Improving hospital-based processes for effective implementation of Government funded health insurance schemes: evidence from early implementation of PM-JAY in India

Background Government-sponsored health insurance schemes (GSHIS) aim to improve access to and utilization of healthcare services and offer financial protection to the population. India’s Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) is one such GSHIS. This paper aims to understand how the processes put in place to manage hospital-based transactions, from the time a beneficiary arrives at the hospital to discharge are being implemented in PM-JAY and how to improve them to strengthen the scheme’s operation. Methods Guidelines were reviewed for the processes associated with hospital-based transactions, namely, beneficiary authentication, treatment package selection, preauthorization, discharge, and claims payments. Across 14 hospitals in Gujarat and Madhya Pradesh states, the above-mentioned processes were observed, and using a semi-structured interview guide fifty-three respondents were interviewed. The study was carried out from March 2019 to August 2019. Results Average turn-around time for claim reimbursement is two to six times higher than that proposed in guidelines and tender. As opposed to the guidelines, beneficiaries are incurring out-of-pocket expenditure while availing healthcare services. The training provided to the front-line workers is software-centric. Hospital-based processes are relatively more efficient in hospitals where frontline workers have a medical/paramedical/managerial background. Conclusions There is a need to broaden capacity-building efforts from enabling frontline staff to operate the scheme’s IT platform to developing the technical, managerial, and leadership skills required for them. At the hospital level, an empowered frontline worker is the key to efficient hospital-based processes. There is a need to streamline back-end processes to eliminate the causes for delay in the processing of claim payment requests. For policymakers, the most important and urgent need is to reduce out-of-pocket expenses. To that end, there is a need to both revisit and streamline the existing guidelines and ensure adherence to the guidelines.

What Parents have to Say: Content and Actionability of Narrative Comments from Child HCAHPS Survey

OBJECTIVE: To examine the content and actionability of written comments from parents and guardians on the Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child HCAHPS) survey. METHODS: We coded 548 narrative text comments linked to demographic information from the Child HCAHPS survey from July 2017 to December 2020 about inpatient pediatric care at an urban children’s hospital-within-a-hospital at an academic medical center. We developed initial codes based on research findings and the content of the Child HCAHPS survey, and also added codes that emerged from the comments. We performed directed and conventional content analysis. RESULTS: Most comments were positive and provided by the child’s mother. About half referred to content on the Child HCAHPS survey, primarily on being treated with courtesy and respect or explaining care at discharge. Comments about other topics most frequently provided a narrative rating of the provider or described whether providers were caring and friendly. Thirty-nine percent of comments were deemed sufficiently specific to make improvements (ie, actionable) in inpatient pediatric care; negative comments or comments about care for sicker patients were more often actionable. CONCLUSIONS: Child HCAHPS comments provided rich detail and a large portion were deemed actionable. Comments also provided insights into topics both on the survey itself and on many other inpatient pediatric issues raised by parents and guardians. More research is needed on the value of Child HCAHPS comments, the association between Child HCAHPS open-ended and closed-ended responses, and how quality leaders and frontline staff use comments to improve inpatient pediatric care.

Emotional Labor in the Tourism Industry

The chapter reviews the key concepts, definitions, individual and organizational antecedents, and individual and organizational outcomes of emotional labour (EL) in the tourism industry. The application of the concept in research and practice is discussed along with the implications. The theoretical domains of convergence and divergence are identified. key challenges and applications of EL with airlines cabin crew, restaurant service staff, and hotel industry frontline staff are identified and discussed. A systematic review of literature on EL in tourism is undertaken followed by critical appraisal of the implications of EL for HR practices in the tourism and hospitality industry.

PERAN KAPABILITAS INTERAKSI DAN KREASI NILAI BERSAMA UNTUK MENINGKATKAN KINERJA PEMASARAN

ABSTRACTThis study focuses on the role of Individual and Relational Interaction Capability in increasing Emotional and Social Value Co-Creation on Market Performance in beauty salon services. Value Co-Creation is one of the service organization's strategies in utilizing external resources from customers. This strategy is crucial because the performance of service organizations is mostly determined by the ability of the frontline staff who interact with customers during service meetings. This research belongs to explanatory research with a population of beauty salon customers in Central Java. The sample consisted of 203 customers, and it was determined using the purposive sampling technique. The author collects customer data through the distribution of offline and online questionnaires analyzed using SPSS 23.0-based regression. This study has proven that Emotional and Social Value Co-Creation can mediate between Individual and Relational Capability with Market Performance. Emotional and social values that are created together will be beneficial for the parties involved. For customers, interactions during the value co-creation process will increase their satisfaction because it can fulfill their needs and desires. This study has also shown the role of individual and relational capability in increasing customer willingness to engage in mutual value creation interactions.JEL Codes: D20, L10, M20.Keywords : individual interaction capability, relational interaction capability, emotional value co-creation, social value co-creation, market performance. ABSTRAKStudi ini fokus pada peran Individual dan Relational Interaction Capability dalam meningkatkan Emotional dan Social Value Co-Creation menuju Market Performance pada jasa salon kecantikan. Value Co-Creation merupakan salah satu strategi organisasi jasa dalam memanfaatkan sumberdaya eksternal yang berasal dari pelanggan. Strategi ini sangat penting karena performa organisasi jasa sangat ditentukan oleh kemampuan frontline staff dalam berinteraksi dengan pelanggan pada saat pertemuan jasa. Jenis penelitian bersifat explanatory research dengan populasi pelanggan salon kecantikan di Jawa Tengah. Ukuran sampel yang digunakan sebanyak 203 pelanggan. Teknik pengambilan sampel menggunakan pPurposive sSampling. Peneliti mengumpulkan data pelanggan melalui penyebaran kuisioner secara offline dan online. Alat analisis data menggunakan regresi berbasis SPSS 23.0. Studi ini telah berhasil membuktikan bahwa Emotsional dan Social Value Co-Creation mampu memediasi antara Individuasl dan Relational Capability dengan Market Performance Nilai emosional dan soscial yang dikreasikan bersama akan bermanfaat bagi pihak-pihak yang terlibat. Bagi pelanggan, interaksi selama proses value co-creation akan meningkatan kepuasannya karena kebutuhan dan keinginannya dapat terpenuhi. Studi ini juga telah membuktikan peran individual dan relational capability dalam meningkatkan keinginan pelanggan terlibat dalam interaksi penciptaan nilai bersama.

Meeting the numbers: Performance politics and welfare-to-work at the street-level

Over the past decade, social policy in Ireland has taken an increasingly ‘workfarist turn’. This has proceeded through benefit cuts, tighter eligibility criteria for payments, and claimant activation via penalty rates for breaching new conduct conditions. However, key to understanding the post-crisis reconfiguration of welfare is not just the increasingly workfarist content of social policy but also how the delivery of public employment services has been reorganised through processes of marketisation and tightening performance management of delivery organisations and the staff who work within them. Positioning these governance reforms as processes of ‘double activation’, and drawing on survey and interview research with frontline staff working for agencies contracted by government to deliver activation, this study explores how frontline staff experience performance management as a disciplinary regime: the degree to which frontline workers are subject to management control and performance management in their jobs, what forms this takes, and how it shapes their field of action and choice. In so doing, the study draws attention to the ways in which the governance of caseworkers and the governance of claimants are inter-related, and the degree to which performance management regimes influence frontline practices to motivate the enforcement of workfarist policy practices.

Key components of post-diagnostic support for people with dementia and their carers: A qualitative study

Background There has been a shift in focus of international dementia policies from improving diagnostic rates to enhancing the post-diagnostic support provided to people with dementia and their carers. There is, however, little agreement over what constitutes good post-diagnostic support. This study aimed to identify the components of post-diagnostic dementia support. Methods We adopted a qualitative design using interviews, focus groups and observation to explore the perspectives of key stakeholders on the content of post-diagnostic dementia support. Purposive sampling was used to identify sites in England and Wales recognised as delivering good practice. Participants included 17 people with dementia, 31 carers, 68 service managers or funders, and 78 frontline staff. Interviews and focus groups were audio recorded and transcribed for analysis. Forty-eight sessions of observation were completed and recorded in fieldnotes. Components were identified through an inductive, thematic approach and cross-checked against national guidelines and existing frameworks; they were subsequently critically reviewed by a range of experts and our mixed stakeholder panel. Results Twenty distinct components of post-diagnostic support were identified, related to five themes: timely identification and management of needs; understanding and managing dementia; emotional and psychological wellbeing; practical support; and integrating support. The first and last of these were cross-cutting themes facilitating the delivery of a unique constellation of components of post-diagnostic support to each individual living with dementia or dyad at a particular time. Conclusions Our work offers an empirically based framework to inform the development and delivery of holistic, integrated and continuous dementia care from diagnosis to end of life. It highlights the relevance of many components to both people living with dementia and their carers. Since the framework was developed in England and Wales, further research is needed to explore the relevance of our components to other sectors, countries and care systems.

The Street-Level Organisation in-between Employer Needs and Client Needs: Creaming Users by Motivation in the Norwegian Employment and Welfare Service (NAV)

Employer engagement is increasingly emphasised in the context of efforts to bring more disadvantaged people into work. A new approach in the Norwegian Employment and Welfare Service (NAV) combines demand-side and supply-side measures in a ‘combined workplace-oriented approach’. Through qualitative interviews with frontline staff – including job coaches following the Supported Employment (SE) method – the paper examines the intermediary role of the street-level organisation (SLO) through the targeted use of SE methods directed at young users and employers. The findings suggest that young users are ‘creamed by motivation’ into the SE programme, which can be explained by the importance the SLO places: on maintaining inter-organisational relationships with employers, on job coaches’ performance goals and the need to uphold an organisational structure in the SLO that seemingly works efficient to shift caseloads of young unemployed into work. Hence, creaming is not specific to outsourcing but can also occur when insourcing employer engagement services into a public SLO. Although relational work directed at both employers and young clients is seen as the benefit of a combined workplace-oriented approach, it appears a rather flimsy foundation for successful ALMPs unless supported by more structural demand-side measures.

Exploring Norwegian prison frontline workers’ perceptions of inter professional collaboration – a pilot study

Purpose Interprofessional collaboration is necessary for handling the complex psychosocial needs of prisoners. This collaboration must be addressed to avoid high recidivism rates and the human and societal costs linked to them. Challenges are exacerbated by a linear approach to handling prisoners’ problems, silo working between welfare agencies and professional boundaries between frontline workers. There are few adequate theoretical frameworks and tools to address these challenges in the prison context. The purpose of this study is to explore the perceptions that frontline staff working in Norwegian prison facilities have regarding interprofessional collaboration in providing mental health services for prisoners. Design/methodology/approach This study had a non-experimental, cross-sectional design to explore perceptions of interprofessional collaboration in a prison context. Descriptive and multifactorial analyses (exploratory factor analysis and confirmatory factor analysis) were used to explore the data. Findings The analysis showed that three factors, communication, organizational culture and domain, explained 95% of the variance. Results are discussed using relational coordination, as well as the conceptual PINCOM model, as a theoretical framework. Originality/value Few studies explicitly explore collaboration between professionals in mental health and prison services despite its being a prerequisite to achieving sufficient services for prisoners. To our knowledge, this current study is one of the first in Norway to explore collaboration in a prison context by analysing quantitative data and focusing on frontline workers perception of the phenomenon.

The impact of COVID-19 on research within the homeless services sector

Purpose This paper aims to discuss the challenges of conducting research with homelessness services frontline workers during the COVID-19 pandemic. Design/methodology/approach Between 2015 and 2019, the research team surveyed frontline staff in three cities about their psychosocial stressors and needs. In 2020, the authors replicated the previous study and expanded data collection to seven cities across Canada to determine the extent to which the COVID-19 pandemic impacted the well-being of frontline staff. This report describes how the authors adapted the research methodologies to continue work throughout the pandemic, despite various restrictions. Findings The original studies had very high participation rates because of several methodological approaches that minimized barriers, especially in-person data collection. During the pandemic, distancing requirements precluded replication of these same methods. Research strategies that enabled staff participation during working hours, with designated time allotted for participation, was key for ensuring high participation rates, as access to technology, availability of free time and other factors frequently make online survey research a hardship for these staff. Restrictive interpretation and regional variations of COVID-19 guidelines by some research ethics boards were also a challenge to rapid and responsive data collection. Originality/value Few studies describe the experiences of frontline workers in the homelessness sector, and quantitative reports of their experiences are particularly scant. Consequently, little is known about specific methodologies that facilitate large-scale data collection in the homelessness services sector. The present research advances the field by providing lessons learned about best practice approaches in pre and post COVID-19 front line worker contexts. A strength of this research is the well-controlled design. The authors collected data within several of the organizations that had previously participated. This fortunate baseline provided opportunity for comparison before and during the pandemic; the authors can highlight factors that might have had influence during the pandemic.

You can tell it works – Experiences from using the VIPS practice model in primary healthcare

Introduction Person-centred care is a philosophy rather than a method ready for implementation and utilization in daily clinical work. Internationally, few methods for person-centred care have been widely adopted in clinical dementia care practice. In Norway, the VIPS practice model is one that is commonly used for the implementation and use of person-centred care in primary healthcare. Method Nursing home physicians, managers and leaders in the municipalities, care institutions and domestic nursing care services were eligible for inclusion if their workplace had implemented and used the VIPS practice model for a minimum of 12 months. Individual interviews were conducted via Facetime, Skype or telephone and analysed with qualitative content analysis. Findings In all, 20 respondents were included: one manager of health and care services in the municipality, six managers and leaders working in domestic care or daytime activity centres and 10 managers/leaders and three physicians working in nursing homes. Two global categories emerged: category 1: Change in staff’s professional reasoning with two sub-categories: (a) an enhanced professional level in discussions and (b) a change in focus from task to person; and category 2: Changes in the clinical work, with three sub-categories: (a) effective interventions, (b) a person-centred work environment and (c) changes in cooperation between stakeholders. Conclusion Regular use of the VIPS practice model appeared to change the work culture for the benefit of both service users and frontline staff. Increased cooperation between frontline staff, nurses, physicians and next of kin was described. Staff were more focused on the needs of the service users, which resulted in care interventions tailored to the needs of the individual with dementia, loyalty to care plans and fewer complaints from next of kin.