scholarly journals Exploring frontliners' knowledge, participation and evaluation in the implementation of a pay-for-performance program (PMAQ) in primary health care in Brazil

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Fabiana da Cunha Saddi ◽  
Matthew Harris ◽  
Fernanda Ramos Parreira ◽  
Raquel Abrantes Pêgo ◽  
Germano Araujo Coelho ◽  
...  
Keyword(s):  
Primary Care ◽  
Organizational Context ◽  
Health Workers ◽  
Organizational Capacity ◽  
Successful Implementation ◽  
Policy Feedback ◽  
Implementation Theory ◽  
Content Type ◽  
Theoretical Concepts ◽  
The City

PurposeThis paper employs implementation theory and the political literature on performance measurement to understand how frontline health workers know, participate and evaluate the Brazilian National Program for Improving Access and Quality of Primary Care (PMAQ, 2nd round).Design/methodology/approachThis paper develops an implementation theory-driven qualitative analysis. The research is developed in the city of Goiania (Brazil): a challenging organizational context in primary care (PHC). Interviews were carried out with 25 frontliners – managers, doctors, nurses and community health workers. Data were thematically and hierarchically analysed according to theoretical concepts such as policy knowledge, policy adherence, forms of accountability, alternative logics, organizational capacity and policy feedback.FindingsResults show the need to foster organizational capacity, knowledge, participation and policy feedback at the frontline. Successful implementation would require those adaptations to counteract policy challenges/failures or the emergence of alternative logics.Research limitations/implicationsThe study was conducted in only one setting, however, our sample includes different types of professionals working in units with different levels of organization capacity, located in distinct HDs, expressing well the implementation of PMAQ/P4P. Qualitative researches need to be developed for further exploring the same/other factors.Social implicationsFindings can be used to improve discussions/planning and design of P4P programs in the city and State of Goias.Originality/valueThe majority of analysis of PMAQ are of a quantitative or results-based nature. This article focuses on politically significant and unanswered questions regarding the implementation of PMAQ.

scholarly journals Role and Applicability of the Constructs “Readiness for Change” and “Capacity for Change”

2021 ◽  
Vol 27 (4) ◽  
pp. 30-38
Keyword(s):  
Dynamic Capabilities ◽  
Organizational Context ◽  
Empirical Studies ◽  
Organizational Capacity ◽  
Readiness For Change ◽  
Successful Implementation ◽  
Change Initiatives ◽  
Strategic Goals ◽  
Major Factors ◽  
Capacity For Change

Readiness for change is amongst the major factors influencing the success of change initiatives in organizations. The construct is multifaceted and usually refers to the commitment (of employees) and belief (shared by the group, organization) in their collective capability to implement a specific change initiative. Applying the dynamic capabilities and organizational ambidexterity lens, some researchers suggest a different construct – organizational capacity for change. The capacity for change refers to the successful implementation of multiple, often overlapping change initiatives, and thus allows organizations to simultaneously achieve short-term, operational tasks and long-term, strategic goals. The capacity for change describes the appropriate organizational context, leadership, organizational learning and takes into account previous experience with changes and the extent to which these are considered fair and personally beneficial by employees. Readiness and capacity for change are not always clearly distinguishable and, in some cases, appear as interchangeable terms denoting similar phenomena. This conceptual article explores the two constructs based on a theoretical study of conceptual and empirical studies. The research conclusions support the proposition that the two constructs share similarities but also differences, which justify their distinct roles in deepening our understanding of change in organizations and how to manage and successfully implement it.

scholarly journals Innovation capacity building

2019 ◽  
Vol 26 (1) ◽  
pp. 12-26 ◽  
Author(s):  
Jacob Brix
Keyword(s):  
Capacity Building ◽  
Organizational Context ◽  
Organizational Capacity ◽  
Management Team ◽  
Exploration And Exploitation ◽  
Content Type ◽  
Theoretical Perspectives ◽  
Innovation Capacity ◽  
The Individual ◽  
Do So

PurposeThe purpose of this paper is to propose how a bottom-up creation of an ambidextrous organization can be enabled. By integrating research on “contextual ambidexterity” and “individual and organizational capacity building”, an “innovation capacity building” framework is conceptualized that suggests how balance between exploration and exploitation can be maintained.Design/methodology/approachThe study is conceptual. As no data are utilized, focus is on discussing the links between the two theoretical perspectives and the advantages of the proposed innovation capacity building framework.FindingsThe innovation capacity building framework discusses the influence, both positive and negative, of the local organizational context for ambidexterity, and the interactions required such as feedback between the management team and the employees so they together can build an ambidextrous working culture. A culture in which it is the individual employee that is responsible for switching between activities related to exploration and exploitation and where the management team empowers the employees to do so.Originality/valueThis study focuses on contextual ambidexterity and how contextual ambidexterity can be implemented as a way of working in contemporary organizations. The originality lies in the proposed framework and in the dedicated focus on “how” ambidexterity can be implemented in organizations.

Barriers to Total Quality Management for sustainability in Indian organizations

2020 ◽  
Vol 37 (6/7) ◽  
pp. 1007-1031 ◽  
Author(s):  
Vimal Kumar ◽  
Pratima Verma ◽  
Sachin Kumar Mangla ◽  
Atul Mishra ◽  
Dababrata Chowdhary ◽  
...  
Keyword(s):  
Quality Management ◽  
Total Quality Management ◽  
Organizational Performance ◽  
Business Performance ◽  
Organizational Context ◽  
Structural Model ◽  
Successful Implementation ◽  
Total Quality ◽  
Interpretive Structural Modeling ◽  
Content Type

PurposeThe paper aims to identify key human and operational focused barriers to the implementation of Total Quality Management (TQM). It develops a comprehensive structural relationship between various barriers to successfully implement TQM for sustainability in Indian organizations.Design/methodology/approachWith the help of expert opinions and extant literature review, we identified the case of TQM failure companies and barriers to implement TQM effectively. Interpretive Structural Modeling (ISM) and fuzzy MICMAC techniques are employed to develop a structural model and the identified barriers are categorized based on their dependence and driving power in the various categories.FindingsFrom the intensive case analysis, we identify fourteen barriers that constrain the successful implementation of TQM. The findings also provide a hierarchy of barriers in which the absence of top management involvement and ineffective leadership are the human barriers having the highest dependence.Research limitations/implicationsThe critical inputs show the implementation of TQM in the firms being more proactive and well prepared in the selected five companies. The study's emphasis on barriers will help organizations in implementing TQM for better sustainability in an organizational context.Originality/valueIn the successful implementation of TQM, barriers need to be identified because failure has often eliminated the organizations from the market. Thus, TQM is the source of strength to achieve higher productivity, profitability, and sustainable business performance. The barriers must be identified to improve organizational performance to contribute to sustainable development.

scholarly journals Perceptions and evaluations of front-line health workers regarding the Brazilian National Program for Improving Access and Quality to Primary Care (PMAQ): a mixed-method approach

2018 ◽  
Vol 34 (10) ◽  
Author(s):  
Fabiana da Cunha Saddi ◽  
Matthew J. Harris ◽  
Germano Araújo Coelho ◽  
Raquel Abrantes Pêgo ◽  
Fernanda Parreira ◽  
...  
Keyword(s):  
Primary Care ◽  
Mixed Method ◽  
Health Workers ◽  
Organizational Capacity ◽  
National Program ◽  
Front Line ◽  
Mixed Method Approach ◽  
Perceived Impact ◽  
Access And Quality ◽  
Method Approach

Abstract: Although it is well known that a successful implementation depends on the front-liners’ knowledge and participation, as well as on the organizational capacity of the institutions involved, we still know little about how front-line health workers have been involved in the implementation of the Brazilian National Program for Improving Access and Quality to Primary Care (PMAQ). This paper develops a contingent mixed-method approach to explore the perceptions of front-line health workers - managers, nurses, community health workers, and doctors - regarding the PMAQ (2nd round), and their evaluations concerning health unit organizational capacity. The research is guided by three relevant inter-related concepts from implementation theory: policy knowledge, participation, and organizational capacity. One hundred and twenty-seven health workers from 12 primary health care units in Goiânia, Goiás State, Brazil, answered semi-structured questionnaires, seeking to collect data on reasons for adherence, forms of participation, perceived impact (open-ended questions), and evaluation of organizational capacity (score between 0-10). Content analyses of qualitative data enabled us to categorize the variables “level of perceived impact of PMAQ” and “reasons for adhering to PMAQ”. The calculation and aggregation of the means for the scores given for organizational capacity enabled us to classify distinct levels of organizational capacity. We finally integrated both variables (Perceived-Impact and Organizational-Capacity) through cross-tabulation and the narrative. Results show that nurses are the main type of professional participating. The low organizational capacity and little policy knowledge affected workers participation in and their perceptions of the PMAQ.

Examining officer support for and perceived effects of police consolidation

2018 ◽  
Vol 41 (6) ◽  
pp. 828-843 ◽  
Author(s):  
Jeff Gruenewald ◽  
Jeremy M. Wilson ◽  
Clifford A. Grammich
Keyword(s):  
Single Case ◽  
Organizational Capacity ◽  
Successful Implementation ◽  
Shared Services ◽  
Law Enforcement Agencies ◽  
Content Type ◽  
Police Services ◽  
Employment Conditions ◽  
Officer Attitudes ◽  
Police Consolidation

PurposeThe purpose of this paper is to review officer support for the consolidation of law enforcement agencies.Design/methodology/approachThe current study surveys 139 officers employed by four agencies that have recently undergone a consolidation of police services. The survey asked officers their level of support for consolidation of services as well as their views of how consolidation has affected employment conditions, organizational characteristics, and the delivery of police services.FindingsWhile officers generally support consolidation, views on the effects of shared services vary significantly by level of support. Officers who most strongly support consolidation are also most likely to view it as leading to improvements in some working conditions (e.g. job satisfaction, morale), elements of organizational capacity (e.g. professionalism, investigative/intelligence capacity, recruitment), and the delivery of services (e.g. cost-effectiveness, quality and efficiency of services, and reductions in crime).Research limitations/implicationsThe sample size and response rate are low. Still, the study offers insights into officer views of consolidation not previously available.Practical implicationsThis research offers insights to communities considering the consolidation of police services regarding what organizational, employment, and service conditions are most likely to appeal to officers, whose support is necessary for successful implementation.Originality/valueWhile single case studies previously considered officer attitudes on these issues, this work is the first to comparatively examine views of shared services across varying levels of support for consolidation.

Depression screening optimization in an academic rural setting

2015 ◽  
Vol 28 (7) ◽  
pp. 709-725 ◽  
Author(s):  
Sohaib Aleem ◽  
William C Torrey ◽  
Mathew S Duncan ◽  
Shoshana J Hort ◽  
John N Mecchella
Keyword(s):  
Primary Care ◽  
Process Improvement ◽  
Performance Metrics ◽  
Critical Role ◽  
Data Entry ◽  
Rural Setting ◽  
Depression Screening ◽  
Successful Implementation ◽  
Content Type

Purpose – Primary care plays a critical role in screening and management of depression. The purpose of this paper is to focus on leveraging the electronic health record (EHR) as well as work flow redesign to improve the efficiency and reliability of the process of depression screening in two adult primary care clinics of a rural academic institution in USA. Design/methodology/approach – The authors utilized various process improvement tools from lean six sigma methodology including project charter, swim lane process maps, critical to quality tree, process control charts, fishbone diagrams, frequency impact matrix, mistake proofing and monitoring plan in Define-Measure-Analyze-Improve-Control format. Interventions included change in depression screening tool, optimization of data entry in EHR. EHR data entry optimization; follow up of positive screen, staff training and EHR redesign. Findings – Depression screening rate for office-based primary care visits improved from 17.0 percent at baseline to 75.9 percent in the post-intervention control phase (p < 0.001). Follow up of positive depression screen with Patient History Questionnaire-9 data collection remained above 90 percent. Duplication of depression screening increased from 0.6 percent initially to 11.7 percent and then decreased to 4.7 percent after optimization of data entry by patients and flow staff. Research limitations/implications – Impact of interventions on clinical outcomes could not be evaluated. Originality/value – Successful implementation, sustainability and revision of a process improvement initiative to facilitate screening, follow up and management of depression in primary care requires accounting for voice of the process (performance metrics), system limitations and voice of the customer (staff and patients) to overcome various system, customer and human resource constraints.

scholarly journals Diffusion theory and multi-disciplinary working in children’s services

2018 ◽  
Vol 26 (2) ◽  
pp. 120-129 ◽  
Author(s):  
Lisa Bostock ◽  
Amy Lynch ◽  
Fiona Newlands ◽  
Donald Forrester
Keyword(s):  
Diffusion Of Innovations ◽  
Health Workers ◽  
Diffusion Theory ◽  
Relative Advantage ◽  
Successful Implementation ◽  
Children's Services ◽  
Senior Managers ◽  
Content Type ◽  
Children’S Services ◽  
Innovation Attributes

Purpose The purpose of this paper is to explore how innovation in children’s services is adopted and developed by staff within new multi-disciplinary children’s safeguarding teams. It draws on diffusion of innovations (DOI) theory to help us better understand the mechanisms by which the successful implementation of multi-disciplinary working can be best achieved. Design/methodology/approach It is based on interviews with 61 frontline safeguarding staff, including social workers, substance misuse workers, mental health workers and domestic abuse workers. Thematic analysis identified the enablers and barriers to implementation. Findings DOI defines five innovation attributes as essential for rapid diffusion: relative advantage over current practice; compatibility with existing values and practices; complexity or simplicity of implementation; trialability or piloting of new ideas; and observability or seeing results swiftly. Staff identified multi-disciplinary team working and group supervision as advantageous, in line with social work values and improved their service to children and families. Motivational interviewing and new ways of case recordings were less readily accepted because of the complexity of practicing confidently and concerns about the risks of moving away from exhaustive case recording which workers felt provided professional accountability. Practical implications DOI is a useful reflective tool for senior managers to plan and review change programmes, and to identify any emerging barriers to successful implementation. Originality/value The paper provides insights into what children’s services staff value about multi-disciplinary working and why some aspects of innovation are adopted more readily than others, depending on the perception of diffusion attributes.

The Evolution of Physical Activity on Prescription (FaR) in Sweden

2014 ◽  
Vol 62 (2) ◽  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Healthcare Professionals ◽  
Systems Approach ◽  
Ecological Model ◽  
Controlled Trial ◽  
Professional Associations ◽  
Successful Implementation ◽  
Surgeon General ◽  
Positive Effects

In 1996, the first Report of the US Surgeon General on Physical Activity and Health provided an extensive knowledge overview about the positive effects of physical activity (PA) on several health outcomes and PA recommendations. This contributed to an enhanced interest for PA in Sweden. The Swedish Professional Associations for Physical Activity (YFA) were appointed to form a Scientific Expert Group in the project “Sweden on the Move” and YFA created the idea of Physical Activity on Prescription (FaR) and the production of a handbook (FYSS) for healthcare professionals. In Swedish primary care, licensed healthcare professionals, i.e. physicians, physiotherapists and nurses, can prescribe PA if they have sufficient knowledge about the patient’s current state of health, how PA can be used for promotion, prevention and treatment and are trained in patient-centred counselling and the FaR method. The prescription is followed individually or by visiting local FaR providers. These include sport associations, patient organisations, municipal facilities, commercial providers such as gyms, sports clubs and walking clubs or other organisations with FaR educated staff such as health promoters or personal trainers. In clinical practice, the FaR method increases the level of PA in primary care patients, at 6 and at 12 months. Self-reported adherence to the prescription was 65% at 6 months, similar to the known compliance for medications. In a randomised controlled trial, FaR significantly improved body composition and reduced metabolic risk factors. It is suggested that a successful implementation of PA in healthcare depends on a combination of a systems approach (socio-ecological model) and the strengthening of individual motivation and capability. General support from policymakers, healthcare leadership and professional associations is important. To lower barriers, tools for implementation and structures for delivery must be readily available. Examples include handbooks such as FYSS, the FaR system and the use of pedometers.

Now they’re listening: involvement in clinical psychology training

2019 ◽  
Vol 23 (1) ◽  
pp. 23-29
Author(s):  
Laura Lea ◽  
Sue Holttum ◽  
Victoria Butters ◽  
Diana Byrne ◽  
Helen Cable ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Clinical Psychology ◽  
Health Professionals ◽  
Service User ◽  
Health Workers ◽  
Psychology Training ◽  
Service Users ◽  
Clinical Psychology Training ◽  
Content Type

PurposeThe 2014/2015 UK requirement for involvement of service users and carers in training mental health professionals has prompted the authors to review the work of involvement in clinical psychology training in the university programme. Have the voices of service users and carers been heard? The paper aims to discuss this issue.Design/methodology/approachThe authors update the paper of 2011 in which the authors described the challenges of inclusion and the specific approaches the authors take to involvement. The authors do this in the context of the recent change to UK standards for service user and carer involvement, and recent developments in relation to partnership working and co-production in mental healthcare. The authors describe the work carried out by the authors – members of a service user involvement group at a UK university – to ensure the voices of people affected by mental health difficulties are included in all aspects of training.FindingsCareful work and the need for dedicated time is required to enable inclusive, effective and comprehensive participation in a mental health training programme. It is apparent that there is a group of service users whose voice is less heard: those who are training to be mental health workers.Social implicationsFor some people, involvement has increased. Trainee mental health professionals’ own experience of distress may need more recognition and valuing.Originality/valueThe authors are in a unique position to review a service-user-led project, which has run for 12 years, whose aim has been to embed involvement in training. The authors can identify both achievements and challenges.

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