integrated behavioral health care (IBHC) from the perspective of Karen refugee participants in an IBHC intervention.Design/methodology/approach This paper is based on in-depth, semi-structured interviews with participants (n=40) who have received an IBHC intervention for one year. These qualitative data are supplemented by descriptive quantitative data from those same participants.Findings This research suggested that IBHC increased awareness and access to behavioral health services, and that IBHC may be especially amenable to treating complex health conditions. The research also found that IBHC provided a point of regular contact for patients who had limited time with their primary care providers, which helped to enhance access to and engagement with health care.Practical implications IBHC has the potential to meet the complex needs of Karen resettled refugees living in an urban setting in the USA.Originality/value IBHC is a promising approach to help meet the mental health needs of refugees in the USA. There are, however, gaps in knowledge about the “active ingredients” of IBHC. This paper helps fill these gaps by studying how IBHC works from the perspective of a group of Karen refugees; these are critical perspectives, missing in the literature, which must be heard in order to better address the complex conditions and needs of resettled refugees. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to report on a postdoctoral research study examining the importance of multi-level leadership and health governance for ensuring the implementation of national and provincial health sector strategies that aim to improve maternal and neonatal health (MNH) in low- and middle-income countries (LMICs).Design/methodology/approach A descriptive-interpretive qualitative, institutional approach was undertaken to explore the impact of provincial and district governance mechanisms on the delivery of MNH services in two districts in East New Britain Province (ENBP), Papua New Guinea (PNG). Data were collected from 12 key informants. Informants were selected on the basis of their direct involvement in health system management and deployment of health at provincial and district health governance levels.Findings The analysis revealed alignment between global strategies and national and provincial policy, suboptimal provincial government support related to implementation of policy, divergent data between districts and a disconnect between the local governance mechanisms and a donor-funded initiative for raising midwifery education.Research limitations/implications This qualitative study was limited by the small sample size and does not claim to be representative of ENBP or other provinces in PNG.Originality/value This paper contributes empirical evidence to the literature on health policy, leadership and governance for MNH, by recognising and exploring the formal and informal rules at play in a given context, and examining how they are made, changed, monitored and enforced. These insights are critical to understanding how the system actually functions (or not) to implement MNH strategies in LMICs. [ABSTRACT FROM AUTHOR]

Purpose: This paper seeks to understand relationships between prison healthcare and integrated care systems (ICS), including how these affect the delivery of new healthcare interventions. It also aims to understand how closer integration between prison and ICS could improve cross system working between community and prison healthcare teams, and highlights challenges that exist to integration between prison healthcare and ICS. Design/methodology/approach: The study uses evidence from research on the implementation of a pilot study to establish telemedicine secondary care appointments between prisons and an acute trust in one English region (a cross-system intervention). Qualitative interview data were collected from prison (n = 12) and community (n = 8) healthcare staff related to the experience of implementing a cross-system telemedicine initiative. Thematic analysis was undertaken on interview data, guided by an implementation theory and framework. Findings: The research found four main themes related to the closer integration between prison healthcare and ICS: (1) Recognition of prison health as a priority; (2) Finding a way to reconcile networks and finances between community and prison commissioning; (3) Awareness of prison service influence on NHS healthcare planning and delivery; and (4) Shared investment in prison health can lead to benefits. Originality/value: This is the first article to provide research evidence to support or challenge the integration of specialist health and justice (H&J) commissioning into local population health. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this action research was to explore, from a workforce and a patient/carer perspective, the skills and the capacity required to deliver integrated care and to inform future workforce development and planning in a new integrated care system in England. Design/methodology/approach: Semi-structured interviews and focus groups with primary, community, acute care, social care and voluntary care, frontline and managerial staff and with patients and carers receiving these services were undertaken. Data were explored using framework analysis. Findings: Analysis revealed three overarching themes: achieving teamwork and integration, managing demands on capacity and capability and delivering holistic and user-centred care. An organisational development (OD) process was developed as part of the action research process to facilitate the large-scale workforce changes taking place. Research limitations/implications: This study did not consider workforce development and planning challenges for nursing and care staff in residential, nursing care homes or domiciliary services. This part of the workforce is integral to the care pathways for many patients, and in line with the current emerging national focus on this sector, these groups require further examination. Further, data explore service users' and carers' perspectives on workforce skills. It proved challenging to recruit patient and carer respondents for the research due to the nature of their illnesses. Practical implications: Many of the required skills already existed within the workforce. The OD process facilitated collaborative learning to enhance skills; however, workforce planning across a whole system has challenges in relation to data gathering and management. Ensuring a focus on workforce development and planning is an important part of integrated care development. Social implications: This study has implications for social and voluntary sector organisations in respect of inter-agency working practices, as well as the identification of workforce development needs and potential for informing subsequent cross-sector workforce planning arrangements and communication. Originality/value: This paper helps to identify the issues and benefits of implementing person-centred, integrated teamworking and the implications for workforce planning and OD approaches. [ABSTRACT FROM AUTHOR]

Purpose: Resources as well as the capacity to employ them judiciously may well be the key to the attainment of the SDGs and other related health goals through primary health care (PHC). Within this PHC framework, however, the source of resources for PHC as well as the systems for managing these associated resources remain unclear, complex and lack substantive integration systems of implementing ministries, departments and agencies (both local and international) in Ghana. These issues are addressed by this study. Design/methodology/approach: The framework approach to thematic analysis was used to analyse qualitative data collected from key PHC managers in Ghana selected purposively from the national, regional and district levels. Data were collected through in-depth interviews specially designed in line with the study objectives. The study was also governed by the Noguchi Memorial Institute for Medical Research which provided ethical clearance for the study. Findings: As per Alma Ata's recommendation, PHC in its purest form is a resource dense activity with far-reaching implications on individuals and communities. Without adequate resources, PHC implementation remained merely on paper. Findings show that the key capacities required for PHC implementation were finance, human resource, technology and logistics. While significant cases of shortages and inadequacies were evident, management and maintenance of these capacities appeared to be another significant determinant of PHC implementation. Additionally, the poor allocation, distribution and sustainability of these capacities had a negative effect on PHC outcomes with more resources being concentrated in capital towns than in rural areas. Research limitations/implications: This study has significant implications on the way PHC is seen, implemented and assessed not in Ghana but in other developing countries. In addition to examining the nature and extent of capacities required for PHC implementation, it gives significant pathways on how limited resources, when properly managed, may catalyse the attainment of the PHC goals. Subsequently, PHC implementation will profit from stakeholder attention and further research into practical ways of ensuring efficiency in the allocation, distribution and management of resources especially considering the limited resources available and the budding constraints associated with the dependency on external stakeholders for PHC implementation. Originality/value: This study is part of a series on PHC implementation in Ghana. Quite apart from putting core implementation issues into perspective, it presents first-hand information on Ghana's PHC implementation journey and is thus relevant for researchers, students, practitioners and the wider public. [ABSTRACT FROM AUTHOR]

Purpose: Living in an area experiencing economic and social disadvantage is a known risk factor to poor mental health and well-being. This paper aims to understand how some communities experiencing disadvantage appear to be more resilient to the enduring challenges they face and display better mental health outcomes. Design/methodology/approach: A qualitative case study approach was used. Semi-structured interviews (total = 74) were undertaken remotely with residents (n = 39) and voluntary, community and social enterprise groups, community leaders and other local stakeholders (n = 35) in four case study areas. Data analysis was cross-case, thematic analysis. Community analysis workshops (n = 4) and resilience mapping workshops (n = 4) in each site corroborated emerging insights. Findings: Four overlapping and interacting themes support community resilience: community hubs and local voluntary, community and social enterprise (VCSE) networks; opportunities to participate and make connections within communities; open and supportive environments to talk about mental health and well-being; and community identities and collective narratives. Differences in access to these resources was a cross-cutting theme. Originality/value: Community resilience can be understood in terms of the amount of resources – articulated in terms of capital – that communities can draw on in response to challenges, and how well these resources are mobilised. A thriving VCSE sector is important for community resilience in communities experiencing disadvantage as a mechanism for both sustainably building and mobilising community resources in the face of daily and enduring challenges. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to describe the design and development of the digital platform for the development and monitoring of care plans for older adults with complex care needs who are users of a home care service. Design/methodology/approach: Case study. The authors conducted an iterative process of design adapted to the environment and user-centred, agile development and research methodologies and a framework of complex interventions. They followed a four-step process: (1) conceptualization: analysis and design; (2) usability and high-fidelity prototyping; (3) software development; and (4) field testing in usual care. Older adults, informal caregivers, professional caregivers, and healthcare and social workers identified specific requirements and participated continuously through interviews, focus groups and consensus. Findings: In the conceptualization phase, the theory, context and requirements were identified, and the content and prototypes were developed. In the usability phase, the design was validated. The approach employed resulted in a digital technology that supports a person-centred care model in a home care company. In the conceptualization phase, the theory, context and requirements were identified, and the content and prototypes were developed. In the usability phase, the design was validated. The approach employed resulted in a digital technology that supports a person-centred care model in a home care company. Originality/value: The methodology employed has allowed the development of a platform based on theory, user needs and context. This could increase the possibilities of use and implementation of the technology and inspire other developers. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to qualitatively explore the views and opinions of service users accessing remote therapy through a community forensic personality disorder service during the COVID-19 pandemic. Design/methodology/approach: A qualitative exploratory approach was adopted. Nine community forensic service users accessing virtual/telephone therapy through a community forensic mental health service were interviewed using semi-structed interviews. Data was analysed using Braun and Clarke (2006) thematic analysis techniques. Findings: Analysis resulted in three overall themes: experience of communication in the therapeutic relationship; impacts of the change to remote working and making the best of what we have. A further seven subthemes were developed. A range of advantages and disadvantages to remote therapy were highlighted. Research limitations/implications: This study was based on a small sample of service users accessing one community forensic service in England, and therefore caution should be taken when generalising the findings. All interviews were conducted remotely and thus may have only supported those who are able to engage in this way. Practical implications: This paper has the potential to inform future remote therapy guidelines. Health services should consider keeping some elements of remote working and offering this as a choice to all service users. Originality/value: This study is, to the best of the authors' knowledge, the first study that attempts to explore the experiences of individuals accessing remote therapy within a forensic population who have personality disorders or traits. [ABSTRACT FROM AUTHOR]

Purpose: Many academic leaders have little formal leadership training, which can result in challenges to effective leadership, succession planning and burnout. This paper aims to explore the leadership skills needed to be an effective senior academic leader in a Canadian medical faculty. Design/methodology/approach: An anonymous voluntary survey of needed leadership skills and supports was sent to 60 senior academic leaders at the University of Alberta. This was followed by interviewing a purposive sample, using open-ended questions based on a multimodal needs assessment of senior academic leaders. The authors used an iterative process to analyze the data; anonymized transcripts were coded and categorized separately by two researchers, and themes were created. Findings: The "ability to influence" was the highest rated needed leadership skill in the survey. The interviewed leaders (n = 12) were unanimous that they felt unprepared at the start of the leadership role. The survey and interviews identified five major themes for leadership skills: Mentoring, Finances, Human Resources, Building Relationships and Protected Time. Networking and leadership courses were identified as major sources of support. Research limitations/implications: Although a single site study, the results were similar to another large Canadian medical faculty (University of Toronto, Lieff et al., 2013). While the survey had a 42% response rate (25/60), the survey responses were echoed in the interviews. Although the purposive sample was small, the interviewed leaders were a representative sample of the larger leadership group. Originality/value: Academic leaders may benefit from a mentorship team/community of leaders and specific university governance knowledge which may help their ability to influence and advance their strategic initiatives. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to report findings from a service evaluation undertaken within a single specialist child and adolescent mental health service (CAMHS) team. The team works closely with local authority children's services to serve specific populations recognised as experiencing higher levels of mental health need, including children living in alternative care and with adoptive families. The evaluation sought to better understand the experience of this provision during the COVID-19 pandemic and concomitant increase in remote and digitally mediated care delivery. Design/methodology/approach: Analysis of the accounts of 38 parents, carers and professionals involved with the team gathered via telephone interviews and email and postal questionnaires. Findings: Similar views were expressed from participants involved with the team before and following the onset of the pandemic. Overall, satisfaction was high; however, changes in care appeared more challenging for those already involved with the team before the pandemic. Differences in experience between groups were also evident. Whereas foster carers' accounts were generally appreciative of the involvement of clinicians, particularly regarding clinician–patient relationships, amongst adoptive parents and members of children's birth families there were more mixed and negative impressions. Originality/value: Locally based service evaluations can help inform care pathway planning in specialist CAMHS provision as part of wider quality improvement initiatives. This is especially relevant considering the repercussions of the COVID-19 pandemic and as the longer-term acceptability of remote working practices is appraised. [ABSTRACT FROM AUTHOR]

Purpose: Prior research shows that a board of directors' gender diversity positively influences organizations. However, little is known about how and why gender diversity influences the board of directors' functioning and decisions. The objective of this paper is to investigate the differences between women and men when fulfilling their role as directors. Design/methodology/approach: This research uses a qualitative approach based on 29 in-depth semi-structured interviews with female and male board members. Findings: The authors' findings reveal that women are as involved as men in the board tasks and responsibilities. Also, women have the same understanding as men of their role and of the skills needed to be board members. However, women fulfil their role differently than men. Women come to board meetings more prepared, take more notes and do more follow-up, and they also dare to ask tough questions to top management. Women directors bring a different point of view — representing different interests — to board discussions, have a different communication style, are not a part of the boys' club and have a social upbringing that might explain gender differences in the boardroom. Research limitations/implications: This study could help boards and policymakers introduce diversity measures and provide ways to better integrate women into top decision-making groups such as board of directors. Practical implications: This study's findings can help organizations include females in key decision-making groups such as board of directors. Social implications: This study reveals that in the same social setting, with the same role and expectations, and the same understanding of their role, both genders continue to perform differently. Originality/value: Based on direct evidence from board members, this study highlights how and why women do their role in the boardroom differently. [ABSTRACT FROM AUTHOR]

Purpose: Paramedics increasingly attend to mental health-related emergencies; however, there has been little evaluation of the mental health training for paramedics. This study aims to analyze the fit between paramedicine pedagogy, patient needs and the conditions for paramedics' skill development. Design/methodology/approach: Data were collected in a single, qualitative, critical ethnographic case study of pre-hospital mental health and psychosocial care in paramedicine in Ontario, Canada. Transcripts from interviews (n = 46), observation (n ∼ 90h) and document analysis were thematically analyzed using a constant comparative method. The study is theoretically grounded in a feminist political economy framework. Findings: Tensions are explored in relation to the pedagogy of paramedicine and the conditions of work faced by paramedics. The paper presents challenges and insufficiencies with existing training, the ways in which certain work and training are valued and prioritized, increased emergency care and training needs and the limitations of training to improving care. Research limitations/implications: Recommendations include more comprehensive didactic training, including the social determinants of health; scenario training; practicum placements in mental health or social services; collaboration with mental health and social services to further develop relevant curriculum and potential inclusion of service users. Originality/value: This paper addresses the lack of mental health pedagogy in Ontario and internationally and the need for further training pre-certification and while in the workforce. It presents promising practices to ameliorate mental health training and education for paramedics. [ABSTRACT FROM AUTHOR]

Purpose: This paper explores absconding from a new perspective. Literature has tended to focus on the risk factors linked with absconding. This paper aims to consider desistance factors for absconding for prisoners at higher risk of absconding in open prisons. Design/methodology/approach: Stage 1 used logistic regression to identify factors associated with increased risk of absconding. Stage 2 identified new receptions with increased risk and used thematic analysis to analyse interviews with prisoners that did not abscond after three months. Findings: Stage 1 found that the total number of previous offences predicted absconding. Stage 2 found three themes linked to desistance in absconding: "support", "ownership" and "sense of self". Practical implications: This study highlights the importance of ensuring prisoners in open prisons are offered the appropriate emotional and practical support. It also identifies the importance of hope amongst prisoners in open conditions. Future research should further explore this idea in more depth. Originality/value: Previous literature has looked at absconding from a risk factor perspective. This research identifies the desistance factors associated with absconding for individuals who have been identified as high risk of absconding. Improvements in factors associated with desistance from absconding may support a reduction in absconding from open prisons. [ABSTRACT FROM AUTHOR]

Purpose: The persistent challenges that healthcare organizations face as they strive to keep patients safe attests to a need for continued attention. To contribute to better understanding the issues currently defying patient safety initiatives, this paper reports on a study examining the aftermath of implementing a national team training program in two hospital units in France.Design/methodology/approach: Data were drawn from a longitudinal qualitative study analyzing the implementation of a French patient safety program aimed at improving teamwork in hospitals. Data collection took place over a four-year period (2015-2019) in two urban hospitals in France and included multiple interviews with 31 participants and 150 h of observations.Findings: Despite explicit efforts to improve inter-professional teamwork, three main obstacles interfered with healthcare professionals' attempts at safeguarding patients: perspectival variations in what constituted "patient safety", a paradoxical injunction to do more with less and conflicting organizational priorities.Originality/value: This paper exposes patient safety as misleadingly consensual and identifies a lack of alignment between stakeholders in the complex system that is a hospital. This ultimately interferes with patient safety objectives and highlights that even well-equipped, frontline actors cannot achieve long-term results without more systemic organizational changes. [ABSTRACT FROM AUTHOR]

Purpose: Social impact bonds (SIBs) have become a favoured way to fund public services, including housing, prison and homelessness projects, in an era of austerity. In a growing critical literature on SIBs, a largely absent voice is that of the link worker. This paper aims to focus on the views of link workers in a SIB funded project which works with long-term entrenched rough sleepers in the East of England. Design/methodology/approach: Interviews with link workers were conducted with a thematic analysis echoing many of the views expressed in the critical literature not only about the problems but also some of the advantages that SIBs offer to this type of project. Findings: Three key themes were discomfort with the funding mechanism; flexible and innovative interventions that SIBs make possible; and problems with the outcome measures that trigger payments. This study concludes that if SIBs are to achieve their promise of providing funding which leads to effective solutions to deeply ingrained social problems, there needs to be more careful evaluation of their true benefits in comparison to publicly funded projects, adoption of more appropriate and project-specific outcome measures and a much clearer explanation and justification of the way in which SIB funding works. Originality/value: Few studies have specifically explored the perceptions of front-line link workers in the homelessness sector. This study highlights not only the concerns but also the benefits associated with the use of SIB as a funding mechanism within the homelessness sector. [ABSTRACT FROM AUTHOR]

Purpose: In general, newly resettled refugees have poorer physical and mental health than native-born Swedes. This indicates that the society must make special efforts to enable refugees to attain health that is on a par with the rest of the population. The challenges rest primarily with employees in the public sector. But what resources do professionals need to meet the refugees' health needs? This paper is about the need to develop strategies for professionals working with diversity and health, with a focus on the establishment of newly resettled refugees in Sweden. Thus, the purpose of this paper is to identify the needs and obstacles in working with diversity and health for the newly resettled. Design/methodology/approach: The paper is based on focus group interviews with 40 professionals working in three large municipalities and one County Administrative Board, all of whom work with challenges related to migration and health on a daily basis. Findings: The needs expressed by the interviewees are primarily about developing and improving communications. Three important areas of communication were expressed: how information can be transferred from sender to receiver, institutionalization and interactions at different levels. Originality/value: This paper identifies important needs and obstacles when working with diversity and health in Sweden, with a focus on the establishment of newly resettled refugees. It is an important contribution because refugees in general have poorer physical and mental health than native-born Swedes and strategies to improve their health, therefore, need to be further developed. [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: The purpose of this paper is to explore, describe and interpret two research questions: How do persons with co-occurring mental health and substance abuse problems, living in supportive housing, experience belonging? How do residential support staff experience promoting a sense of belonging for persons with co-occurring mental health and substance abuse problems, living in a supportive housing? Design/methodology/approach: Individual semi-structured interviews were conducted with five persons with co-occurring mental health and substance abuse problems living in supportive housing in a Norwegian district. In addition, one semi-structured focus group was conducted with nine residential support staff. All interviews were transcribed verbatim and analyzed using thematic analysis. Findings: Analysis resulted in three main themes: "I do not go to sleep in my pajamas", "Do I have a choice?" and "Be kind to each other". Research limitations/implications: More research on how inclusive practices that are commonly described in guidelines actually affect the experience of residents and residential support staff is needed. Practical implications: Practices that incorporate a communal and contextual understanding when assigning supportive housing are warranted. Originality/value: By paying attention to the components of social recovery, this paper provides a nuanced understanding of how persons with co-occurring mental health and substance abuse problems, living in supportive housing, experience belonging. In addition, residential support staffs' experiences with promoting a sense of belonging for this group are explored. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to update the core data set of self-neglect safeguarding adult reviews (SARs) and accompanying thematic analysis and explore the degree to which SARs draw upon available research and learning from other completed reviews. Design/methodology/approach: Further published reviews are added to the core data set, mainly drawn from the websites of Safeguarding Adults Boards (SABs). Thematic analysis is updated using the four domains used previously. The four domains and the thematic analysis are rounded in the evidence-based model of good practice, reported in this journal previously. Multiple exclusion homelessness and alcohol misuse are prominent in this sample of reviews. Findings: Familiar findings emerge from the thematic analysis and reinforce the evidence-base of good practice with individuals who self-neglect and for policies and procedures with which to support those practitioners working with such cases. Multiple exclusion homelessness emerges as a subset within this sample, demonstrating that SABs are engaging in reviews of people who die on the streets or in temporary accommodation. Research limitations/implications: The national database of reviews commissioned by SABs remains incomplete and does not contain many of the SARs reported in this evolving data set. The Care Act 2014 does not require publication of reports but only a summary of findings and recommendations in SAB annual reports. NHS Digital annual data sets do not enable identification of reviews by types of abuse and neglect. It is possible, therefore, that this data set is also incomplete. Drawing together the findings from the reviews nonetheless builds on what is known about the components of effective practice, and effective policy and organisational arrangements for practice. Practical implications: Answering the question "why" remains a significant challenge for safeguarding adult reviews. The findings confirm the relevance of the evidence-base for effective practice but SARs are limited in their analysis of what enables and what obstructs the components of best practice. Greater explicit use of research and other published SARs might assist with answering the "why" question, drawing attention where appropriate to policies being pursued by the central government that undermine any initiative to end rough sleeping. Originality/value: This paper extends the thematic analysis of available reviews that focus on work with adults who self-neglect, further reinforcing the evidence-base for practice. The evidence-base also supports practice with individuals who experience multiple exclusion homelessness. Policymakers and practitioners have an approach to follow in this complex, challenging and demanding area of practice. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to describe and discuss both the early implementation of a US mental health intervention for young children in the context of its introduction to a pilot site in a London borough and the progress made in establishing a randomised controlled trial (RCT). Design/methodology/approach: This paper describes an evaluation of a new intervention and the learning that followed in terms of its implementation and future evaluation. Qualitative data were collected from a range of stakeholders and practitioners through interviews and small group discussions. These interviews focussed on both of these issues, with particular reference to the proposal to conduct an RCT. Findings: The findings of this evaluation add to the evidence on how best to support new initiatives that have been introduced from other settings and countries to embed in a receiving site and the optimal timing and feasibility of conducting an RCT. At the end of the feasibility study, which took place within the year of the service being introduced and which was only open to clients for six months of this year the conclusion was that an RCT at that point was neither possible nor desirable. Over the following years, the commitment of the judiciary to examine if there was a way to make an RCT study in respect of this intervention meant that a template was established that may well have broader application. Research limitations/implications: At a time when there is an increasing demand for evidence on effective interventions this paper makes a valuable contribution to the development of RCTs in general and specifically in the family court arena. It also recommends that attention must also be paid to the time, which is needed to implement and establish interventions and then to test them. Practical implications: This paper highlights the need to establish realistic timescales not only around the implementation of initiatives but also for their evaluation. Originality/value: This study breaks new ground in considering implementation challenges in the court and children's services' context. It brings to the fore the important role of the judiciary in approving new processes. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to investigate the dynamics of ephemerality within consumer tribes by conceptualizing how tribes constitute, disperse and reconstitute. Building upon assemblage thinking, a philosophical approach that redistributes agency from the subject to a web of interconnected human–material actants, this paper shows that tribes manifest via hybrid assemblages of people, things and ideas. Design/methodology/approach: Insights are drawn from a three-year assemblage-oriented ethnographic study of a salsa-dancing tribe, specifically their ephemeral gatherings across multiple sites without hierarchical organization. Methods include observations as a consumer–participant, producer–participant and in-depth interviewing. Findings: Introduces a framework documenting how tribes disperse temporarily and reconstitute via a dual process of ascription and distribution. Tribes reconstitute when consumers reproduce an assemblage that effectively overcomes a meshwork of practical challenges. Consumers ascribe to the standards of the tribe while, alternatively, tribes distribute the assemblage beyond the immediate group. Research limitations/implications: Conceptualizes the socio-technical dynamics that tribes mobilize to disassemble and reassemble through ephemeral gatherings. Proposes a framework on hybrid interdependencies, including not only participants but also techniques, devices and sites. Practical implications: While previous research shows that tribes can collapse, the authors propose that marketers can intervene to foster long-term resilience. As tribes disperse, consumer and marketing efforts operate at different temporal sequences to enable tribal reconstitutions. Originality/value: Contributes to the literature on consumer tribes by theorizing ephemerality per ascription and distribution mechanisms. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to report the findings of a study that explores the contribution volunteers make to social care for older adults, identifying lessons for the social care sector and policymakers. Design/methodology/approach: An exploratory multiple case study design was used to capture the perspectives and experiences of managers of services, volunteer co-ordinators, volunteers, paid care staff and older people. Seven diverse social care organisations took part in the study drawn from three locations in the South West of England. Findings: This study identified three distinct models of volunteer contribution to social care services for older people. Although the contributions made by volunteers to services are valued, the study drew attention to some of the challenges related to their involvement. Research limitations/implications: The organisations taking part in this small-scale study were all based in the South West of England, and the findings are therefore not generalisable but contribute to the growing evidence base related to this important field. Practical implications: This study demonstrates the importance of the volunteer co-ordinator role and suggests that it is properly funded and resourced. It also confirms the importance of volunteers receiving appropriate training and support. Originality/value: Given the increasing involvement of volunteers in the provision of social care, this paper provides lessons to ensure the role of volunteers in social care enhances rather than diminishes the quality of care provided. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to explore the impact of stressors and the strategies staff use to cope with these at a detention facility. It documents through case studies some of the triggers of trauma, possible coping mechanisms that might assist in navigating the associated stressors in a workplace and recommendations as to what might assist staff. Design/methodology/approach: A naturalist approach was used in this research, using an ethnographic qualitative methodology. Grounded theory assisted in the analysis of the data to capture naturalistically the subjective experience of the participants of the study. Conversations occurred with staff who had worked in a detention facility using face to face semi-structured interviews. The structure was open-ended to allow the staff to discuss and share their experiences freely. Findings: Stressors that impacted staff working in a detention facility resulted from areas such as heightened reactions from detainees because of the length of their detainment, detainee self-harm, dealing with the effects of an increase of substance abuse through detainees obtaining contraband and the associated violent reactions that can occur as a result. Adverse symptoms noted within the lives of staff included acute anxiety, sleeplessness, depression and tension within impersonal relationships, including family. What compounded the issue was staffs' reluctance to talk about work stressors. Research limitations/implications: The research used nine participants for case studies of staff who had formerly experienced various adverse impacts of stressors. This is not a comprehensive study, however, of the broader experiences of staff at an Australian detention facility. It does provide, however, a snapshot of the experiences of a small group who had significantly been impacted by the stressors of the workplace. Practical implications: This paper provides fresh perspectives or initiatives that are needed to assist staff to navigate the changing environment of working in a detention facility. In particular, some support mechanisms and protective factors that could be put in place to curb the negative impact of stressors in the workplace and to mitigate against long term stress disorders developing in the personal lives of staff. Social implications: Many staff are not getting the help they need to cope with the emotional distress they experience in their workplace. However, there are practical interventions to support staff in managing the stressors they face. These will be outlined in this article. Originality/value: This study was carried out with the goal of giving staff a voice and to capture their former experiences in their vocational responsibilities in a venue that has had very limited research attention. This study has presented the challenges staff faced in a unique venue of working in a detention facility. It has documented some of the common stressors staff faced, the impact of such and some coping mechanisms used to handle them. [ABSTRACT FROM AUTHOR]

Purpose: Research has long focused on the notion of access and the trajectory towards a healthcare encounter but has neglected what happens to patients after these initial encounters. This paper focuses attention on what happens after an initial healthcare encounter leading to a more nuanced understanding of how patients from a diverse range of backgrounds make sense of medical advice, how they mix this knowledge with other forms of information and how they make decisions about what to do next. Design/methodology/approach: Drawing on 160 in-depth interviews across four European countries the paper problematizes the notion of access; expands the definition of "decision partners"; and reframes the medical encounter as a journey, where one encounter leads to and informs the next. Findings: This approach reveals the significant unseen, unrecognised and unacknowledged work that patients undertake to solve their health concerns. Originality/value: De-centring the professional from the healthcare encounter allows us to understand why patients take particular pathways to care and how resources might be more appropriately leveraged to support both patients and professionals along this journey. [ABSTRACT FROM AUTHOR]

Purpose: Many healthcare organizations are looking for methods, such as Lean, to reduce their costs and increase the productivity of their professionals. The Lean method looks at every step in every process to assess if this step adds value for the customer or not. The aim of this study was to explore the value adding and non-value adding process steps in stroke patient admission in an integrated care stroke service in the Netherlands. Design/methodology/approach: This study focused on discharge of stroke patients from hospital acute treatment, and they were admitted for rehabilitation. According to the Grounded Theory, value stream mapping, organized interviews and expert meetings and coded was used. A configuration analysis was used to distinguish aggregates and configurations. Findings: The most reported issues concerned in the paper are as follows: (1) insufficient internal logistics in the hospital, (2) miscommunication about medical readiness for discharge of the patient, (3) missing or delayed medical patient information, (4) overlapping discharge interviews, (5) unsafe transfer of sensitive information and (6) waiting lists and queuing up in rehabilitation facility. Originality/value: At least six main areas of waste were identified in this stroke service, and they form the target for waste reducing activities. The results give insight in possible wastes in healthcare organizations and are therefore beneficial for other healthcare organizations which are planning to reduce wastes. [ABSTRACT FROM AUTHOR]

Purpose: While one-third of Australians live outside major cities, there are ongoing challenges in providing accessible, sustainable, and appropriate primary health care services in rural and remote communities. The purpose of this paper is to explore a partnership approach to understanding and addressing complex primary health workforce issues in the western region of New South Wales (NSW), Australia. Design/methodology/approach: The authors describe how a collaboration of five organisations worked together to engage a broader group of stakeholders and secure commitment and resources for a regional approach to address workforce challenges in Western NSW. A literature review and formal interviews with stakeholders gathered knowledge, identified issues and informed the overarching approach, including the development of the Western NSW Partnership Model and Primary Health Workforce Planning Framework. A stakeholder forum tested the proposed approach and gained endorsement for a collaborative priority action plan. Findings: The Western NSW Partnership Model successfully engaged regional stakeholders and guided the development of a collaborative approach to building a sustainable primary health workforce for the future. Originality/value: Given the scarcity of literature about effective partnerships approaches to address rural health workforce challenges, this paper contributes to an understanding of how to build sustainable partnerships to positively impact on the rural health workforce. This approach is replicable and potentially valuable elsewhere in NSW, other parts of Australia and internationally. [ABSTRACT FROM AUTHOR]

Purpose: This paper investigates how an externally imposed programme with the objective of improving the income of the poor is measured and managed by a public agency in Malaysia. Design/methodology/approach: A qualitative case study approach is used in this research. The data were collected over a three-year period with interviews conducted with key officers at various levels ranging from the Ministry to the agency responsible for implementing the programme. Findings: The introduction of the programme into the organisation's activity was loosely coupled, reflected by the way in which the programme was being implemented. There was some inter-dependency between the three hierarchical levels in terms of their performance measures and targets, responsibilities and reporting. There were no significant changes to the organisation's practices and weak linkages between the programme's objective, the formulation of indicators and the way the information was used in performance assessment. The lack of integration of the programme resulted in high importance being attached to measurement and reporting, rather than focusing on the achievement of the programme objective. Originality/value: This paper contributes to understanding the performance management issue regarding the vertical and horizontal coupling of a system in relation to an externally derived programme. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to explore and describe first-person experiences of relational recovery in co-occurring mental health and substance use conditions. Design/methodology/approach: Within a phenomenological and collaborative approach, in-depth individual interviews with eight persons with co-occurring conditions were analysed using systematic text condensation. Findings: Participants described interpersonal relationships as both supporting and hindering recovery in fundamental ways. Four categories of experiences of relational recovery were described as follows: choosing one's child; living with loneliness and a painful past; sacrificing everything for one's partner; and regaining trust and support. Originality/value: This paper provides an enhanced understanding of how interpersonal relationships may be experienced by persons who live with co-occurring conditions. The results generally support an understanding of recovery as a relational process. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to identify the characteristics practitioners consider essential to effective multisensory rooms and the barriers they experience when trying to realise the potential of such rooms. Design/methodology/approach: The paper presents semi-structured interviews with 27 multisensory room practitioners from a range of backgrounds followed by analysis to identify key characteristics and barriers. Findings: Eleven positive room characteristics were identified. The three deemed most significant were that the rooms are dark, activity associated and uninterrupted spaces. Two negative room characteristics were identified: inaccessible design and broken equipment. Ten barriers to effective multisensory room practice were identified and grouped according to themes of logistics, suboptimal usage and practitioner capabilities. Research limitations/implications: The research focuses on a small self-selecting sample, coded by one person acting independently of any institution. This is an under researched area which would benefit from further more rigorous investigation. Practical implications: This research enables practitioners to remove barriers to effective multisensory room practice and to focus on the characteristics most significant in generating benefits for room users. Understanding of the essential characteristics and potential barriers to effective practice will allow practitioners to better exploit limited resources of time, money and staffing. Originality/value: Past research into multisensory rooms has focused on specific user groups or specific multisensory environments. This research examined multisensory room practice across both a range of environments and a range of users, giving an original overview of current multisensory room usage in the UK. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to illustrate that some enterprise unions in South China, as strategic labor actors, made local progress in collective bargaining, but further elaborates on why gainful bargaining would require a more systematic understanding of the prevailing industrial structure. Design/methodology/approach: This paper is mainly drawn from intensive site visits and 51 in-depth interviews in 2013 and 2014, and several follow-ups up to 2018. Three cases of collective bargaining, featuring different union strategies of assertive negotiation, informal cooperation and direct confrontation, are discussed in detail. Findings: The study illustrates that viable collective bargaining with worker-supported unions is possible in China. However, the effectiveness of bargaining does not count on this alone; the supply chain structure also imposes significant constraints, mainly by narrowing the bargaining scope of each supplier and differentiating the structural power of their unions. In these cases, institutionalized union coordination beyond individual suppliers is proposed. Research limitations/implications: These cases began as post-strike bargaining in Japanese auto supply chains and became the frontier of industrial relations in China. The impact of the supply chain in different sectors or regions requires further study. Originality/value: This paper draws attention to the effect of an "invisible" but increasingly significant factor, industrial structure, on enterprise-level collective bargaining in China, unlike many previous criticisms of unwillingness or incompetence among labor actors. [ABSTRACT FROM AUTHOR]

Purpose: Approximately 20 per cent of Australian children live with a parent who experiences mental illness. These children have poorer health and psychosocial outcomes than their peers. While family-focused practice (FFP) can improve these outcomes, family-focused service provision is inconsistent. The purpose of this paper is to understand clinicians' experiences of FFP and associated workplace factors. Design/methodology/approach: In-depth interviews were conducted with ten community mental health clinicians. Interviews were audio recorded and transcribed. Data were analysed using thematic analysis. Findings: A global theme of "navigating rocky terrain" captured clinicians' experiences of working with families. The rocky terrain encompassed both family complexity and workplace barriers to FFP. Clinicians navigated this terrain by using multiple strategies to support families, working in partnership with families and other clinicians and services, and drawing on personal resources. Interactive approaches to enhancing knowledge and skills were preferred over paper-based information. While an organisation-wide approach to support FFP was beneficial, clinicians continued to feel challenged in implementing FFP. Research limitations/implications: Working with families in which parents experience mental illness is affected by systemic issues at the family and organisational levels. Systemic approaches to both delivering and supporting this work are required. Partnership working and organisation-wide capacity building strategies emphasising interactive approaches to learning appear to have positive effects. Originality/value: This study explores the challenges of FFP in a real-world multidisciplinary context where there has been a systemic approach to enabling this work. It highlights the challenges clinicians face in family-focused practice in spite of substantial organisational supports and suggests some approaches that might be effective. This is a topic which has received minimal attention in the literature. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to explore the defining characteristics of an interdisciplinary culturally sensitive approach to family therapy with traumatized refugee families affected by family violence. Furthermore, the paper aims to explore the mechanisms of change as seen from the perspective of the therapists. Design/methodology/approach: Based on qualitative analysis of semi-structured interviews with therapists working in an interdisciplinary team as well as observations of treatment conferences, the study identified the ways in which therapists perceive the challenges faced by their patients, the ways in which positive change is facilitated within therapy and the characteristics of a culturally sensitive interdisciplinary approach to family therapy with traumatized refugee families. Findings: The study identified a number of defining characteristics of the treatment model, which includes the interdisciplinary approach, treatment objectives and concrete interventions targeting these objectives. Originality/value: Through a theoretically informed critical analysis of the data, the present study examined the defining characteristics of the treatment model as well as the mechanisms of change as perceived by the therapists. [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: The purpose of this paper is to investigate the perceptions of key informants on a national support programme for the development of new care models (NCM) in England (2015/2016–2017/2018). It focuses on the perceived facilitators and barriers affecting the development and implementation of the NCM programme and offers some insight into the role of national level support in enabling local integration initiatives. Design/methodology/approach: A set of 29 interviews were carried out with a variety of respondents at the national level (including current and past programme leads, strategic account managers, advisors to the programme and external regulators) between October 2017 and March 2018, and analysed thematically. Findings: A set of facilitative elements of the programme were identified: the development of relationships and alliances, strong local and national leadership, the availability of expert knowledge and skills, and additional funding. Challenges to success included perceived expectations from the national Vanguard programme, oversight and performance monitoring, engagement with regulators, data availability and quality, as well as timetables and timescales. Crucially, the facilitators and challenges were found to interact in dynamic and complex ways, which resulted in significant tensions and ambiguities within the support programme. Research limitations/implications: While the sample was drawn from a range of different senior players and the authors ensured a diverse sample associated with the NCM support programme, it inevitably cannot be complete and there may have been valuable perspectives absent. Originality/value: The paper demonstrates that the analysis of facilitators and challenges with respect to the national support of implementation of integrated care initiatives should move beyond the focus on separate influencing factors and address the tensions that the complex interplay among these factors create. [ABSTRACT FROM AUTHOR]

Purpose: New psychoactive substances (NPS) are increasingly being used in secure mental health settings. Within these settings, NPS use presents a range of challenges and staff currently lack adequate training to manage these challenges. The purpose of this paper is to explore nursing staffs' perception of the challenges of working with patients who use NPS and to explore nursing staffs' perception of their training needs in relation to NPS. Design/methodology/approach: A cross-sectional qualitative design was employed. Semi-structured interviews were conducted with eight nursing staff from a medium secure unit (MSU). Findings: A thematic analysis identified three overarching themes: "There Will Always Be Something", "We Are Doing Our Best" and "If We Know More, We Can Do More". The findings describe how nursing staff manage NPS use at present, and their perceptions of how training could improve their management of NPS use in the future. Practical implications: The findings suggest that MSUs require a local policy for managing NPS use. The research implies that staff training programmes should recognise the existing methods staff use to manage NPS use. The findings also suggest that NPS interventions should target the whole peer group and not just the individual using NPS. Originality/value: This paper contributes to the limited literature on NPS. The findings demonstrate the importance of developing evidence-based mechanisms for managing NPS use. Changes to practice are suggested, with the view of developing ways in which staff currently manage NPS use by complementing this with specific training on NPS. [ABSTRACT FROM AUTHOR]