A paradoxical dynamic in a service labyrinth: insights from HIV care

2018 ◽  
Vol 52 (11) ◽  
pp. 2252-2265 ◽  
Author(s):  
Angela Gracia B. Cruz ◽  
Elizabeth Snuggs ◽  
Yelena Tsarenko
Keyword(s):  
Integrated Care ◽  
Social Dynamics ◽  
Care Service ◽  
Service Systems ◽  
System Level ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Content Type ◽  
Individual Level ◽  
Consumption Practices

PurposeWhile theories of complex service systems have advanced important insights about integrated care, less attention has been paid to social dynamics in systems with finite resources. This paper aims to uncover a paradoxical social dynamic undermining the objective of integrated care within an HIV care service system.Design/methodology/approachGrounded in a hermeneutic analysis of depth interviews with 26 people living with HIV/AIDS (PLWHA) and drawing on Bourdieu’s (1984) theory of capital consumption to unpack dynamics of power, struggle and contestation, the authors introduce the concept of the service labyrinth.FindingsTo competently navigate the service labyrinth of HIV care, consumers adopt capital consumption practices. Paradoxically, these practices enhance empowerment at the individual level but contribute to the fragmentation of the HIV care labyrinth at the system level, ultimately undermining integrated care.Research limitations/implicationsThis study enhances understanding of integrated care in three ways. First, the metaphor of the service labyrinth can be used to better understand complex care-related service systems. Second, as consumers of care enact capital consumption practices, the authors demonstrate how they do not merely experience but actively shape the care system. Third, fragmentation is expectedly part of the human dynamics in complex service systems. Thus, the authors discuss its implications. Further research should investigate whether a similar paradox undermines integrated care in better resourced systems, acute care systems and systems embedded in other cultural contexts.Originality/valueContrasted to provider-centric views of service systems, this study explicates a customer-centric view from the perspective of heterosexual PLWHA.

The HPWS and AMO: a dynamic study of system- and individual-level effects

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Fiona Edgar ◽  
Jing A. Zhang ◽  
Nancy M. Blaker
Keyword(s):  
Task Performance ◽  
Service Sector ◽  
Contextual Performance ◽  
System Level ◽  
Human Resource Research ◽  
Organizational System ◽  
Content Type ◽  
Individual Level ◽  
The Relationship ◽  
And Task

PurposeDrawing on the dynamic model of ability, motivation, opportunity (AMO) for human resource research, this study aims to examine how organizational system-level (i.e. the high-performance work system (HPWS)) and individual-level AMO affect employees' performance. Specifically, this paper proposes that employee task performance is resultant from the integration of system- and individual-level AMO factors with employee contextual performance.Design/methodology/approachA survey design is employed with data collected from 250 employees working in New Zealand's service sector.FindingsThis study finds both organizational system (HPWS) and individual AMO dimensions have positive associations with employees' performance. At the system level, the supportive role played by contextual performance is highlighted with pro-social behaviors fully mediating the relationship between the HPWS and task performance. At the individual level, contextual performance is found to partially mediate the relationship between ability and task performance and fully mediate the relationship between motivation and task performance. Opportunity, on the other hand, is significantly associated with task but not contextual performance.Originality/valueIn acknowledging there are a plurality of factors that impact performance, this study enriches our understanding of AMO's influence in the context of people management.

Improvement attributes in healthcare: implications for integrated care

2018 ◽  
Vol 31 (3) ◽  
pp. 214-227 ◽  
Author(s):  
Patrick John Harnett
Keyword(s):  
Literature Review ◽  
Integrated Care ◽  
Change Process ◽  
Social Dynamics ◽  
Complex Adaptive System ◽  
Policy Makers ◽  
Content Type ◽  
Healthcare Improvement ◽  
Complex Adaptive ◽  
Systemic Improvement

Purpose Healthcare quality improvement is a key concern for policy makers, regulators, carers and service users. Despite a contemporary consensus among policy makers that integrated care represents a means to substantially improve service outcomes, progress has been slow. Difficulties achieving sustained improvement at scale imply that methods employed are not sufficient and that healthcare improvement attributes may be different when compared to prior reference domains. The purpose of this paper is to examine and synthesise key improvement attributes relevant to a complex healthcare change process, specifically integrated care. Design/methodology/approach This study is based on an integrative literature review on systemic improvement in healthcare. Findings A central theme emerging from the literature review indicates that implementing systemic change needs to address the relationship between vision, methods and participant social dynamics. Practical implications Accommodating personal and professional network dynamics is required for systemic improvement, especially among high autonomy individuals. This reinforces the need to recognise the change process as taking place in a complex adaptive system where personal/professional purpose/meaning is central to the process. Originality/value Shared personal/professional narratives are insufficiently recognised as a powerful change force, under-represented in linear and rational empirical improvement approaches.

Culture’s causes: the next challenge

2015 ◽  
Vol 22 (4) ◽  
pp. 545-569 ◽  
Author(s):  
Gert Jan Hofstede
Keyword(s):  
Strategic Management ◽  
Control Measure ◽  
Cross Cultural ◽  
System Level ◽  
Cultural Patterns ◽  
Job Interviews ◽  
Content Type ◽  
Cultural Elements ◽  
Individual Level ◽  
New Synthesis

Purpose – The purpose of this paper is to argue that in cross-cultural and strategic management, we must pay attention to the processes creating and maintaining culture. How can everyday interactions give rise to national, “deep” cultures, recognizable across centuries, or organizational cultures, recognizable across decades? Design/methodology/approach – This is a conceptual paper using the evidence provided by research about cultural patterns, and using sociological status-power theory to explain the causation of these patterns. Emergence, also called self-organization, is introduced as mechanism connecting individual-level causation with resulting system-level patterns. Cases are used to illustrate points. Findings – Simulation gaming and computational social simulation are introduced. These methods allow “growing” a system, thus allowing to experiment with potential interventions and their unanticipated effects. Research limitations/implications – This essay could have major implications for research, adding new methods to survey-based and case-based studies, and achieving a new synthesis. Strategic management today almost invariably involves cross-cultural elements. As a result, cross-cultural understanding is now strategically important. Practical implications – The suggestions in this essay could lead to new collaborations in the study of culture and organizational processes. Examples include team formation, negotiation, mergers and acquisitions, trans-national collaboration, incentive systems and job interviews. Social implications – The suggestions in this essay could contribute to our ability of proactively steering processes in organizations. In particular, they can provide a check to the notion that a control measure necessarily results in its intended effect. Originality/value – The synthesis of biological, sociological and cross-cultural psychological viewpoints with design-oriented method, using games or social simulations as research instruments, is original in the field.

Individual-level cultural consumer engagement styles

2018 ◽  
Vol 35 (1) ◽  
pp. 42-71 ◽  
Author(s):  
Linda D. Hollebeek
Keyword(s):  
Cultural Values ◽  
Social Dynamics ◽  
Consumer Engagement ◽  
Content Type ◽  
Individual Level ◽  
Managerial Implications ◽  
Conceptual Paper ◽  
Cultural Traits ◽  
Research Propositions ◽  
S Model

Purpose While the consumer engagement (CE) concept is gaining traction in the literature, little remains known regarding the ways in which consumers displaying differing cultural traits engage with brands and their differences. The purpose of this paper is to explore CE with brands for consumers exhibiting differing cultural traits, and develop a set of research propositions for these individuals’ cognitive, emotional, behavioral, and social CE in brand interactions. These propositions, collectively, reflect consumers’ individual-level cultural CE styles – consumers’ motivationally driven disposition to think, feel, act, and relate to others in a certain manner characteristic of their specific individual cultural traits in brand interactions. Design/methodology/approach In this conceptual paper, literature is reviewed in the areas of CE and its conceptual relationship with Yoo et al.’s (2011) individual cultural values. Findings Key differences between individual-level cultural traits and consumers’ ensuing cognitive, emotional, behavioral, and social CE with brands are addressed in a set of research propositions based on Yoo et al.’s model of individual cultural values, from which the concept of individual-level cultural CE styles is developed. Research limitations/implications This research explores differences across individuals displaying differing cultural traits and their ensuing CE with brands, which remains underexplored to date. It also develops the concept of individual-level cultural CE styles, which reflect consumers’ characteristic cultural trait-based cognitions, emotions, behaviors, and social dynamics in engaging with particular brands. Practical implications The outlined managerial implications reveal that unique marketing approaches are expected to be effective for engaging consumers exhibiting different cultural traits with brands, based on their distinctive CE styles (e.g. focusing on personalized interactions/interactions that stress consumers’ similarity to and fit with salient others for individualist/collectivist consumers, respectively). Originality/value This paper makes two important theoretical contributions. First, by offering a conceptual analysis of consumers displaying differing cultural traits and their ensuing engagement with brands, it provides an early attempt to explore individual-level cultural CE-based differences. Second, it develops the concept of individual-level cultural CE styles, which is expected to hold important theoretical and managerial implications.

The development of an evaluation framework for a Hospital at Home service

2015 ◽  
Vol 23 (6) ◽  
pp. 336-351 ◽  
Author(s):  
Rebecca Jester ◽  
Karen Titchener ◽  
Janet Doyle-Blunden ◽  
Christine Caldwell
Keyword(s):  
Integrated Care ◽  
Care Service ◽  
Good Practice ◽  
Evaluation Framework ◽  
Evidence Based ◽  
Content Type ◽  
Home Service ◽  
Wide Range ◽  
Hospital At Home ◽  
At Home

Purpose – The purpose of this paper is to share good practice with interested professionals, commissioners and health service managers regarding the development of an evidence-based approach to evaluation of an integrated care service providing acute level care for patients in their own homes in South London called the Guys and St Thomas’ @home service. Design/methodology/approach – A literature review related to Hospital at Home (HH) schemes was carried out with an aim of scoping approaches used during previous evaluations of HH type interventions to inform the development of an evaluation strategy for @home. The results of the review were then applied to the Donabedian conceptual model: Structure; Process; and Outcome and contextualised to the population being served by the scheme to ensure a robust, practical and comprehensive approach to evaluation. Findings – Due to the heterogeneity of the studies it was not possible to conduct a systematic review or meta-analysis. In total, 28 studies were identified that met the inclusion criteria and included both HH to facilitate early discharge and admission prevention across a wide range of conditions. The key finding was there is a dearth of literature evaluating staff preparation to work on HH, models of delivery, specifically integrated care and trans-disciplinary working and few studies included the experiences of family carers. Originality/value – This paper will be of value to those involved in the commissioning and delivery of HH and other models of integrated care services type services and will help to inform evaluation strategies that are practical, evidence based and include all stakeholder perspectives.

Space, time and demographic change

2017 ◽  
Vol 25 (1) ◽  
pp. 39-48 ◽  
Author(s):  
Hamish Robertson
Keyword(s):  
Integrated Care ◽  
Social Care ◽  
Care Service ◽  
Population Ageing ◽  
Social Care Service ◽  
Content Type ◽  
Care Integration ◽  
Health And Social Care ◽  
Geographical Perspective ◽  
Practical Implications

Purpose The purpose of this paper is to explore the potential value of applying spatial science and technology to the issue of care integration across what are the often fragmented domains of health and social care provision. The issue of focus for this purpose is population ageing because it challenges existing information and practice silos. Better integration, the author proposes, needs to adopt a geographic approach to deal with the challenges that population ageing present to health and social care as they currently function in many countries. Design/methodology/approach The approach utilised here explores the role that could be played by enhancing spatial perspectives in care integration. Spatial and temporal strategies need to be coordinated to produce systems of integrated care that are needed to meet the needs of growing numbers of older people. Findings The author’s premise is that, with some rare exceptions, geographies of care are needed to address important shifts in demography such as population ageing and their epidemiological consequences. The rising intersection between the ageing and disability concepts illustrates how the fluid nature of health and social care client groups will challenge existing systems and their presuppositions. Health and medical geography offer a theoretical and practical response to some of these emerging problems. Research limitations/implications This is a brief conceptual piece in favour of integrating geographic concepts and methods in the context of changing demography and the social, economic and service implications of such changes. It is limited in scope and a more detailed explanation would be required for a proof of concept. Practical implications Practically we know that all human services vary across space as do both healthcare and related social services and supports. Issues of quality and safety are numerous in these policy domains generally, with aged care evidencing a growing number of problems and challenges. Being able to inquire on significant challenges in health and social care through a spatial lens has the potential to provide another, highly practical, kind of evidence in this field of work. This lens is, the author contends, very poorly integrated into either health or social care at present. However, doing so would have a variety of useful outcomes for monitoring and intervening on real problems in care integration. An example could be “frequent flyers” in emergency departments as has been done in Camden, New Jersey through patient mapping. Social implications The author’s position in this paper is that the challenges we face in providing integrated care to ageing and increasingly disabled (including both physical and cognitive impairments) populations will only grow in the face of variable governmental responses and increasingly complex funding and service provider arrangements. Without a geographical perspective and the concepts and tools of spatial science the author does not see an adequate response emerging. The shift to community-based care for many groups, including the aged, means that location will become more important rather than less so. This is a societal concern of major proportions and the very concept of integrated care requires of us a geographical perspective. Originality/value This is a short but, the author believes, conceptually rich piece with a variety of potential practical implications for health and social care service provision. Issues of equity, quality, safety and even basic access can only grow as population ageing progresses and various forms of chronic disease and disability continue to grow. Knowing where the most affected people and their social and service connections are located will support better integration. And better integration may resolve some of the financial and related resource problems that are already evident but which can only continue to increase. In this context, the author suggests that the integrated care of the future needs to be geographically informed to be effective.

Shifting the balance of power

2019 ◽  
Vol 13 (1) ◽  
pp. 3-14 ◽  
Author(s):  
Jo Whaley ◽  
Di Domenico ◽  
Jane Alltimes
Keyword(s):  
Learning Disability ◽  
Balance Of Power ◽  
System Level ◽  
Content Type ◽  
Individual Level ◽  
Ordinary Life ◽  
System Service ◽  
Care And Support ◽  
Service Redesign ◽  
And Control

Purpose This purpose of this paper is to examine the role of engagement and empowerment in “Transforming Care”, for people with a learning disability. The aim is to shift the balance of power so that people are able to live ordinary lives in the community, in the home they choose, close to people they love. It shares ideas to support people to take control over their own lives and to influence the system, so that it works with people, rather than “doing to” people. Design/methodology/approach The paper examines barriers and enablers to people having their rights as citizens. So that people have as much choice and control as they are comfortable with to live an ordinary life (bearing in mind any legal restrictions). The paper includes people’s involvement in system/service redesign. It critiques traditional views of looking at language, participation and power. The authors have used the language throughout which people have told us they prefer as a descriptor. Findings The authors present a framework for looking at the power of, and around, people with a learning disability who have mental health issues or have displayed behaviour that can challenge services. Originality/value This paper offers advice on how to address power imbalances at individual level and at organisational/system level. It looks at the language we use, the information we share and how we work with experts by experience to ensure we can transform care and support and enable people to live ordinary lives as citizens.

scholarly journals HIV patient access to healthcare services in post-austerity era in Greece

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
George Tsiakalakis ◽  
Christina Golna ◽  
Nikos Dedes ◽  
George Papageorgiou ◽  
Kostas Athanasakis ◽  
...  
Keyword(s):  
Viral Load ◽  
Economic Crisis ◽  
Access To Health Care ◽  
Health Care Services ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Patient Access ◽  
Content Type ◽  
The Past ◽  
The Impact

Purpose The ten-year economic crisis and the ensuing fiscal adjustment that Greece experienced between 2009 and 2018 has had a major impact on patient access to health-care services and resulted in an increase in unmet population health needs. The present study aims to assess the impact of economic crisis and ensuing austerity on HIV patient access to health-care services. Design/methodology/approach A cross-sectional study was carried out between February and April 2019 to assess barriers in access to HIV care faced by people living with HIV. A total of 329 HIV positive individuals participated in the study. An online, self-reporting questionnaire was developed and adapted to the specific clinical and societal characteristics of HIV. Findings A total of 94.2% of respondents were male and 67.80% lived in Athens. Most of them were diagnosed with HIV-1 10 years ago. Out of the total respondents, 37.40% reported obstacles in accessing HIV care over the past year. A total of 24.30% reported they were not tested for viral load in the past six months and received a result. Individuals, who self-evaluate their financial status as very bad or bad, were more likely to be unaware of their viral load (55.60%) than those with better financial status (33.5%) (P < 0.01). Only 33.3% of uninsured participants were aware of their viral load, and this figure rose to 63.30% (P <0.01) amongst insured participants. Originality/value The ten-year economic crisis that Greece experienced in the period 2009–2018 had significant effects on the quality of services of the National Health System. This study attempts to fill the research gap regarding the impact of one of the severest economic crises during the past century with complex social extensions, in one of the most vulnerable patient groups. In this context, the study assesses barriers to access to optimal care of people living with HIV in Greece after a decade of austerity and the variables that impact on such access.

scholarly journals Development and Validation of a Multivariable Prediction Model for Missed HIV Healthcare Provider Visits in a Large United States Clinical Cohort

2021 ◽  
Author(s):  
April C Pettit ◽  
Aihua Bian ◽  
Cassandra O Schember ◽  
Peter F Rebeiro ◽  
Jeanne C Keruly ◽  
...  
Keyword(s):  
Prediction Models ◽  
Community Level ◽  
Research Network ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Individual Level ◽  
Visit Adherence ◽  
Level Data ◽  
Missed Visits ◽  
The Individual

Abstract Background Identifying individuals at high risk of missing HIV care provider visits could support proactive intervention. Previous prediction models for missed visits have not incorporated data beyond the individual-level. Methods We developed prediction models for missed visits among people living with HIV (PLWH) with ≥1 follow-up visit in the Center for AIDS Research Network of Integrated Clinical Systems from 2010-2016. Individual-level (medical record data and patient-reported outcomes), community-level (American Community Survey), HIV care site-level (standardized clinic leadership survey), and structural-level (HIV criminalization laws, Medicaid expansion, and state AIDS Drug Assistance Program budget) predictors were included. Models were developed using random forests with 10-fold cross-validation; candidate models with highest area under the curve (AUC) were identified. Results Data from 382,432 visits among 20,807 PLWH followed for a median of 3.8 years were included; median age was 44 years, 81% were male, 37% were Black, 15% reported injection drug use, and 57% reported male-to-male sexual contact. The highest AUC was 0.76 and strongest predictors were at the individual-level (prior visit adherence, age, CD4+ count) and community-level (proportion living in poverty, unemployed, and of Black race). A simplified model, including readily accessible variables available in a web-based calculator, had a slightly lower AUC of 0.700. Conclusions Prediction models validated using multi-level data had a similar AUC to previous models developed using only individual-level data. Strongest predictors were individual-level variables, particularly prior visit adherence, though community-level variables were also predictive. Absent additional data, PLWH with previous missed visits should be prioritized by interventions to improve visit adherence.

Healthcare resources are inadequate to address the burden of illness among HIV-infected male prisoners in Malaysia

2016 ◽  
Vol 12 (4) ◽  
pp. 253-269 ◽  
Author(s):  
Joseph Bick ◽  
Gabriel Culbert ◽  
Haider A. Al-Darraji ◽  
Clayton Koh ◽  
Veena Pillai ◽  
...  
Keyword(s):  
Burden Of Illness ◽  
Communicable Disease ◽  
Healthcare Providers ◽  
Heavy Drinking ◽  
Health Needs ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Infected Male ◽  
Content Type ◽  
Male Prisoners

Purpose Criminalization of drug use in Malaysia has concentrated people who inject drugs (PWID) and people living with HIV into prisons where health services are minimal and HIV-related mortality is high. Few studies have comprehensively assessed the complex health needs of this population. The paper aims to discuss these issues. Design/methodology/approach From October 2012 through March 2013, 221 sequentially selected HIV-infected male prisoners underwent a comprehensive health assessment that included a structured history, physical examination, and clinically indicated diagnostic studies. Findings Participants were mostly PWID (83.7 percent) and diagnosed with HIV while incarcerated (66.9 percent). Prevalence of hepatitis C virus (90.4 percent), untreated syphilis (8.1 percent), active (13.1 percent), and latent (81.2 percent) tuberculosis infection was several fold higher than non-prisoner Malaysian adults, as was tobacco use (71.9 percent) and heavy drinking (30.8 percent). Most (89.5 percent) were aware of their HIV status before the current incarceration, yet few had been engaged previously in HIV care, including pre-incarceration CD4 monitoring (24.7 percent) or prescribed antiretroviral therapy (ART) (16.7 percent). Despite most (73.7 percent) meeting Malaysia’s criteria for ART (CD4 <350 cells/μL), less than half (48.4 percent) ultimately received it. Nearly one-quarter (22.8 percent) of those with AIDS (<200 cells/μL) did not receive ART. Originality/value Drug addiction and communicable disease comorbidity, which interact negatively and synergistically with HIV and pose serious public health threats, are highly prevalent in HIV-infected prisoners. Interventions to address the critical shortage of healthcare providers and large gaps in treatment for HIV and other co-morbid conditions are urgently needed to meet the health needs of HIV-infected Malaysian prisoners, most of whom will soon transition to the community.

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