Facing Supply Chain Disruptions: Strategies to Ensure Relational Continuity

The COVID-19 pandemic is not comparable for extension and implications to any other crisis faced by organizations over the last decades. Understandably, in its first and most acute phases, managers have focused their attention on how companies could ensure business continuity at the organizational level, by guaranteeing safe operating conditions and reshaping working procedures. Yet, for companies operating in business markets, adjusting internal processes to face a supply chain disruption is not enough to ensure business continuity, as these companies also need to sustain the network of external relationships in the whole supply chain in which they operate. To avoid jeopardizing their long-term survival, maintain their scope of action, and keep up with the challenges of the new normal, business companies need to engage in effective strategies that focus on a different component of business continuity, which we call relational continuity. After a brief review of the literature, the chapter first introduces the relational continuity concept in supply chain relationships. Drawing on a series of qualitative in-depth interviews with managers from the industrial machinery industry, whose sampled firms are actually connected through a direct supplier-client relationship, the chapter identifies three strategies that industrial companies should implement to ensure relational continuity with their key partners (suppliers and especially clients): supply chain intelligence, relational slack and key partners’ integration. Their full-fledged implementation proved to smooth and strengthen relationships among all players in the supply-chain and make business companies more responsive and capable to address the relational challenges of the “new normal” scenario.

Associations between regular GP contact, diabetes monitoring and glucose control: an observational study using general practice data

ObjectiveContinuity and regularity of general practitioner (GP) contacts are associated with reduced hospitalisation in type 2 diabetes (T2DM). We assessed associations of these GP contact patterns with intermediate outcomes reflecting patient monitoring and health.DesignObservational longitudinal cohort study using general practice data 2011–2017.Setting193 Australian general practices in Western Australia and New South Wales participating in the MedicineInsight programme run by NPS MedicineWise.Participants22 791 patients aged 18 and above with T2DM.InterventionsRegularity was assessed based on variation in the number of days between GP visits, with more regular contacts assumed to indicate planned, proactive care. Informational continuity (claims for care planning incentives) and relational continuity (usual provider of care index) were assessed separately.Outcome measuresProcess of care indicators were glycosylated haemoglobin (HbA1c) test underuse (8 months without test), estimated glomerular filtration rate (eGFR) underuse (14 months) and HbA1c overuse (two tests within 80 days). The clinical indicator was T2DM control (HbA1c 6.5% (47.5 mmol/mol)–7.5% (58.5 mmol/mol)).ResultsThe quintile with most regular contact had reduced odds of HbA1c and eGFR underuse (OR 0.74, 95% CI 0.67 to 0.81 and OR 0.78, 95% CI 0.70 to 0.86, respectively), but increased odds of HbA1c overuse (OR 1.20, 95% CI 1.05 to 1.38). Informational continuity was associated with reduced odds of HbA1c underuse (OR 0.53, 95% CI 0.49 to 0.56), reduced eGFR underuse (OR 0.62, 95% CI 0.58 to 0.67) and higher odds of HbA1c overuse (OR 1.48, 95% CI 1.34 to 1.64). Neither had significant associations with HbA1c level. Results for relational continuity differed.ConclusionsThis study provides evidence that regularity and continuity influence processes of care in the management of patients with diabetes, though this did not result in the recording of HbA1c within target range. Research should capture these intermediate outcomes to better understand how GP contact patterns may influence health rather than solely assessing associations with hospitalisation outcomes.

Association of Continuity of General Practitioner Care with Utilisation of General Practitioner and Specialist Services in China: A Mixed-Method Study

Background: Continuity of general practitioner (GP) care, widely known as the core value of high-quality patient care, has a positive association with health outcomes. Evidence about the relationship between continuity and health service utilisation has so far been lacking in China. This study aimed to analyse the association of continuity of GP care with utilisation of general practitioner and specialist services in China. Method: A cross-sectional mixed methods study was conducted in 10 urban communities in Hangzhou. Quantitative data were collected from a random sample of 624 residents adopting the self-developed questionnaire. Measurement of continuity of GP care included informational continuity (IC), managerial continuity (MC) and relational continuity (RC). With adjustment for characteristics of residents, multivariate regression models were established to examine the association of continuity of GP care with the intention to visit GP, frequency of GP and specialist visitations. Qualitative data were collected from 26 respondents using an in-depth interview, and thematic content analysis for qualitative data was conducted. Results: Quantitative analysis showed that the IC was positively associated with the intention to visit GP and frequency of GP visitations. Those people who gave a high rating for RC also used GP services more frequently than their counterparts. MC was negatively associated with frequency of specialist visitations. Qualitative analysis indicated that service capabilities, doctor–patient interaction and time provision were regarded as three important reasons why patients chose GPs or specialists. Conclusions: Overall, high IC and RC are independently associated with more GP service utilisation, but a high MC might reduce specialist visitations. Continuity of GP care should be highlighted in designing a Chinese GP system.

A Realist Review of the Home care Literature and its Blind Spots

Rationale, aims and objectives: There is a large body of literature from all over the world that describes, analyzes, or evaluates home care models and interventions. The present article aims to identify the practical lessons that can be gained from a systematic examination of that literature. Method: We conducted a three-step sequential search process from which 113 documents were selected. That corpus was then narratively analyzed according to a realist review approach. Results: A first level of observation is that there are multiple blind spots in the existing literature on home care. The definition and delimitation of what constitutes home care services is generally under-discussed. In the same way, the composition of the basket of care provided and its fit with the need of recipients is under-addressed. Finally, the literature relies heavily on RCTs whose practical contribution to decisions or policy is disputable.At a second level, our analysis suggests that three mechanisms (system integration, case management and relational continuity) are core characteristics of home care models effectiveness. Conclusion: We conclude by providing advice for creating effective home care system change through rational and participatory design and evaluation alongside public dialogue about the purpose and future of home care.

Title Patient Involvement in the Encounter between General Practice and Patients with Chronic Diseases – A Scoping Review

Background Globally, there is increasing interest in patient involvement in healthcare. Research has shown improved health outcomes when patients are involved in managing their own health conditions and when their individual needs are considered. The aim of this scoping review was to map the existing research regarding chronic disease patients’ involvement in their encounters with general practice, with a specific focus on patients with Type 2 diabetes (TD2) or (Chronic obstructive pulmonary disease (COPD).Methods Studies of any design, date, and language reporting the involvement of adult patients with T2D or COPD were included. A systematic search was conducted using the following databases: MEDLINE, CINAHL, Psycinfo Scopus, and EMBASE. All databases were searched from August 2020 until October 2020. Data were systematically charted by the following study characteristics: Bibliographic aims; study aims; setting; area of interest; results; conclusion.Results 19 studies were included and published between 2001 and 2020 and conducted qualitative methods, survey, or mixed methods. Three and 17 studies contained knowledge on the involvement of patients with COPD and TD2, respectively. The patients reported the importance of being more involved in treatment discussions during consultations as well as a friendly environment. A good relationship and relational continuity make it easier for patients to be more involved in treatment decisions. The general practitioners(GP) mentioned their high work load, long-standing relationships, knowledge about the patients, and prepared patients as factors influencing their ability to involve patients in treatment discussions.Conclusion The existing knowledge within patient involvement in general practice clearly indicates that focus and action must be directed towards research exploring the perspectives of patients with COPD on their involvement in general practice.

When Maintaining Relationships and Social Connectivity Matter: The Case of New Zealand Midwives and COVID-19

New Zealand’s response to COVID-19 was go hard and go early into Level 4 lockdown on 25th March 2020. This rapid response has resulted in low rates of infection and deaths. For New Zealand midwives, the sudden changes to how they work with women and families during pregnancy, birth and postnatally, especially in the community, required unprecedented innovation and adaptation. The volume of information coming from many different sources, and the speed with which it was changing and updating, added further stress to the delivery of a midwifery model of care underpinned by partnership, collaboration, informed choice, safety and relational continuity. Despite the uncertainties, midwives continued their care for women and their families across all settings. In the rapidly changing landscape of the pandemic, news media provided a real time account of midwives’ and families’ challenges and experiences. This article provides background and discussion of these events and reports on a content analysis of media reporting the impact on the maternity system in New Zealand during the initial surge of the COVID-19 pandemic. We found that the New Zealand midwife was a major influencer and initiator for relational care to occur uninterrupted at the frontline throughout the COVID-19 lockdown, despite the personal risk. The initial 5-week lockdown in March 2020 involved stringent restrictions requiring all New Zealanders, other than essential workers such as midwives, to remain at home. Midwives kept women, their families and communities central to the conversation throughout lockdown whilst juggling their concerns about keeping themselves and their own families safe. Insights gained from the media analysis suggest that despite the significant stress and upheaval experienced by midwives and wāhine/women, relational continuity facilitates quality and consistent care that honors women’s choices and cultural needs even during situations of national crisis.