scholarly journals Sense-making strategies and help-seeking behaviours associated with urgent care services: a mixed-methods study

2019 ◽  
Vol 7 (26) ◽  
pp. 1-122 ◽  
Author(s):  
Joanne Turnbull ◽  
Gemma McKenna ◽  
Jane Prichard ◽  
Anne Rogers ◽  
Robert Crouch ◽  
...  
Keyword(s):  
Decision Making ◽  
Literature Review ◽  
Help Seeking ◽  
Service Use ◽  
Urgent Care ◽  
Sense Making ◽  
Service Users ◽  
The Public ◽  
Care Services ◽  
Future Work

BackgroundPolicy has been focused on reducing unnecessary emergency department attendances by providing more responsive urgent care services and guiding patients to ‘the right place’. The variety of services has created a complex urgent care landscape for people to access and navigate.ObjectivesTo describe how the public, providers and policy-makers define and make sense of urgent care; to explain how sense-making influences patients’ strategies and choices; to analyse patient ‘work’ in understanding, navigating and choosing urgent care; to explain urgent care utilisation; and to identify potentially modifiable factors in decision-making.DesignMixed-methods sequential design.SettingFour counties in southern England coterminous with a NHS 111 provider area.MethodsA literature review of policy and research combined with citizens’ panels and serial qualitative interviews. Four citizens’ panels were conducted with the public, health-care professionals, commissioners and managers (n = 41). Three populations were sampled for interview: people aged ≥ 75 years, people aged 18–26 years and East European people. In total, 134 interviews were conducted. Analyses were integrated to develop a conceptual model of urgent care help-seeking.FindingsThe literature review identified some consensus between policy and provider perspectives regarding the physiological factors that feature in conceptualisations of urgent care. However, the terms ‘urgent’ and ‘emergency’ lack specificity or consistency in meaning. Boundaries between urgent and emergency care are ill-defined. We constructed a typology that distinguishes three types of work that take place at both the individual and social network levels in relation to urgent care sense-making and help-seeking.Illness workinvolves interpretation and decision-making about the meaning, severity and management of physical symptoms and psychological states, and the assessment and management of possible risks. Help-seeking was guided bymoral work: the legitimation and sanctioning done by service users.Navigation workconcerned choosing and accessing services and relied on prior knowledge of what was available, accessible and acceptable. From these empirical data, we developed a model of urgent care sense-making and help-seeking behaviour that emphasises that work informs the interaction between what we think and feel about illness and the need to seek care (sense-making) and action – the decisions we take and how we use urgent care (help-seeking).LimitationsThe sample population of our three groups may not have adequately reflected a diverse range of views and experiences. The study enabled us to capture people’s views and self-reported service use rather than their actual behaviour.ConclusionsMuch of the policy surrounding urgent and emergency care is predicated on the notion that ‘urgent’ sits neatly between emergency and routine; however, service users in particular struggle to distinguish urgent from emergency or routine care. Rather than focusing on individual sense-making, future work should attend to social and temporal contexts that have an impact on help-seeking (e.g. why people find it more difficult to manage pain at night), and how different social networks shape service use.Future workA whole-systems approach considering integration across a wider network of partners is key to understanding the complex relationships between demand for and access to urgent care.Study registrationThis study is registered as UKCRN 32207.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

‘Everywhere and nowhere’: interventions and services under austerity

2020 ◽  
pp. 271-290
Author(s):  
Stephen Crossley
Keyword(s):  
Decision Making ◽  
Information Technology ◽  
Power Relations ◽  
The State ◽  
Service Users ◽  
The Public ◽  
It Systems ◽  
New Information ◽  
Access Services

This chapter explains how austerity has led to an increasingly fragmented and disparate economy and geography of welfare. These changes have affected people's ability to access services, leaving some of them isolated and excluded from activities that they previously enjoyed. The chapter then questions the use of new information technology (IT) systems and the related expansion of cybernetic relations to register, administer, manage, and target some of the most vulnerable members of society. It argues that these virtual systems emerge as a way of dealing with cases that need physical and in-depth contact in the context of austerity budgets rather than a tested way of pooling information to save lives. This argument suggests that they can also be a way to exclude service users from decision-making about their entitlement and ultimately their lives, reconfiguring the power relations between the public and the state.

scholarly journals Change management in information systems projects for public organizations

10.28945/2185 ◽  
2015 ◽  
Vol 10 ◽  
pp. 047-062 ◽  
Author(s):  
Ewa Ziemba ◽  
Iwona Oblak
Keyword(s):  
Information Systems ◽  
Literature Review ◽  
Change Management ◽  
Success Factors ◽  
Public Organizations ◽  
The Public ◽  
Critical Success ◽  
Research Findings ◽  
Future Work ◽  
Is Projects

It can be argued that public organizations, in order to provide the public with sufficient services in the current, highly competitive and continuously evolving environment, require changes. The changes that become necessary are often related to the implementation of information systems (IS). Moreover, when organizations are faced with changes, a change management (CM) process needs to be put in place. CM theories that are currently available to practitioners and academics are often contradictory; they mostly lack empirical evidence and are supported by unchallenged hypotheses concerning the nature of the contemporary CM. The aim of this paper is, therefore, to identify critical success factors (CFSs) for CM in IS projects. In order to reach this aim an explanation of changes in public organizations and the nature of CM are presented. Following this, a framework of CFSs for CM in IS projects are identified based on the literature review. The paper also examines two IS projects and uses them to demonstrate CFSs influencing CM in IS projects in Polish pubic organizations. A discussion of the research findings is provided and the paper concludes with a presentation of the study’s contributions and limitations as well as the stream of future work.

Economic Decision-Making in Private Corporations Versus Public Sector

2020 ◽  
Vol 11 (1) ◽  
pp. 73-98
Author(s):  
Brian J. Galli
Keyword(s):  
Decision Making ◽  
Public Sector ◽  
Literature Review ◽  
Private Firms ◽  
Public And Private ◽  
Economic Decision ◽  
The Public ◽  
Economic Decisions ◽  
Economic Decision Making ◽  
Decision Making Processes

This research takes a comparative analysis approach to study the process of economic decision-making within the private sector and the public sector. There are four main research objectives that guided this article. First, it aims to identify the different kinds of decision-making methods. Second, this article analyzes the economic decision-making processes that stakeholders have to make in public and private firms. Third, this r seeks to illustrate that establish effective decision-making and financial performance relate. Lastly, the article will offer effective economic decision-making procedures in private and public organizations, so as to make recommendations and to guide these businesses. To do so, there is a literature review in this research to find the best economic decision-making processes. Data collection tools were created in reference to the literature review that directed the structuring of the variables, and the study based the quantitative analysis on the adopted descriptive methodology. The sample was comprised of 100 respondents from China, and since 95% responded, that was a total of 95 responses. Based on the formulated study hypothesis and the research objectives, the collected data was examined for descriptive and inferential statistical analysis. In general, the findings showed that cost-benefit analysis was the favored economic evaluation method, and the respondents specified that they their internal and external economic decisions directly influence the company's operations. When focusing on how organizational performance is affected by effective economic decisions, the findings established that there was a key component for a better economic analysis outcome in the public and private firms: accounting information. Additionally, evaluating the number of processes in public and private firms led to findings that revealed the following: every decision in the public sector requires many approvals. These approvals greatly hinder economic decisions and decision-making. Social, cultural, and environmental aspects influence the decision process significantly, so they must be addressed immediately.

scholarly journals Potential cost savings by minimisation of blood sample delays on care decision making in urgent care services

2017 ◽  
Vol 20 ◽  
pp. 37-40 ◽  
Author(s):  
David M.S. Bodansky ◽  
Sophie E. Lumley ◽  
Rudrajoy Chakraborty ◽  
Dhanasekaran Mani ◽  
James Hodson ◽  
...  
Keyword(s):  
Decision Making ◽  
Blood Sample ◽  
Cost Savings ◽  
Urgent Care ◽  
Potential Cost ◽  
Care Services ◽  
Care Decision

scholarly journals Articulation, service use, managing and coping: understanding the needs of older people and carers living with dementia

2013 ◽  
Vol 3 (2) ◽  
pp. 1-17
Author(s):  
Josephine Tetley ◽  
Keyword(s):  
Decision Making ◽  
Service Use ◽  
Interview Data ◽  
Care Services ◽  
People With Dementia ◽  
Practical Support ◽  
Decision Making Processes ◽  
Key Issues ◽  
And Coping ◽  
The Impact

Background: There is increasing recognition of the need to involve people living with dementia in research that can impact on service developments in the field. Despite this, people with dementia are still under-represented and proxy/carer views have dominated discourses of care. For nursing, understanding the views and experiences of people living with dementia is particularly important for the development of effective person-centred practices. Aim and objectives: The aims of the research were to identify: The conditions that enable people living with dementia to participate effectively in decision making about the use and uptake of services The factors that affect access, uptake and use of care services for people living with dementia and their supporters Methods: A participatory and constructivist methodology guided the study; consistent with this, a mixed qualitative method approach was used to gather data. Participatory observation was used to identify key issues and key participants (four people living with dementia and four carers), who were then interviewed. The interview data were analysed using the constructivist data analysis processes of unitising and categorising. Findings: Three main themes were identified from the interview data; barriers to articulation of experiences; finding help and support; and managing and coping. The impact of these issues on the choice and decision-making processes of people living with dementia and their carers emerged in a range of ways and are presented here. Conclusions and implications for practice: Researchers and practitioners need to develop skills in engaging with conversations that may seem disjointed or to drift on to different topics The role of carers in interviews raises challenges, but ultimately researchers and practitioners need to balance and blend the views of carers while prioritising the voices of people living with dementia To be effective, services for people living with dementia and their carers, need to provide emotional and practical support

Towards Zero Suicide: need and opportunities to improve implementation of clinical elements for older adults

2021 ◽  
pp. 103985622110540
Author(s):  
Anne Wand ◽  
Roderick McKay ◽  
Dimity Pond
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Decision Making ◽  
Older People ◽  
Cultural Change ◽  
Help Seeking ◽  
Service Use ◽  
Evidence Based ◽  
Evidence Based Practices ◽  
Self Harm

Objective: The Zero Suicide (ZS) framework is increasingly used in Australia, but without published adaptations for older people, and limited access by older people when implemented. The aim of this paper is to inform Towards Zero Suicide (TZS) implementations to benefit older adults by considering the key differences in older adults at risk of suicide according to each clinical component of the ZS framework. Conclusion: TZS aspires to reduce deaths by suicide for people within healthcare by refocusing interventions on suicidality rather than diagnosis alone, emphasising evidence-based practices and cultural change. For TZS to be effective for older people, it is essential to ensure practices are based upon evidence relevant to older people and to ensure ageism is effectively counteracted. Older adults have distinct patterns of help seeking and service use, accompanied by differences in risk factors, presentations, and outcomes of suicidal behaviours. Ageism affects assessment, decision-making and actions to address self-harm and suicide for older people. Immediate and longer-term actions are essential to effectively implement TZS in this population.

scholarly journals Modelling tool to support decision-making in the NHS Health Check programme: workshops, systematic review and co-production with users

2021 ◽  
Vol 25 (35) ◽  
pp. 1-234
Author(s):  
Martin O’Flaherty ◽  
Ffion Lloyd-Williams ◽  
Simon Capewell ◽  
Angela Boland ◽  
Michelle Maden ◽  
...  
Keyword(s):  
Decision Making ◽  
Health Economic ◽  
Cost Effectiveness ◽  
Literature Review ◽  
Health Technology ◽  
Health Check ◽  
Local Authorities ◽  
User Friendly ◽  
Future Work ◽  
Nhs Health Check

Background Local authorities in England commission the NHS Health Check programme to invite everyone aged 40–74 years without pre-existing conditions for risk assessment and eventual intervention, if needed. However, the programme’s effectiveness, cost-effectiveness and equity impact remain uncertain. Aim To develop a validated open-access flexible web-based model that enables local commissioners to quantify the cost-effectiveness and potential for equitable population health gain of the NHS Health Check programme. Objectives The objectives were as follows: (1) co-produce with stakeholders the desirable features of the user-friendly model; (2) update the evidence base to support model and scenario development; (3) further develop our computational model to allow for developments and changes to the NHS Health Check programme and the diseases it addresses; (4) assess the effectiveness, cost-effectiveness and equity of alternative strategies for implementation to illustrate the use of the tool; and (5) propose a sustainability and implementation plan to deploy our user-friendly computational model at the local level. Design Co-production workshops surveying the best-performing local authorities and a systematic literature review of strategies to increase uptake of screening programmes informed model use and development. We then co-produced the workHORSE (working Health Outcomes Research Simulation Environment) model to estimate the health, economic and equity impact of different NHS Health Check programme implementations, using illustrative-use cases. Setting Local authorities in England. Participants Stakeholders from local authorities, Public Health England, the NHS, the British Heart Foundation, academia and other organisations participated in the workshops. For the local authorities survey, we invited 16 of the best-performing local authorities in England. Interventions The user interface allows users to vary key parameters that represent programme activities (i.e. invitation, uptake, prescriptions and referrals). Scenarios can be compared with each other. Main outcome measures Disease cases and case-years prevented or postponed, incremental cost-effectiveness ratios, net monetary benefit and change in slope index of inequality. Results The survey of best-performing local authorities revealed a diversity of effective approaches to maximise the coverage and uptake of NHS Health Check programme, with no distinct ‘best buy’. The umbrella literature review identified a range of effective single interventions. However, these generally need to be combined to maximally improve uptake and health gains. A validated dynamic, stochastic microsimulation model, built on robust epidemiology, enabled service options analysis. Analyses of three contrasting illustrative cases estimated the health, economic and equity impact of optimising the Health Checks, and the added value of obtaining detailed local data. Optimising the programme in Liverpool can become cost-effective and equitable, but simply changing the invitation method will require other programme changes to improve its performance. Detailed data inputs can benefit local analysis. Limitations Although the approach is extremely flexible, it is complex and requires substantial amounts of data, alongside expertise to both maintain and run. Conclusions Our project showed that the workHORSE model could be used to estimate the health, economic and equity impact comprehensively at local authority level. It has the potential for further development as a commissioning tool and to stimulate broader discussions on the role of these tools in real-world decision-making. Future work Future work should focus on improving user interactions with the model, modelling simulation standards, and adapting workHORSE for evaluation, design and implementation support. Study registration This study is registered as PROSPERO CRD42019132087. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 35. See the NIHR Journals Library website for further project information.

scholarly journals Perkembangan Gamification dan Dampak Game Online terhadap Jiwa Manusia di Kota Pintar DKI Jakarta

2020 ◽  
Vol 5 (3) ◽  
pp. 315
Author(s):  
Nur Kumala Dewi ◽  
Arman Syah Putra
Keyword(s):  
Decision Making ◽  
Literature Review ◽  
Smart City ◽  
Research Method ◽  
Online Games ◽  
Research Problem ◽  
Online Application ◽  
The Public ◽  
Human Psyche ◽  
The Impact

In this study, online games are a research problem that is raised, by raising all things in online games, the author wants to know the impact of online games that have been troubling society and the results of this study are suggestions that will make the basic ingredients of decision making in terms of online games has troubled all levels of society. This research method uses literature review and field review, with the two process methods used it will produce valid research, with research based on previous research, the research will be more renewable, and research carried out in the field will find out the problems in the field. There have been many studies discussing the effect of online games, and in this study discussing the impact on the human psyche. In this study, researchers took data from many parties who were deemed necessary, and made the basis of their research. This research will produce suggestions and proposals that will be applied in a smart city in making a policy in an online application that is troubling the public.

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