Micro-enterprises: better outcomes at a lower cost

Author(s):  
Catherine Needham ◽  
Kerry Allen ◽  
Kelly Hall

Chapter six examines issues relating to the outcomes of care, bringing in the formal outcomes data from the Adult Social Care Outcomes Toolkit (ASCOT). The chapter sets out the increased privileging of outcomes data, over process and output measures. It also discusses the extent to which outcomes are more elusive than other measures: they are compromised by attribution problems and the absence of counter-factuals. Drawing on pricing data from the organisations in our study and outcomes data from people using those organisations the chapter draws conclusions about value for money. Comparing the hourly rates of care providers in the sample of 27 organisations of different sizes, micro-enterprises were found to be the cheapest. These findings are contextualised within broader debates about how care is financed, and the fit between micro-enterprises and individualised purchasing by personal budget-holders and people who fund their own care (called self-funders).

Author(s):  
Catherine Needham ◽  
Kerry Allen ◽  
Kelly Hall

Chapter eight draws on the interviews undertaken with people running care organisations, to bring out three types of innovation - what innovation, how innovation and who innovation. This chapter identifies the different types of innovation that are displayed within the specific context of care; referred to here as what, how and who innovations. In terms of what innovations, some micro-enterprises are delivering services that deviate from the traditional residential, domiciliary and day models of care through the provision of flexible ‘one-to-one support’. Whilst micro-enterprises were offering more flexible services, larger organisations were also offering a broad range of services, and in day provision especially, larger services were found to offer more choice to service users. Whilst it tends to be the what and who innovations within micro-enterprises that are most widely reported, it may be the how innovations that are most important when it comes to the context of social care for older people. For people receiving personal care in the home, the scope for micro providers to take a more flexible approach gives them an advantage over large care providers.


2021 ◽  
pp. 089976402110014
Author(s):  
Anders M. Bach-Mortensen ◽  
Ani Movsisyan

Social care services are increasingly provisioned in quasi-markets in which for-profit, public, and third sector providers compete for contracts. Existing research has investigated the implications of this development by analyzing ownership variation in latent outcomes such as quality, but little is known about whether ownership predicts variation in more concrete outcomes, such as violation types. To address this research gap, we coded publicly available inspection reports of social care providers regulated by the Care Inspectorate in Scotland and created a novel data set enabling analysis of ownership variation in violations of (a) regulations, and (b) national care standards over an entire inspection year ( n = 4,178). Using negative binomial and logistic regression models, we find that for-profit providers are more likely to violate non-enforceable outcomes (national care standards) relative to other ownership types. We did not identify a statistically significant difference between for-profit and third sector providers with regard to enforceable outcomes (regulations).


2018 ◽  
Vol 2 (1) ◽  
pp. 65-87
Author(s):  
Jon Glasby ◽  
Catherine Needham ◽  
Kerry Allen ◽  
Kelly Hall ◽  
Steve McKay

2017 ◽  
pp. 306-327
Author(s):  
Emanuela Saita ◽  
Susanna Zanini ◽  
Enrico Minetti ◽  
Chiara Acquati

Increasing evidence has demonstrated that patients' involvement promotes better health care outcomes and cost-effectiveness of services. However, limited literature is available about the experience of living donor kidney transplantation and best practices to promote patients and donors' engagement. Aim of the present chapter is to review the literature about patient engagement in the context of chronic kidney disease, and to introduce an innovative protocol developed to promote potential donors and recipients' participation and adherence to care at the Niguarda Ca' Granda Hospital in Milan (Italy). Results are critical to reflect on the identification of best practices for patients' engagement in the context of chronic kidney disease. Through a better understanding of the emotional and affective dynamics and the relational implications that may influence the elaboration of the information given by health care providers, it will be possible to develop evidence-informed interventions.


Author(s):  
Emanuela Saita ◽  
Susanna Zanini ◽  
Enrico Minetti ◽  
Chiara Acquati

Increasing evidence has demonstrated that patients' involvement promotes better health care outcomes and cost-effectiveness of services. However, limited literature is available about the experience of living donor kidney transplantation and best practices to promote patients and donors' engagement. Aim of the present chapter is to review the literature about patient engagement in the context of chronic kidney disease, and to introduce an innovative protocol developed to promote potential donors and recipients' participation and adherence to care at the Niguarda Ca' Granda Hospital in Milan (Italy). Results are critical to reflect on the identification of best practices for patients' engagement in the context of chronic kidney disease. Through a better understanding of the emotional and affective dynamics and the relational implications that may influence the elaboration of the information given by health care providers, it will be possible to develop evidence-informed interventions.


2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Claire A. Surr ◽  
Sahdia Parveen ◽  
Sarah J. Smith ◽  
Michelle Drury ◽  
Cara Sass ◽  
...  

Abstract Background The health and social care workforce requires access to appropriate education and training to provide quality care for people with dementia. Success of a training programme depends on staff ability to put their learning into practice through behaviour change. This study aimed to investigate the barriers and facilitators to implementation of dementia education and training in health and social care services using the Theoretical Domains Framework (TDF) and COM-B model of behaviour change. Methods A mixed-methods design. Participants were dementia training leads, training facilitators, managers and staff who had attended training who worked in UK care homes, acute hospitals, mental health services and primary care settings. Methods were an online audit of care and training providers, online survey of trained staff and individual/group interviews with organisational training leads, training facilitators, staff who had attended dementia training and managers. Data were analysed using descriptive statistics and thematic template analysis. Results Barriers and facilitators were analysed according the COM-B domains. “Capability” factors were not perceived as a significant barrier to training implementation. Factors which supported staff capability included the use of interactive face-to-face training, and training that was relevant to their role. Factors that increased staff “motivation” included skilled facilitation of training, trainees’ desire to learn and the provision of incentives (e.g. attendance during paid working hours, badges/certifications). “Opportunity” factors were most prevalent with lack of resources (time, financial, staffing and environmental) being the biggest perceived barrier to training implementation. The presence or not of external support from families and internal factors such as the organisational culture and its supportiveness of good dementia care and training implementation were also influential. Conclusions A wide range of factors may present as barriers to or facilitators of dementia training implementation and behaviour change for staff. These should be considered by health and social care providers in the context of dementia training design and delivery in order to maximise potential for implementation.


Sign in / Sign up

Export Citation Format

Share Document