scholarly journals Shifting care from community hospitals to intensive community support: a mixed method study

2017 ◽  
Vol 19 (01) ◽  
pp. 53-63
Author(s):  
Kate S. Williams ◽  
Stoyan Kurtev ◽  
Kay Phelps ◽  
Emma Regen ◽  
Simon Conroy ◽  
...  
Keyword(s):  
Mixed Method ◽  
Qualitative Interviews ◽  
Community Support ◽  
Routine Data ◽  
Very Elderly ◽  
Acute Hospital Care ◽  
Staff Members ◽  
Admission Rates ◽  
Home Based ◽  
General Rehabilitation

Aim To examine how the introduction of intensive community support (ICS) affected admissions to community hospital (CH) and to explore the views of patients, carers and health professionals on this transition. Background ICS was introduced to provide an alternative to CH provision for patients (mostly very elderly) requiring general rehabilitation. Method Routine data from both services were analysed to identify the number of admissions and length of stay between September 2012 and September 2014. In total, 10 patients took part in qualitative interviews. Qualitative interviews and focus groups were undertaken with 19 staff members, including managers and clinicians. Findings There were 5653 admissions to CH and 1710 to ICS between September 2012 and September 2014. In the five months before the introduction of ICS, admission rates to CH were on average 217/month; in the final five months of the study, when both services were fully operational, average numbers of patients admitted were: CH 162 (a 25% reduction), ICS 97, total 259 (a 19% increase). Patients and carers rated both ICS and CH favourably compared with acute hospital care. Those who had experienced both services felt each to be appropriate at the time; they appreciated the 24 h availability of staff in CH when they were more dependent, and the convenience of being at home after they had improved. In general, staff welcomed the introduction of ICS and appreciated the advantages of home-based rehabilitation. Managers had a clearer vision of ICS than staff on the ground, some of whom felt underprepared to work in the community. There was a consensus that ICS was managing less complex and dependent patients than had been envisaged. Conclusion ICS can provide a feasible adjunct to CH that is acceptable to patients. More work is needed to promote the vision of ICS amongst staff in both community and acute sectors.

"Jedes starre Konzept ist schlecht und passt net' in diese Welt"

2007 ◽  
Vol 37 (148) ◽  
pp. 369-381 ◽  
Author(s):  
Wolfgang Ludwig-Mayerhofer ◽  
Ariadne Sondermann ◽  
Olaf Behrend
Keyword(s):  
Public Management ◽  
New Public Management ◽  
Qualitative Interviews ◽  
Unemployed People ◽  
Staff Members ◽  
Public Employment Service ◽  
New Public ◽  
Recent Reform ◽  
The Unemployed ◽  
New Procedures

The recent reform of the Bundesagentur fijr Arbeit, Germany's Public Employment Service (PES), has introduced elements of New Public Management, including internal controlling and attempts at standardizing assessments ('profiling' of unemployed people) and procedures. Based on qualitative interviews with PES staff, we show that standardization and controlling are perceived as contradicting the 'case-oriented approach' used by PES staff in dealing with unemployed people. It is therefore not surprising that staff members use considerable discretion when (re-)assigning unemployed people to one of the categories pre-defined by PES headquarters. All in all, the new procedures lead to numerous contradictions, which often result in bewilderment and puzzlement on the part of the unemployed.

scholarly journals Healthcare use and costs in the last year of life: a national population data linkage study

2021 ◽  
pp. bmjspcare-2020-002708
Author(s):  
Katharina Diernberger ◽  
Xhyljeta Luta ◽  
Joanna Bowden ◽  
Marie Fallon ◽  
Joanne Droney ◽  
...  
Keyword(s):  
End Of Life ◽  
Secondary Care ◽  
Urban Areas ◽  
Data Linkage ◽  
Hospital Admissions ◽  
Community Support ◽  
Population Data ◽  
Linkage Study ◽  
Healthcare Use ◽  
Admission Rates

BackgroundPeople who are nearing the end of life are high users of healthcare. The cost to providers is high and the value of care is uncertain.ObjectivesTo describe the pattern, trajectory and drivers of secondary care use and cost by people in Scotland in their last year of life.MethodsRetrospective whole-population secondary care administrative data linkage study of Scottish decedents of 60 years and over between 2012 and 2017 (N=274 048).ResultsSecondary care use was high in the last year of life with a sharp rise in inpatient admissions in the last 3 months. The mean cost was £10 000. Cause of death was associated with differing patterns of healthcare use: dying of cancer was preceded by the greatest number of hospital admissions and dementia the least. Greater age was associated with lower admission rates and cost. There was higher resource use in the urban areas. No difference was observed by deprivation.ConclusionsHospitalisation near the end of life was least frequent for older people and those living rurally, although length of stay for both groups, when they were admitted, was longer. Research is required to understand if variation in hospitalisation is due to variation in the quantity or quality of end-of-life care available, varying community support, patient preferences or an inevitable consequence of disease-specific needs.

scholarly journals The Positive Legacy of Vision Loss: Pathways to Posttraumatic Growth

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 616-617
Author(s):  
Corinna Tanner ◽  
Michael Caserta ◽  
Jia-Wen Guo ◽  
Margaret Clayton ◽  
Paul Bernstein ◽  
...  
Keyword(s):  
Posttraumatic Growth ◽  
Cognitive Processing ◽  
Mixed Method ◽  
Vision Loss ◽  
Social Issues ◽  
Qualitative Interviews ◽  
Age Related Macular Degeneration ◽  
Age Related ◽  
Severe Vision Loss ◽  
Age Range

Abstract This mixed method study describes posttraumatic growth (PTG) accruing form experience with vision loss caused by severe age related macular degeneration (AMD) and explores relationships between depression, social support, and cognitive processing, on the path to PTG. Research describing the psychological and social issues surrounding AMD has focused on negative outcomes. However, learning from highly challenging experiences, such as vision loss, can offer benefits. In this study, these included an increased sense of personal strength, increased spirituality, and empathy for others (all domains of PTG). 89 participants with severe vision loss (mean age = 85.3 years, age range = 74–98 years) completed the interviewer-administered composite questionnaire, which identified elements of Tedeschi and Calhoun’s model of PTG. Relationships between variables were examined using path analysis. Findings were contextualized with data from 15 qualitative interviews. Findings underscored the importance of supportive others and deliberate cognitive processing in the path to PTG.

Remote Follow-up of Self-isolating COVID-19 Patients with a Patient Portal: Protocol for a Mixed-method Pilot Study (The Opal-COVID Study) (Preprint)

2021 ◽  
Author(s):  
David Lessard ◽  
Kim Engler ◽  
Yuanchao Ma ◽  
Adriana Rodriguez Cruz ◽  
Serge Vicente ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Mixed Method ◽  
Healthcare Professionals ◽  
Qualitative Interviews ◽  
Sociodemographic Characteristics ◽  
Patient Portal ◽  
Implementation Outcomes ◽  
Service Outcomes ◽  
Qualitative Analyses

BACKGROUND Individuals diagnosed with COVID-19 are instructed to self-isolate at home. However, during self-isolation, they may experience anxiety and insufficient care. Some patient portals can allow patients to self-monitor and share their health status with healthcare professionals for remote follow-up, but little data is available on the feasibility of their use. OBJECTIVE This manuscript presents the protocol of the Opal-COVID Study which has four objectives: 1) assess the implementation of using the Opal patient portal for distance monitoring of COVID-19 patients self-isolating at home; 2) identify influences on the intervention’s implementation; and describe 3) service and 4) patient outcomes of this intervention. METHODS This mixed-method pilot study aims to recruit 50 COVID-19 patient participants tested at the McGill University Health Centre (MUHC, Montreal, Canada) for 14 days of remote follow-up. With access to questionnaires through the Opal patient portal smartphone app, configured for this study, patients will complete a daily self-assessment of symptoms, vital signs, and mental health, monitored by a nurse, and receive subsequent teleconsultations, as needed. Study questionnaires will be administered to collect data on sociodemographic characteristics, medical background, implementation outcomes (acceptability, usability, and respondent burden) and patient satisfaction. Coordinator logbook entries will inform on feasibility outcomes, namely, recruitment/retention rates and fidelity, as well as on the frequency and nature of contacts with healthcare professionals via Opal. The statistical analyses for Objectives 1 (implementation outcomes), 3 (service outcomes), and 4 (patient outcomes) will evaluate the effects of time and sociodemographic characteristics on the outcomes. For Objectives 1 (implementation outcomes) and 4 (patient outcomes), the statistical analyses will also examine the attainment of predefined success thresholds. As to the qualitative analyses, for Objective 2 (influences on implementation), semi-structured qualitative interviews will be conducted with four groups of stakeholders (i.e., patient participants, healthcare professionals, technology developers and study administrators) and submitted to content analysis, guided by the Consolidated Framework for Implementation Research to help identify barriers and facilitators of implementation. For Objective 3 (service outcomes), reasons for contacting healthcare professionals through Opal will also be submitted to content analysis. RESULTS Between December 2020 and March 2021, 51 patient-participants were recruited. Qualitative interviews were conducted with 39 involved stakeholders, from April to September 2021. Delays in the study process were experienced due to implemented measures at the MUHC to address COVID-19 but the quantitative and qualitative analyses are currently underway. CONCLUSIONS This protocol is designed to generate multidisciplinary knowledge on the implementation of a patient portal-based COVID-19 care intervention and will lead to a comprehensive understanding of feasibility, stakeholder experience, and influences on implementation that may prove useful for scaling up similar interventions. CLINICALTRIAL ClinicalTrials.gov identifier NCT04978233.

Leadership in a time of financial crisis: what do we want from our leaders?

2015 ◽  
Vol 36 (5) ◽  
pp. 612-627 ◽  
Author(s):  
Arlene Haddon ◽  
Catherine Loughlin ◽  
Corinne McNally
Keyword(s):  
Mixed Methods ◽  
Mixed Method ◽  
Sex Role ◽  
Qualitative Interviews ◽  
Crisis Leadership ◽  
Organizational Crisis ◽  
Content Type ◽  
Mixed Methods Approach ◽  
Nuanced Understanding ◽  
Method Approach

Purpose – The purpose of this paper is to gain a nuanced understanding of what employees want from leaders in an organizational crisis context. Design/methodology/approach – The authors use a mixed methods approach to explore employee leadership preferences during organizational crisis and non-crisis times using the Multi Factor Leadership Questionnaire (Avolio and Bass, 2004), and qualitative interviews. The authors also investigate sex roles using the Bem Sex Role Inventory (Bem, 1981). Findings – The mixed method approach reveals some potential limitations in how leadership is typically measured. The qualitative findings highlight employees’ expectations of leaders to take action quickly while simultaneously engaging in continuous communication with employees during crisis. None of the components of transformational leadership encapsulate this notion. Originality/value – The mixed methods approach is novel in the crisis leadership literature. Had the authors relied solely on the quantitative measures, the importance of continuous communication during crisis would not have been apparent. As a result of this approach, the findings suggest that widely used and accepted measures of leadership may not adequately capture leadership in a crisis context. This is timely as it aligns with current literature which questions the way this construct is operationalized (Van Knippenberg and Sitkin, 2013).

scholarly journals Home-Based Cardiac Rehabilitation During COVID-19: A Qualitative Study

2021 ◽  
Author(s):  
Smitha Ganeshan ◽  
Crystal Tse ◽  
Alexis Beatty
Keyword(s):  
Cardiac Rehabilitation ◽  
Organizational Factors ◽  
Structured Interviews ◽  
Ongoing Research ◽  
Staff Members ◽  
Use Of Technology ◽  
Home Based ◽  
Mobile Phone Applications ◽  
Delivery Models

Abstract Background: Cardiac rehabilitation (CR) has been shown to reduce mortality, morbidity, and hospitalizations. Increasingly, digital tools have augmented the ease of delivering programs outside of the traditional rehabilitation center setting. Because of the need for distancing during the COVID-19 pandemic, many cardiac rehabilitation (CR) centers suspended in-person services and pivoted to home-based CR (HBCR). In this study, we qualitatively evaluated implementation of HBCR, which included weekly phone or video visits for individualized exercise plans, nutrition and health education counseling, wellness sessions, and optional mobile phone applications.Methods: Patient participants and staff members (physician, nurses, exercise physiologists, dietician, administrative staff) participated in semi-structured interviews. Two independent reviewers coded interview transcripts for emergent themes and pre-specified themes from the Theory of Planned Behavior, Unified Theory of Acceptance and Use of Technology, and the Consolidated Framework for Implementation Research.Results: A total of 12 patients and 7 staff were interviewed. Narrative descriptions highlighted the isolation, fear, and disruption of life activities during COVID-19. Key facilitators of the HBCR patient experience included strong relationships with staff who served as coaches and sources of accountability and the ability of HBCR to deliver an individually tailored experience within a patient’s home. Important organizational factors for implementation included leadership buy-in, culture of change, and support for staff. Though technology tools facilitated communication and accountability, not all participants embraced technology and some reported challenges with use.Conclusions: Individually tailored HBCR can facilitate access for patients to participate outside of a CR center. Ongoing research is needed to understand the long-term outcomes of flexible delivery models that may include both in-person and remote visits, and the role of technology in these models.

scholarly journals Fortellingens betydning for å fremme livsmotet i møte med alvorlig sykdom

2019 ◽  
Vol 15 (2) ◽  
pp. 16
Author(s):  
Kjersti Sunde Mæhre
Keyword(s):  
Life Story ◽  
Qualitative Interviews ◽  
Phenomenological Approach ◽  
Severe Illness ◽  
Illness Narrative ◽  
Life Situation ◽  
Hermeneutic Phenomenological ◽  
Patient Interviews ◽  
Home Based ◽  
The Face

The importance of the story to promote hope and life courage in the face of serious illnessIn connection with my PhD (Mæhre, 2017), I conducted qualitative interviews with five critically ill patients in an enhanced ward of a nursing home, based on the Coordination Reform. The purpose of the interviews was to increase understanding of patient experiences of the ward, and their perceived challenges and needs for assistance. The research method was a hermeneutic-phenomenological approach. The essay is based on one of the patient interviews, which has been rewritten as a narrative. This narrative emphasizes how the patient has fought against her illness, and her need to be seen as herself as a person and not understood in terms of a diagnosis. The illness narrative becomes part of her life story. The article highlights opportunities for narratives in the face of serious illness. The narrative reveals how a changed life situation, despite severe illness, can add courage and joy to life, but also how it can lead to hopelessness, doubt, and uncertainty.

scholarly journals Protocol for a Mixed-Method Investigation of the Impact of the COVID-19 Pandemic and Gambling Practices, Experiences and Marketing in the UK: The “Betting and Gaming COVID-19 Impact Study”

2020 ◽  
Vol 17 (22) ◽  
pp. 8449
Author(s):  
Kate Hunt ◽  
Nathan Critchlow ◽  
Ashley Brown ◽  
Christopher Bunn ◽  
Fiona Dobbie ◽  
...  
Keyword(s):  
Young Adults ◽  
Mixed Method ◽  
Qualitative Interviews ◽  
Risk Groups ◽  
Third Wave ◽  
Policy Makers ◽  
Treatment Providers ◽  
Sports Events ◽  
The Uk ◽  
The Impact

The COVID-19 pandemic led to unprecedented restrictions on people’s movements and interactions, as well as the cancellation of major sports events and social activities, directly altering the gambling landscape. There is urgent need to provide regulators, policy makers and treatment providers with evidence on the patterns and context of gambling during COVID-19 and its aftermath. This protocol describes a study addressing the following three questions: (1) How has COVID-19 changed gambling practices and the risk factors for, and experience of, gambling harms? (2) What is the effect of COVID-19 on gambling marketing? (3) How has COVID-19 changed high risk groups’ gambling experiences and practices? This mixed-method study focuses on two groups, namely young adults and sports bettors. In workpackage-1, we will extend an existing longitudinal survey of gambling in young adults (aged 16–24 years) (first wave conducted June–August 2019), adding COVID-19-related questions to the second wave (July–August 2020) and extending to a third wave in 2021; and undertake a survey of sports bettors in the UK (baseline n = 4000, ~July–August 2020), with follow-ups in ~October–November 2020 and ~February-March 2021. In workpackage-2, we will examine changes in expenditure on paid-for gambling advertising from January 2019 to July 2021 and undertake a mixed-method content analysis of a random sample of paid-for gambling advertising (n ~ 200) and social media marketing (n ~ 100) during the initial COVID-19 “lockdown”. Workpackage-3 will involve qualitative interviews with a purposive sample of (a) young adults (aged 18–24 years) and (b) sports bettors.

Do institutions matter?

2019 ◽  
Vol 13 (3) ◽  
pp. 319-332
Author(s):  
Habiba Ibrahim
Keyword(s):  
Social Networks ◽  
Low Income ◽  
Qualitative Interviews ◽  
Community Support ◽  
Institutional Perspective ◽  
Content Type ◽  
Credit Line ◽  
Institutional Determinants ◽  
The Usa ◽  
Nationally Representative

Purpose Guided by the institutional theory of savings, the purpose of this study is to assess the institutional elements of rotating, savings and credit associations (ROSCAs) that enable participants to save. Design/methodology/approach The study used data from in-depth qualitative interviews (N = 10) conducted among the ROSCA group leaders from African immigrant communities in the USA. Findings The primary goal for joining the ROSCA group among participants is to achieve economic stability. The results of the study postulate that, through institutional mechanisms and social networks, ROSCAs create an environment for families to save and invest. The emphasis on the concept of “you cannot save alone” underscores the importance of supportive structures to enable low-income households to save. Although “alternative savings programs” such as ROSCAs are imagined as something that less well-to-do persons use, the findings from this study demonstrate that such strategies also appeal to some people with higher socioeconomic status. This appeal and utility speaks to the importance of ROSCAs as an institutional response, rather than just an informal arrangement among persons known to each other. Research limitations/implications It is prudent to bear in mind that the study sample is not nationally representative, and therefore, the results presented cannot be generalized to immigrants across the country. However, as one of the few ROSCA studies in the USA, the findings from this study make generous contributions to the immigrants’ savings and ROSCA practices literature. Practical implications ROSCAs could be used as a bridge to the formal financial institutions. Non-profit agencies working with these communities could work with these groups to report ROSCA payments to the major credit bureaus, to help them build a credit line in their new country. Originality/value Previous studies of ROSCAs have assessed ROSCAs as community support systems and social networks. The current study has analyzed ROSCAs from an institutional perspective by examining the institutional characteristics of ROSCAs comparable to the institutional determinants of savings that enable savings among the participants.

Investigating the role of middle managers in strategy-making process: An Australian mixed method study

2014 ◽  
Vol 20 (2) ◽  
pp. 187-205 ◽  
Author(s):  
Tim O'Shannassy
Keyword(s):  
Mixed Method ◽  
Middle Managers ◽  
Information Source ◽  
Qualitative Interviews ◽  
Mixed Method Study ◽  
Henry Mintzberg ◽  
Organization Strategy ◽  
Strategy Making ◽  
Mix Methods

AbstractSeveral influential writers including Henry Mintzberg and Gary Hamel have highlighted the need for organizations to value the contribution to strategy work of middle managers in an uncertain world. In this study quantitative surveys and qualitative interviews are used to mix methods and investigate the role of middle managers in strategy-making process in Australia. The results indicate that middle managers are the ‘doers’ of strategy, with important ‘analyst’, ‘coordinator’, ‘information source’ and ‘communicator’ roles. Middle managers reported some frustration in interviews that at times they feel their input to strategic conversations is not translated effectively into organization strategy.

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