scholarly journals Dual Agency in Hospitals: What Strategies Do Managers and Physicians Apply to Reconcile Dilemmas Between Clinical and Economic Considerations?

2021 ◽  
Author(s):  
Ruth Waitzberg ◽  
Nora Gottlieb ◽  
Wilm Quentin ◽  
Reinhard Busse ◽  
Dan Greenberg
Keyword(s):  
Decision Making ◽  
Interdisciplinary Teams ◽  
Financial Sustainability ◽  
Payment Systems ◽  
Structured Interviews ◽  
Hospital Managers ◽  
Dual Agency ◽  
Clinical Considerations ◽  
Economic Considerations ◽  
Practicing Physicians

Background: Hospital professionals are "dual agents" who may face dilemmas between their commitment to patients’ clinical needs and hospitals’ financial sustainability. This study examines whether and how hospital professionals balance or reconcile clinical and economic considerations in their decision-making in two countries with activity-based payment systems. Methods: We conducted 46 semi-structured interviews with hospital managers, chief physicians and practicing physicians in five German and five Israeli hospitals in 2018/2019. We used thematic analysis to identify common topics and patterns of meaning. Results: Hospital professionals report many situations in which activity-based payment incentivizes proper treatment, and clinical and economic considerations are aligned. This is the case when efficiency can be improved, eg, by curbing unnecessary expenditures or specializing in certain procedures. When considerations are misaligned, hospital professionals have developed a range of strategies that may contribute to balancing competing considerations. These include ‘reshaping management,’ such as better planning of the entire course of treatment and improvement of the coding; and ‘reframing decision-making,’ which involves working with averages and developing tool-kits for decision-making. Conclusion: Misalignment of economic and clinical considerations does not necessarily have negative implications, if professionals manage to balance and reconcile them. Context is important in determining if considerations can be reconciled or not. Reconciling strategies are fragile and can be easily disrupted depending on context. Creating tool-kits for better decision-making, planning the treatment course in advance, working with averages, and having interdisciplinary teams to think together about ways to improve efficiency can help mitigate dilemmas of hospital professionals.

scholarly journals The Impact of Social Media Use on Consumers’ Restaurant Consumption Experiences: A Qualitative Study

2021 ◽  
Vol 13 (12) ◽  
pp. 6581
Author(s):  
Jooyoung Hwang ◽  
Anita Eves ◽  
Jason L. Stienmetz
Keyword(s):  
Decision Making ◽  
Social Media ◽  
Selection Process ◽  
Decision Making Process ◽  
Structured Interviews ◽  
High Standards ◽  
Tourism And Hospitality Industry ◽  
Tourism And Hospitality ◽  
Search For Information ◽  
The Impact

Travellers have high standards and regard restaurants as important travel attributes. In the tourism and hospitality industry, the use of developed tools (e.g., smartphones and location-based tablets) has been popularised as a way for travellers to easily search for information and to book venues. Qualitative research using semi-structured interviews based on the face-to-face approach was adopted for this study to examine how consumers’ restaurant selection processes are performed with the utilisation of social media on smartphones. Then, thematic analysis was adopted. The findings of this research show that the adoption of social media on smartphones is positively related with consumers’ gratification. More specifically, when consumers regard that process, content and social gratification are satisfied, their intention to adopt social media is fulfilled. It is suggested by this study that consumers’ restaurant decision-making process needs to be understood, as each stage of the decision-making process is not independent; all the stages of the restaurant selection process are organically connected and influence one another.

Purchasing Power and Self-Determination: Social Worker Perspectives

2021 ◽  
Author(s):  
Charlotte Bailey ◽  
Debbie Plath ◽  
Alankaar Sharma
Keyword(s):  
Decision Making ◽  
Social Work ◽  
Social Workers ◽  
Work Practice ◽  
Social Work Practice ◽  
Self Determination ◽  
Purchasing Power ◽  
Service Users ◽  
Structured Interviews ◽  
Management Approaches

Abstract The international policy trend towards personalised budgets, which is designed to offer people with disabilities purchasing power to choose services that suit them, is exemplified in the Australian National Disability Insurance Scheme (NDIS). This article examines how the ‘purchasing power’ afforded to service users through individualised budgets impacts on social work practice and the choice and self-determination of NDIS service users. Social workers’ views were sought on the alignment between the NDIS principles of choice and control and social work principles of participation and self-determination and how their social work practice has changed in order to facilitate client access to supports through NDIS budgets and meaningful participation in decision-making. A survey was completed by forty-five social workers, and in-depth semi-structured interviews were conducted with five of these participants. The findings identify how social workers have responded to the shortfalls of the NDIS by the following: interpreting information for clients; assisting service users to navigate complex service provision systems; supporting clients through goal setting, decision-making and implementation of action plans; and adopting case management approaches. The incorporation of social work services into the NDIS service model is proposed in order to facilitate meaningful choice and self-determination associated with purchasing power.

scholarly journals Birds of a Feather Flock Together: Disadvantageous Decision Making in Augmented Restless Legs Syndrome Patients with and without Impulse Control Disorders

2021 ◽  
Vol 11 (3) ◽  
pp. 383
Author(s):  
Beatrice Heim ◽  
Philipp Ellmerer ◽  
Ambra Stefani ◽  
Anna Heidbreder ◽  
Elisabeth Brandauer ◽  
...  
Keyword(s):  
Decision Making ◽  
Restless Legs Syndrome ◽  
Impulse Control ◽  
Compulsive Sexual Behavior ◽  
Structured Interviews ◽  
Restless Legs ◽  
Information Sampling ◽  
Patient Groups ◽  
Post Hoc ◽  
Beads Task

Background: Augmentation (AUG) in patients with restless legs syndrome (RLS) can be associated with impulse control disorder (ICD) symptoms, such as compulsive sexual behavior, gambling disorder or compulsive shopping. In this study, we wanted to assess whether RLS patients with AUG differ in decision making from those patients who have augmentation and in addition ICD symptoms (AUG + ICD) in a post hoc analysis of a patient cohort assessed in a previous study. Methods: In total, 40 RLS patients with augmentation (19 AUG + ICD, 21 AUG without ICDs) were included. RLS diagnosis, severity, and diagnosis of augmentation were made by sleep disorder specialists. ICD symptoms were assessed using semi-structured interviews. All patients performed the beads task, which is an information sampling task where participants must decide from which of the two cups colored beads were drawn. Results were compared to 21 healthy controls (HC). Results: There was no difference in information sampling or irrational decision making between AUG and AUG + ICD patients (p = 0.67 and p = 1.00, respectively). Both patient groups drew less beads and made more irrational decisions than HC (all p-values < 0.03, respectively). Conclusions: Our results suggest that augmentation itself is associated with poorer decision making even in the absence of ICD symptoms. Further studies are necessary to explore whether rapid and hasty decision making are a harbinger of augmentation in RLS.

scholarly journals Competing interests, clashing ideas and institutionalizing influence: insights into the political economy of malaria control from seven African countries

2020 ◽  
Author(s):  
Justin Parkhurst ◽  
Ludovica Ghilardi ◽  
Jayne Webster ◽  
Robert W Snow ◽  
Caroline A Lynch
Keyword(s):  
Decision Making ◽  
Malaria Control ◽  
Qualitative Interviews ◽  
Sub Saharan Africa ◽  
African Countries ◽  
Health Community ◽  
Control Programmes ◽  
Control Decision ◽  
Sub Saharan ◽  
Economic Considerations

Abstract This article explores how malaria control in sub-Saharan Africa is shaped in important ways by political and economic considerations within the contexts of aid-recipient nations and the global health community. Malaria control is often assumed to be a technically driven exercise: the remit of public health experts and epidemiologists who utilize available data to select the most effective package of activities given available resources. Yet research conducted with national and international stakeholders shows how the realities of malaria control decision-making are often more nuanced. Hegemonic ideas and interests of global actors, as well as the national and global institutional arrangements through which malaria control is funded and implemented, can all influence how national actors respond to malaria. Results from qualitative interviews in seven malaria-endemic countries indicate that malaria decision-making is constrained or directed by multiple competing objectives, including a need to balance overarching global goals with local realities, as well as a need for National Malaria Control Programmes to manage and coordinate a range of non-state stakeholders who may divide up regions and tasks within countries. Finally, beyond the influence that political and economic concerns have over programmatic decisions and action, our analysis further finds that malaria control efforts have institutionalized systems, structures and processes that may have implications for local capacity development.

scholarly journals ‘Don’t Put the Cart before the Mule!’ Challenging Assumptions Regarding Health-Related Treatment Practices of Working Equid Owners in Northern India

Animals ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 1307
Author(s):  
Caroline Nye ◽  
Tamlin Watson ◽  
Laura M. Kubasiewicz ◽  
Zoe Raw ◽  
Faith Burden
Keyword(s):  
Decision Making ◽  
Lived Experience ◽  
Health Management ◽  
Animal Health ◽  
Structured Interviews ◽  
Treatment Practices ◽  
Northern India ◽  
Brick Kilns ◽  
Treatment Measures ◽  
Working Equids

This paper challenges assumptions that the health management of working equids among some of India’s poorest communities is mainly dependent upon income, economic influence, or access to veterinary services. Using a mixed-methods approach, hierarchies of treatment practices are revealed through an examination of the ‘lived experience’ of equid owners in brick kilns and construction sites in northern India. Semi-structured interviews with 37 equid owners and corresponding livelihood surveys, combined with data from two focus groups with professional animal health practitioners and the welfare data of 63 working equids collected using the Equid Assessment, Research, and Scoping (EARS) tool, contributed to the findings of the study. Four principal influencing factors were found to affect the decision-making practices of equid owners. Infrastructural factors, community characteristics and experience, owners’ characteristics and experience, and economic factors all impact the belief structures of equid owners. However, without verifying the validity of the treatment measures being employed, some animals are at risk from hazardous treatment behaviours. By understanding decision-making using the theory of planned behaviour, the findings of this study can provide a crucial contribution to informing future interventions involved in the health management and welfare of working equids.

scholarly journals ‘Every medicine is part poison’: a qualitative inquiry into the perceptions and experiences of choosing contraceptive methods of migrant Chinese women living in Australia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hankiz Dolan ◽  
Mu Li ◽  
Deborah Bateson ◽  
Rachel Thompson ◽  
Chun Wah Michael Tam ◽  
...  
Keyword(s):  
Decision Making ◽  
Contraceptive Method ◽  
Intrauterine Device ◽  
Qualitative Inquiry ◽  
Medical Advice ◽  
The Body ◽  
Hormonal Contraceptives ◽  
Contraceptive Methods ◽  
Structured Interviews ◽  
Women’S Perceptions

Abstract Background In Australia, ethnic Chinese people are one of the largest, youngest and fastest growing overseas-born groups. Yet, little is known about their perceptions of contraceptive methods and their experiences with choosing one. Decisions about contraceptive methods are preference sensitive. Understanding the influencing factors of Chinese migrant women’s contraceptive method choice and practices will help cater to their decision-making needs in a culturally sensitive and responsive way. Methods A qualitative study design underpinned by critical realism approach was used to explore Chinese migrant women’s perceptions and experiences of choosing contraceptive methods. Semi-structured interviews were conducted with 22 women who self-identified as being ethnically Chinese and had been living in Australia for no more than 10 years. The interview guide was adapted from the Ottawa Decision Support Framework. Majority of the interviews were conducted in Mandarin Chinese. Transcribed data was analysed using thematic analysis method. Results Four major themes were identified, including: ‘every medicine is part poison: hormonal contraceptives cause harm to the body’; ‘intrauterine device, a device used in the past for married women’; ‘it takes two (or one) to decide, depending on the relationship dynamics and contraception preferences’; and ‘it is not necessary to seek medical advice in choosing contraceptive methods’. Conclusions Our findings suggest that Chinese migrant women’s perceptions and experiences of choosing contraceptive methods are influenced by complex personal, cultural, societal and inter-relational factors. Chinese migrant women were cautious of using hormonal methods due to fears of side-effects, including reduced or absent menstrual bleeding. Women were also reluctant to consider intrauterine devices as options due to associating them with past experiences of other women and themselves and also fears of potential complications. There was a reluctant attitude towards seeking medical advice regarding contraception due to beliefs that needing to use contraception is not an illness requiring treatment. Such findings are likely to be useful in increasing healthcare professionals’ and policy makers’ understanding of Chinese migrant women’s contraceptive method preferences, beliefs and behaviours. They also help to develop culturally and linguistically sensitive strategies, which goes beyond the provision of contraceptive counselling, in assisting Chinese migrant women’s decision-making needs.

Has Lean improved organizational decision making?

2016 ◽  
Vol 29 (5) ◽  
pp. 536-549 ◽  
Author(s):  
Pascale Simons ◽  
Jos Benders ◽  
Jochen Bergs ◽  
Wim Marneffe ◽  
Dominique Vandijck
Keyword(s):  
Decision Making ◽  
Design Methodology ◽  
Lean Management ◽  
Structured Interviews ◽  
Organizational Decision Making ◽  
Content Type ◽  
Organizational Contexts ◽  
Sustainable Improvement ◽  
Care Processes ◽  
Practical Implications

Purpose – Sustainable improvement is likely to be hampered by ambiguous objectives and uncertain cause-effect relations in care processes (the organization’s decision-making context). Lean management can improve implementation results because it decreases ambiguity and uncertainties. But does it succeed? Many quality improvement (QI) initiatives are appropriate improvement strategies in organizational contexts characterized by low ambiguity and uncertainty. However, most care settings do not fit this context. The purpose of this paper is to investigate whether a Lean-inspired change program changed the organization’s decision-making context, making it more amenable for QI initiatives. Design/methodology/approach – In 2014, 12 professionals from a Dutch radiotherapy institute were interviewed regarding their perceptions of a Lean program in their organization and the perceived ambiguous objectives and uncertain cause-effect relations in their clinical processes. A survey (25 questions), addressing the same concepts, was conducted among the interviewees in 2011 and 2014. The structured interviews were analyzed using a deductive approach. Quantitative data were analyzed using appropriate statistics. Findings – Interviewees experienced improved shared visions and the number of uncertain cause-effect relations decreased. Overall, more positive (99) than negative Lean effects (18) were expressed. The surveys revealed enhanced process predictability and standardization, and improved shared visions. Practical implications – Lean implementation has shown to lead to greater transparency and increased shared visions. Originality/value – Lean management decreased ambiguous objectives and reduced uncertainties in clinical process cause-effect relations. Therefore, decision making benefitted from Lean increasing QI’s sustainability.

Information behaviour and decision-making in patients during their cancer journey

2017 ◽  
Vol 35 (3) ◽  
pp. 494-506 ◽  
Author(s):  
Shih-Chuan Chen
Keyword(s):  
Decision Making ◽  
Cancer Patients ◽  
Information Source ◽  
Alternative Therapy ◽  
Treatment Decision ◽  
Treatment Method ◽  
Structured Interviews ◽  
Content Type ◽  
Information Behaviour ◽  
Treatment Decision Making

Purpose This paper aims to investigate the effect of cancer patients’ information behaviour on their decision-making at the diagnosis and treatment stages of their cancer journey. Patients’ information sources and their decision-making approaches were analyzed. Design/methodology/approach Semi-structured interviews were conducted with 15 participants. Findings The cancer patients sought information from various sources in choosing a hospital, physician, treatment method, diet and alternative therapy. Physicians were the primary information source. The patients’ approaches to treatment decision-making were diverse. An informed approach was adopted by nine patients, a paternalistic approach by four and a shared decision-making approach by only two. Practical implications In practice, the findings may assist hospitals and medical professionals in fostering pertinent interactions with patients. Originality/value The findings can enhance researcher understanding regarding the effect of cancer patients’ information behaviour on their decision-making.

Negotiating Flexibility: External Contracting and Working Time Control in German and Danish Telecommunications Firms

ILR Review ◽  
2017 ◽  
Vol 71 (1) ◽  
pp. 117-142 ◽  
Author(s):  
Virginia Doellgast ◽  
Peter Berg
Keyword(s):  
Decision Making ◽  
Agenda Setting ◽  
Call Center ◽  
Critical Power ◽  
Working Time ◽  
Structured Interviews ◽  
Power Resource ◽  
Time Control ◽  
Flexible Working ◽  
Working Time Models

This study examines how different participation rights and structures affect employee control over working time. The analysis is based on a comparison of matched call center and technician workplaces in two major telecommunications firms in Germany and Denmark. It draws on data from semi-structured interviews with managers, supervisors, and employee representatives between 2010 and 2016. Unions and works councils in both firms agreed to a series of concessions on working time policies in the early 2010s in exchange for agreements to halt or reverse outsourcing. The authors use Lukes’ concepts of decision-making and agenda-setting power to explain these common trends, as well as later divergence in outcomes. Germany’s stronger formal co-determination rights over working time proved a critical power resource for employee representatives as they sought to re-establish employee control in new, more flexible working time models.

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