Case study 4

Author(s):  
Ewan Ferlie ◽  
Sue Dopson ◽  
Chris Bennett ◽  
Michael D. Fischer ◽  
Jean Ledger ◽  
...  

This chapter reviews the role and high impact of management knowledge on a specialist health care provider in the independent sector. The chapter highlights the role of the government-wide austerity programme, QIPP, in the importing of operations management. Specifically, the chapter considers the impact of the balanced scorecard in transforming the organization’s practice and financial position in a period of austerity. It begins by offering a review of the increasing private-sector involvement in the NHS, as well as the emergence of hybrid organizations and social enterprises. It then describes the history of the specialist health care provider under scrutiny in this case. Finally, the chapter reflects on the impact of formal management knowledge being complemented by a range of other sources of more experiential knowledges, for example, education and development activities, and the importance of embedded agency in achieving organizational change.

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2174-2174
Author(s):  
Michelle Neier ◽  
Michele P. Lambert ◽  
Rachael F. Grace ◽  
Kerry Hege ◽  
Stephanie Chiu ◽  
...  

Background: Immune thrombocytopenia (ITP) is an immune mediated bleeding disorder characterized by isolated thrombocytopenia. ITP can have a variety of presentations from asymptomatic to life threatening bleeding. Although childhood ITP is most often a self-resolving illness which can be closely observed without intervention, it can be associated with significant impact on quality of life (QoL). Prospective studies of QoL in ITP patients show that there is not always a correlation with treatment or disease severity. The pathway from initial presentation to final diagnosis varies and may include encounters with emergency room, primary care or specialty providers. There have been no published studies to date showing the impact of factors prior to the diagnosis of ITP on treatment decision making and QoL. Objective: To identify the role of physician-patient and physician-caregiver interactions on the QoL and emotional well-being of patients and their families. Ascertaining the impact of pre-diagnosis factors may provide an opportunity to improve access and quality of care provided. Methods: The ITP Consortium of North America (ICON) "Pathways" study was a multicenter observational prospective cohort study focused on the pathways to diagnosis of ITP. The study was supported by a Foundation for Morristown Medical Center Research Fund Grant. Subjects were included if they had presumed primary ITP and were age >12 months to <18 years. Subjects were excluded if they had secondary ITP, including Evans syndrome. Treatment was determined by the physician. Subjects were consented and presented with questionnaires to be completed at the conclusion of the initial hematology visit. The hematologist also completed survey data at that time. Survey data forms included demographic form, physician form, Peds QL Family Impact Questionnaire, Kids ITP tools (KIT) Parent Impact Report and parent proxy report, and child (patient) KIT self-report. There was a parent questionnaire which included a question about worry with a scale from 0 to 10. Study data were collected and managed using REDCap electronic data capture tools hosted at Atlantic Health System. Correlation between variables were calculated using Pearson coefficient or Spearman's rho depending on the distribution of the data variables. Results: Sixty subjects and caregivers were enrolled at 6 ICON centers; 52 were eligible for inclusion. The majority (40%) had Grade 1 bleeding. Most patients (82%) were seen in outpatient hematology clinic by the hematologist and had been referred by the emergency room (73%). The median time to consultation with a hematologist from onset of symptoms was 7 days (1-199) and the median time to diagnosis by hematologist from initial contact with a health care provider was 5 days (0-154). Most subjects had seen 2 health care providers prior to the hematologist. KIT proxy report cumulative scores were a mean of 76.03 (SD 14.72). There was no significant difference between the time to diagnosis or the time from initial encounter with health care provider to hematologist and initial level of worry (p=0.70 and 0.90, respectively). There was also no significant difference between the time to diagnosis or the time from initial encounter with health care provider to hematologist and KIT proxy scores (p=0.96 and 0.50, respectively). However, there was a significant decline in level of worry (scale 0-10) prior to the hematologist visit (median 8, range 1-10) to after the visit (median 4, range 1-10). The association between number of medical providers encountered prior to diagnosis and KIT proxy scores was not significant (p=0.45) (Table). Conclusions: In this study at 6 teaching institutions, we were unable to detect a significant difference in proxy-reported KIT scores relative to the number of health care providers seen or time from diagnosis until the first encounter with the hematologist. We were, however, able to detect a significant change in the level of caregiver worry pre- and post- visit with the pediatric hematologist, supporting a benefit of specialist care to the caregivers of children with ITP. This study was limited by its small sample size and retrospective design. ITP is considered a benign disease but is associated with a significant amount of worry and impact on QoL for patients and caregivers which warrants further investigation. Disclosures Lambert: CSL Behring: Consultancy; Amgen: Consultancy, Other; Bayer: Other: Ad boards; Novartis: Other: Ad boards, Research Funding; Shionogi: Consultancy; Kedrion: Consultancy; Sysmex: Consultancy; AstraZeneca: Research Funding; PDSA: Research Funding. Grace:Agios Pharmaceuticals, Inc: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Research Funding.


2021 ◽  
Author(s):  
◽  
Maria Kuhns

Due to rural health disparities and an uneven distribution of health providers across the rural urban continuum, retaining the existing rural health care provider workforce may be an important strategy to maintain existing rural health care provision. While a large body of literature addresses how to recruit health care providers to rural areas, less is known about how to retain these providers. Even less literature has focused on the role of rural communities in health care provider retention. In this thesis, I examine the role of provider background and familial characteristics, workplace characteristics, and community characteristics that may impact a provider's likelihood to consider leaving a rural community. I use data from a survey of over 900 rural health care providers across nine states and a probit model to estimate the impact of these characteristics on a provider's propensity to consider leaving. I find that establishing social ties and integrating within the community through volunteering reduces providers' likelihood to consider leaving by 10 percent. Additionally, providers who engage in entrepreneurship by investing in part or all of their practice are 12 percent less likely to consider leaving, all else being equal. I also find that having unacceptable on-call responsibilities increases a provider's likelihood to consider leaving by 17 percent. This thesis contributes to the existing literature by estimating the effects of work-life balance, entrepreneurship, and the role of family and personal integration on provider retention. Furthermore, it emphasizes the role of communities in provider retention. These results offer insights to rural communities and decision-makers seeking to identify how to maintain their existing rural health care workforce.


2018 ◽  
Vol 37 (3) ◽  
pp. 221-226
Author(s):  
Arch G. Mainous ◽  
Hend Mansoor ◽  
Kiarash P. Rahmanian ◽  
Peter J. Carek

2021 ◽  
Vol 16 (1) ◽  
pp. 125-145
Author(s):  
Tamara Rajić ◽  
Ana Rakić ◽  
Isidora Milošević

Customer loyalty, with satisfaction of customers as its main precondition, has long been regarded as an overarching goal of service businesses. With the proliferation of health care providers, which brought about rising competitive pressures on the market, the issue of how to satisfy and keep patients has been attracting increasing attention of researchers and health care management. Therefore, this study aims to examine the antecedents of patient satisfaction and its direct and mediated impact on patients' behavioural intentions in thus far under-studied context of emerging economy's health care system. The study has been conducted in a primary health care setting, on a convenience sample of 300 patients, by means of structured questionnaire. The application of structural equation modelling (SEM) revealed direct impact of health care service quality on patient satisfaction and its mediated impact on satisfaction, via perceived value of health care services. In addition to direct influence of satisfaction on patients' behavioural intentions, its total effect on positive intentions of patients is increased by the impact of patient commitment to a health care provider, which, as evidenced by this study's findings, increases with patient's rising trust into a health care provider. Implications for theory and practice are discussed and further research directions are provided.


2008 ◽  
Vol 13 (2) ◽  
pp. 67-85 ◽  
Author(s):  
Lee Ellington ◽  
Sonia Matwin ◽  
Bert N. Uchino ◽  
Srichand Jasti ◽  
William N. Dudley ◽  
...  

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