That's how it should work: the perceptions of a senior management on the value of decentralisation in a service delivery organisation

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Mikael Ohrling ◽  
Sara Tolf ◽  
Karin Solberg-Carlsson ◽  
Mats Brommels
Keyword(s):  
Health Care ◽  
Scientific Literature ◽  
Care Delivery ◽  
A Priori ◽  
Healthcare Delivery ◽  
Management Team ◽  
Senior Management ◽  
Management Model ◽  
System Perspective ◽  
Content Type

PurposeDecentralisation in health care has been proposed as a way to make services more responsive to local needs and by that improve patient care. This study analyses how the senior management team conceptualised and implemented a decentralised management model within a large public health care delivery organisation.Design/methodology/approachData from in-depth interviews with a senior management team were used in a directed content analysis. Underlying assumptions and activities in the decentralisation process are presented in the logic model and scrutinised in an a priori logic analysis using relevant scientific literature.FindingsThe study found support in the scientific literature for the underlying assumptions that increased responsibility will empower managers as clinical directors know their local prerequisites best and are able to adapt to patient needs. Top management should function like an air traffic control tower, trust and loyalty improve managerial capacity, increased managerial skills release creativity and engagement and a system perspective will support collaboration and learning.Originality/valueTo the authors’ knowledge this is the first a priori logic analysis of a decentralised management model in a healthcare delivery organisation in primary and community care. It shows that the activities consist with underlying assumptions, supported by evidence, and timely planned give managers decision space and ability to use their delegated authority, not disregarding accountability and fostering necessary organisational and individual capacities to avoid suboptimisation.

West Kendall Baptist Hospital: meeting the demand of community-based healthcare in the new (and stormy) regulatory environment

2017 ◽  
Vol 13 (5) ◽  
pp. 592-632
Author(s):  
Miriam Weismann ◽  
Javier Hernandez Lichtl ◽  
Heather Pierce ◽  
Denise Harris ◽  
Lourdes Boue ◽  
...  
Keyword(s):  
Research Methodology ◽  
Care Delivery ◽  
Healthcare Delivery ◽  
Management Team ◽  
Regulatory Environment ◽  
Regulatory Change ◽  
Health Administration ◽  
The West ◽  
Content Type ◽  
Baptist Hospital

Synopsis The first three years of operation of the West Kendall Baptist Hospital (WKBH) in Miami, Florida provided a “poster child” for efficient and cost effective healthcare delivery to the West Kendall community that it served. The hospital leadership and management team exemplified a quality-oriented staff that moved as a cohesive and dedicated organization. WKBH exceeded every budget prediction and showed a profit in year 3, well before expected. Then came the winds of regulatory change. With the passage of the Affordable Care Act (ACA) and the attendant imposition of new reimbursement metrics, the picture at WKBH changed almost overnight. By the first quarter of 2016, WKBH started to lose money in excess of budget predictions despite its increased patient admissions, careful financial planning, expense reductions, quality service, and excellence in patient care delivery. A serious financial crisis was looming with little relief in sight. The hospital management team began to search for solutions. Research methodology The research methodology includes collecting quantitative data: original financial statements and financial data from WKBH, as well as qualitative data: interviews of hospital administrators and historical information. Relevant courses and levels Graduate capstone course in a finance course; masters in health administration; and/or the MBA program. Theoretical bases While it is clear that the ACA was designed with all good intentions, it has created substantial and perhaps, unanticipated financial burdens for caregivers. These issues are not only faced by WKBH. Most hospitals could relate to one or more of the four questions examined as part of this learning process. Graduate MBA students worked with the hospital to identify, define, focus, and resolve difficult quantitative and qualitative issues faced by the hospital as a result of major changes in the regulatory environment with the passage of the ACA. This case focuses upon the current reimbursement environment that has only recently emerged as a result of the implementation of the ACA.

Contingency framework for understanding quality in public and private hospitals of India

2019 ◽  
Vol 14 (1) ◽  
pp. 137-158
Author(s):  
Geeta Marmat ◽  
Pooja Jain
Keyword(s):  
Health Care ◽  
Care Delivery ◽  
Situational Factors ◽  
Future Research ◽  
Private Hospitals ◽  
Public And Private ◽  
System Perspective ◽  
Content Type ◽  
Public And Private Hospitals ◽  
Contingency Framework

Purpose Health-care delivery organizations (hospitals) constitute a complex adaptive system; hence, a contingency perspective is imperative to guide the design of customized approaches to quality management in different health-care settings. Accordingly, this paper aims to propose a contingency framework to advance the understanding of the relationship between situational factors and effectiveness of quality approaches in health-care organizations (HCOs), such as hospitals in India. Design/methodology/approach Related literature was reviewed to identify existing research and theories related to quality and quality approaches, situational factors of the HCOs (hospitals) and some existing logical evidence on public and private hospitals in India. Then a contingencies framework for quality and quality approaches was conceptualized. Findings This paper proposes contingent determinants arise out of conceptualization of the HCOs (hospitals) from different system perspective such as rational system, natural system, open system and integrative system; uncertainty because of physicians’ behaviour, nurses’ approach and a dual line of authority; and the task environment such as patients, competition and economic pressure. These determinants represent situational constructs to the quality enhancement of any attempt at quality approaches. While these determinants have an influence on the quality and quality approaches of the HCOs (hospital), it is imperative to build any quality improvement strategy to work effectively, i.e., quality approach is dependent on determinants of the contingencies of the hospital’s environment, be it external or internal. Propositions for future research are also incorporated. Research limitations/implications This paper proposes a conceptual model as well as research propositions that need to be validated and confirmed empirically. It advances the research and theory related to quality and quality approaches in a health-care setting. It can enable policymakers, hospital managers to analyze and gauge the appropriateness of quality approaches in a given context before implementing them and could help to improve the introverted quality approaches and quality dimensions currently followed in HCOs (hospitals). Originality/value Contingency framework is a new approach for research on the effectiveness of quality approaches in hospitals. The fundamental idea behind this framework is that effectiveness of quality approaches can be understood best by examining its contingent determinants. Thus, it has the capacity to contribute to the efforts of government and policymakers to make the quality of care affordable to all in India. Essentially, we examine the contexts and variables that determine the effectiveness of quality approaches.

Governance and coordination in health care: organic processes and structural capacity

2019 ◽  
Vol 33 (7/8) ◽  
pp. 757-763
Author(s):  
Peter Nugus ◽  
Jean-Louis Denis ◽  
Denis Chênevert
Keyword(s):  
Health Care ◽  
Organizational Behavior ◽  
Health Care Delivery ◽  
Research Policy ◽  
Care Delivery ◽  
Healthcare Delivery ◽  
Human Action ◽  
Future Research ◽  
Content Type ◽  
Local Agency

Purpose The purpose of this paper is to articulate cutting-edge conceptions of the relationship between local processes in the here-and-now, and the broader influences on those processes, that are both organic and overtly designed, and to discern the implications of this relationship for future research, policy and practice. Design/methodology/approach A focused and structured approach was taken to give effect to this purpose by reviewing the chosen articles in this collection, which from the 2018 Organizational Behavior in Health Care conference papers. Findings Research in coordination within and across health care boundaries increasingly recognizes: the multilevel influences on human action and interaction in health care delivery; the challenge of balancing individual or local agency with overt interventions; the everchanging the local circumstances of healthcare delivery; and the need to foster reflexivity, that is, self-improvement capacity, in healthcare organizations. Research limitations/implications Interventions to improve care coordination must be grounded in the reality of changing local circumstances and incentives for action from the broader environment. Originality/value This paper articulates the implied tension in health care delivery between individual and local agency, and imposed structures that may contradict, but are at the same time necessary, to foster such agency.

scholarly journals Incorporating digital self-services into integrated mental health care: a physician’s perspective

2018 ◽  
Vol 52 (11) ◽  
pp. 2234-2250 ◽  
Author(s):  
Heini Sisko Maarit Taiminen ◽  
Saila Saraniemi ◽  
Joy Parkinson
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Health Care Delivery ◽  
Value Creation ◽  
Care Delivery ◽  
Service Marketing ◽  
Content Type ◽  
Integrated Mental Health ◽  
Physician’S Perspective

Purpose This paper aims to enhance the current understanding of digital self-services (computerized cognitive behavioral therapy [cCBT]) and how they could be better incorporated into integrated mental health care from the physician’s perspective. Service marketing and information systems literature are combined in the context of mental health-care delivery. Design/methodology/approach An online survey of 412 Finnish physicians was undertaken to understand physicians’ acceptance of cCBT. The study applies thematic analysis and structural equation modeling to answer its research questions. Findings Adopting a service marketing perspective helps understand how digital self-services can be incorporated in health-care delivery. The findings suggest that value creation within this context should be seen as an intertwined process where value co-creation and self-creation should occur seamlessly at different stages. Furthermore, the usefulness of having a value self-creation supervisor was identified. These value creation logic changes should be understood and enabled to incorporate digital self-services into integrated mental health-care delivery. Research limitations/implications Because health-care systems vary across countries, strengthening understanding through exploring different contexts is crucial. Practical implications Assistance should be provided to physicians to enable better understanding of the application and suitability of digital self-service as a treatment option (such as cCBT) within their profession. Additionally, supportive facilitating conditions should be created to incorporate them as part of integrated care chain. Social implications Digital self-services have the potential to serve goals beyond routine activities in a health-care setting. Originality/value This study demonstrates the relevance of service theories within the health-care context and improves understanding of value creation in digital self-services. It also offers a profound depiction of the barriers to acceptance.

Preparation for safeguarding in UK pre-registration graduate nurse education

2015 ◽  
Vol 17 (6) ◽  
pp. 371-379 ◽  
Author(s):  
Julie McGarry ◽  
Charley Baker ◽  
Claire Wilson ◽  
Anne Felton ◽  
Anirban Banerjee
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Student Evaluation ◽  
Care Delivery ◽  
Educational Support ◽  
Content Type ◽  
Graduate Nurse ◽  
Nursing Curricula ◽  
Adults And Children ◽  
The Uk

Purpose – It is now widely acknowledged that health care professionals on the front line of care delivery will often be among the first to whom patients or clients who have experienced abuse will present or disclose abuse in a clinical context. It is therefore of pivotal importance that all health care professionals, including nurses, are adequately prepared at the earliest opportunity to effectively respond to a disclosure of abuse or identify where abuse may be suspected. The paper aims to discuss these issues. Design/methodology/approach – In order to address this contemporary challenge within health care the authors present a model, developed in the UK, for the embedding of safeguarding knowledge, skills and attitudes within undergraduate pre-registration nursing curricula. This model is integrative and focuses on the acquisition of knowledge and skills in the field of safeguarding vulnerable adults and children. Findings – Student evaluation to date has been extremely positive with the majority of student responses indicating that individuals felt that they had received the requisite level of educational support and knowledge to enable them to recognise concerns. However, it was also clear that students felt that the knowledge gained within the classroom setting needed to be effectively supported and translated in the practice setting. Practical implications – Safeguarding clearly forms a central part of professional accountability and responsibility. It is therefore pivotal that professionals receive the requisite education, skills and knowledge at the earliest opportunity. Originality/value – To the authors’ knowledge this initiative is novel in approach and as such has the potential to inform similar education programmes.

scholarly journals A COMPARATIVE STUDY OF THE PERCEPTIONS OF RURAL DWELLERS TOWARDS HEALTH CARE DELIVERY

2021 ◽  
Vol 9 (04) ◽  
pp. 451-454
Author(s):  
Felix a ◽  
◽  
J. Ugwu ◽  
Clara Okenyi ◽  
◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Delivery ◽  
Significant Relationship ◽  
Survey Design ◽  
Care Delivery ◽  
Healthcare Delivery ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Test Analysis ◽  
Rural Dwellers

The present study aimed to comparatively analyze healthcare delivery perception among rural dwellers based on education (formal/informal) and gender. The study adopted a cross-sectional survey design. A total of two hundred rural dwellers comprising males and females participated in the study. Perception towards health care delivery was measured with a self-developed instrument with demographic information. An independent t-test analysis found no statistically significant relationship between education and perception towards health care delivery. However, the result revealed a significant relationship between gender and perception towards health care delivery. Females were found to show a more positive attitude towards health care delivery than their male counterparts. The findings and conclusions are discussed.

scholarly journals Video-Based Telemedicine for Kidney Disease Care

2021 ◽  
Vol 16 (12) ◽  
pp. 1813-1823
Author(s):  
Ann Young ◽  
Ani Orchanian-Cheff ◽  
Christopher T. Chan ◽  
Ron Wald ◽  
Stephanie W. Ong
Keyword(s):  
Health Care ◽  
Kidney Disease ◽  
Systematic Reviews ◽  
Care Delivery ◽  
Case Series ◽  
Care Utilization ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Content Type ◽  
Patient Reported

Background and objectivesVideo-based telemedicine provides an alternative health care delivery model for patients with CKD. The objective was to provide an overview of the available evidence on the implementation and outcomes of adopting video-based telemedicine in nephrology.Design, setting, participants, & measurementsMEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and CINAHL were searched in December 2019 and again in January 2021 for studies using video-based telemedicine for adults across the spectrum of kidney disease. Study types included peer-reviewed clinical trials, observational studies, and descriptive studies available in full text. Search results were independently screened by two authors, who then independently reviewed and extracted data from the eligible studies. Results were synthesized in tabular format, summarizing study characteristics by area within nephrology; the video-based interventions used; and clinical, health care utilization, and patient-reported outcomes.ResultsAfter reviewing 1870 unique citations, 24 studies were included (four randomized controlled trials, six cohort studies, five pre-post intervention studies, seven case series, and two qualitative studies). Video-based technology was used to facilitate care across all stages of CKD. Although earlier studies used a range of institution-specific technologies that linked main hospital sites to more remote health care locations, more recent studies used technology platforms that allowed patients to receive care in a location of their choice. Video-based care was well received, with the studies reporting high patient satisfaction and acceptable clinical outcomes.ConclusionsVideo-based telemedicine is being used for kidney care and has evolved to be less reliant on specialized telemedicine equipment. As its use continues to grow, further primary studies and systematic reviews of outcomes associated with the latest innovations to video-based care in nephrology can address knowledge gaps, such as approaches to sustainable integration and minimization of barriers to access.

Managed care Medicaid

2017 ◽  
Vol 11 (2) ◽  
pp. 198-210 ◽  
Author(s):  
William Trombetta
Keyword(s):  
Health Care ◽  
Managed Care ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Care Quality ◽  
Market Segment ◽  
Economic Aspects ◽  
Content Type ◽  
The Poor

Purpose Providing health care to the poor is evolving in the new US marketplace. The Affordable Care Act has set goals enhancing access to health care, lowering costs and improving patient outcomes. A key segment in this evolution is the most vulnerable health-care population of all: Medicaid. This paper aims to provide a general review of how providing health care to Medicaid patients is changing including how socio-economic aspects of this vulnerable population affects the quality of the health care provided. Design/methodology/approach The paper is entirely secondary research; no primary research has been conducted. Findings Managed care Medicaid provides a risk-based model to treating a vulnerable health-care market segment. The jury is still out on whether managed care Medicaid (MCM) is improving health-care quality and saving cost, but the provision of health care to the Medicaid segment is definitely shifting from a fee-for-service model to value based payment. Very recent developments of new health-care delivery approaches present a positive outlook for improving quality and containing costs going forward. Research limitations/implications At this stage, whether or not MCM saves money or provides better health-care quality to this vulnerable population is a work in progress. Health-care marketing can impact socio-economic aspects of health care for the poor. There is a need to follow up on the positive results being documented in demonstration health-care delivery models. Practical implications At this point, there has been no long-term study of whether managed care Medicaid offers better quality of health care and cost savings. The research to date suggest that the quality of health-care delivery to the poor is improving at a lower cost to payers. Social implications Medicaid patients are an underserved market segment. Managed care Medicaid offers a new model that has the potential to provide quality care at acceptable cost. Critical to this vulnerable market segment is the need to integrate socio-economic aspects of the population with the delivery of health care. Originality/value There has been very little discussion of Medicaid overall in the marketing literature, much less any discussion of managed care Medicaid.

Intensive Care Unit Operational Modeling and Analysis

2011 ◽  
pp. 132-147
Author(s):  
Yue Dong ◽  
Huitian Lu ◽  
Ognjen Gajic ◽  
Brian Pickering
Keyword(s):  
Health Care ◽  
Critical Care ◽  
Health Care Providers ◽  
Systems Engineering ◽  
Care Delivery ◽  
Healthcare Delivery ◽  
Organizational Factors ◽  
Modeling And Analysis ◽  
Novel Approach ◽  
Life Threatening

The outcome of critical illness depends not only on life threatening pathophysiologic disturbances, but also on several complex “system” dimensions: health care providers’ performance, organizational factors, environmental factors, family preferences and the interactions between each component. Systems engineering tools offer a novel approach which can facilitate a “systems understanding” of patient-environment interactions enabling advances in the science of healthcare delivery. Due to the complexity of operations in critical care medicine, certain assumptions are needed in order to understand system behavior. Patient variation and uncertainties underlying these assumptions present a challenge to investigators wishing to model and improve health care delivery processes. In this chapter we present a systems engineering approach to modeling critical care delivery using sepsis resuscitation as an example condition.

Welcome to Pointsoft family

2012 ◽  
Vol 2 (8) ◽  
pp. 1-8
Author(s):  
Chandra Vadhana R.
Keyword(s):  
Learning Outcomes ◽  
Subject Area ◽  
Management Team ◽  
Senior Management ◽  
Content Type ◽  
Software Company ◽  
Indian Firm ◽  
Organisational Behaviour ◽  
One Year ◽  
Core Issues

Subject area Human resource management, strategic management, organisational behaviour. Study level/applicability Graduate and post graduate students of management, organisational behaviour and strategic HRM. Case overview This case is about a small company named Pointsoft Pvt. Ltd, which is a 25-year-old software company situated in Pune, India. Thanks to the IT boom, the company grew well under the leadership of Aravind, who is the managing director. Aravind took care of all matters related to human resources (HR) directly. So far, the company never had any HR manager, but now Aravind thought about handing over HR matters to an HR manager. After much scrutiny Meenaxi was appointed as HR manager. The case then proceeds narrating a series of incidents after the arrival of the new HR manager and how there began a clash between the new HR manager and the senior management team of the firm. A situation then arose where the HR manager, after one year of service, submitted her resignation quoting that she was being harassed by the senior management team. The core issues in this case are whether Pointsoft's decision of having an HR manager was right and whether the decision of having appointed Meenaxi was right. Expected learning outcomes The case brings out the necessary characteristics of an HR manager by showing the undesirable characteristics of an HR manager. The case also highlights typical issues of working in a small Indian firm which is trying to rise to a globalised setting. The case will also help the students understand about organisational culture and the importance of gelling with the same. Supplementary materials Teaching notes are available. Please consult your librarian for access.

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