JournalTOCs

Journal of Health Services Research and Policy
Journal Prestige (SJR): 0.713

Citation Impact (citeScore): 2
Number of Followers: 16

Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1355-8196 - ISSN (Online) 1758-1060
Published by Sage Publications

[1174 journals]

Towards sustainability for medical devices and consumables: The radical
and incremental challenges in the technology ecosystem
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  Authors: Saba Hinrichs-Krapels, Jan-Carel Diehl, Nicole Hunfeld, Erik van Raaij
  Abstract: Journal of Health Services Research & Policy, Ahead of Print.
  
  Citation: Journal of Health Services Research & Policy
  PubDate: 2022-06-24T02:21:46Z
  DOI: 10.1177/13558196221110416
Socioeconomic inequalities in health care utilization in Paraguay:
Description of trends from 1999 to 2018
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  Authors: Diego A Capurro, Sam Harper
  Abstract: Journal of Health Services Research & Policy, Ahead of Print.
  ObjectiveParaguay’s health care system is characterized by segmented provision and low public spending, with limited coverage and asymmetries in terms of access and quality of care. The present study provides national estimates of income-related inequality in health care utilization and trends in the country over the past two decades.MethodsUsing data from the Paraguayan Permanent Household Survey, we estimated socioeconomic inequality in health care use during the period 1999–2018. We used poverty-to-income ratio as the socioeconomic stratifier and defined health care use as having reported a health problem and subsequent health care use in the last 90 days before interview. Inequality was summarized by rank- and level-based versions of the Concentration Index for binary outcomes.ResultsInequalities affecting those with lower incomes were present in all years assessed, although the magnitude of these inequalities declined over time. Inequality as expressed by the rank-based index decreased from 0.209 (95%CI 0.164; 0.253) in 1999 to 0.032 (95%CI -0.010; 0.075) in 2018. The level-based index decreased from 0.076 (95%CI -0.029; 0.182) in 1999 to 0.024 (0.002; 0.045) in 2018. Trends in both indices were generally stable from 1999 to 2009, with a noticeable decrease in 2010. The sharpest decreases relative to the 1999 baseline were observed in the period 2010–2018, reflecting changes in health care use and income distribution. Stratification by area, sex and older people suggest similar trends within subgroups.ConclusionsDecreases in inequality coincide temporally with increments in public health expenditure, removal of user fees in public health care facilities and the expansion of conditional cash-transfer programmes. Future research should disentangle the role of each of these policies in explaining the trends described.
  Citation: Journal of Health Services Research & Policy
  PubDate: 2022-06-22T09:23:19Z
  DOI: 10.1177/13558196221079160
Encouraging openness in health care: Policy and practice implications of a
mixed-methods study in the English National Health Service
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  Authors: Graham Martin, Sarah Chew, Imelda McCarthy, Jeremy Dawson, Mary Dixon-Woods
  Abstract: Journal of Health Services Research & Policy, Ahead of Print.
  ObjectiveThe National Health Service (NHS) in England has introduced a range of policy measures aimed at fostering greater openness, transparency and candour about quality and safety. We draw on the findings of an evaluation of the implementation of these policies in NHS organisations, with the aim of identifying key implications for policy and practice.MethodsWe undertook a mixed-methods policy evaluation, comprising four substudies: a longitudinal analysis of data from surveys of NHS staff and service users; interviews with senior stakeholders in NHS provider organisations and the wider system; a survey of board members of NHS provider organisations and organisational case studies across acute, community and mental health, and ambulance services.ResultsOur findings indicate a mixed picture of progress towards improving openness in NHS organisations, influenced by organisational history and memories of past efforts, and complicated by organisational heterogeneity. We identify four features that appear to be necessary conditions for sustained progress in improving openness: (1) authentic integration into organisational mission is crucial in making openness a day-to-day concern; (2) functional and effective administrative systems are vital; (3) these systems must be leavened by flexibility and sensitivity in implementation and (4) a spirit of continuous inquiry, learning and improvement is required to avoid the fallacy that advancing openness can be reduced to a time-limited project. We also identify four persistent challenges in consolidating and sustaining improvement: (1) a reliance on goodwill and discretionary effort; (2) caring for staff, patients and relatives who seek openness; (3) the limits of values-driven approaches on their own and (4) the continued marginality of patients, carers and families.ConclusionsVariation in policy implementation offers important lessons on how organisations can better deliver openness, transparency and candour. These lessons highlight practical actions for policymakers, managers and senior clinicians.
  Citation: Journal of Health Services Research & Policy
  PubDate: 2022-06-22T09:18:20Z
  DOI: 10.1177/13558196221109053
Operating room waste management: A case study of primary hip operations at
a leading national health service hospital in the United Kingdom
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  Authors: Melissa Pegg, Rebecca Rawson, Uchechukwu Okere
  Abstract: Journal of Health Services Research & Policy, Ahead of Print.
  ObjectiveThis research examines current waste management within an operating room at a large United Kingdom National Health Service (NHS) hospital. The study measured the volume and type of waste produced for primary hip operations (PHOs) and estimated the total waste produced across the United Kingdom by the procedure.MethodsThree PHOs were audited to measure and compare the waste volumes generated.ResultsThe average volume of waste per surgical procedure was 10.9 kg, consisting of clinical (84.4%), recyclable (12.8%) and bio-bin (2.8%) waste. This research also found that single-use devices contribute significantly to operating room waste. In addition, it was estimated that there is a missed opportunity to reduce clinical waste volume in each procedure, where approximately 15% of clinical waste disposal consisted of visibly clean recyclable waste material, including cardboard and plastics.ConclusionsIt was estimated that in the NHS approximately 1043 tonnes of waste is produced annually by PHOs alone. A significant volume of this waste could be prevented through improved recycling and reduced use of single-use devices.
  Citation: Journal of Health Services Research & Policy
  PubDate: 2022-05-30T01:20:23Z
  DOI: 10.1177/13558196221094488
Implementing joint training sessions of general practitioners and
specialists aimed at improving clinical coordination in Colombia:
Contributions from participatory action research
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  Authors: Heisel G León-Arce, Josefina Chávez Chávez, Amparo-Susana Mogollón-Pérez, Ingrid Vargas, María-Luisa Vázquez
  Abstract: Journal of Health Services Research & Policy, Ahead of Print.
  ObjectiveTo analyse the contribution of participatory action research (PAR) in designing and implementing joint training sessions as a means to improve clinical coordination in a public health care network in Bogotá, Colombia.MethodsA qualitative, descriptive-interpretative study using semi-structured individual interviews and focus groups with 40 professionals (GPs, specialists, members of the local steering committee (LSC) and network middle managers) involved in designing and implementing joint training sessions to improve cross-level clinical coordination. The intervention consisted of two forms of joint training sessions for GPs and specialists, implemented through two PAR cycles.ResultsThe PAR approach in designing and implementing joint training sessions led to greater awareness of clinical coordination problems and helped adapting sessions to the local health care context. Study participants highlighted the role of LSC leadership during the PAR process and the importance of ensuring the necessary resources for adopting the intervention. Limited institutional support and differences between joint training sessions affected doctors’ participation and reduced the time available to conduct the sessions. The use of a reflexive method was essential in enhancing doctors’ participation, along with session duration, the facilitator’s role and session content.ConclusionsThe study provides evidence regarding the contribution of a PAR process to designing and implementing joint training sessions for improving clinical coordination. The findings can inform similar approaches in other health systems.
  Citation: Journal of Health Services Research & Policy
  PubDate: 2022-05-22T01:46:19Z
  DOI: 10.1177/13558196221094676
Implementing patient navigator programmes within a hospital setting in
Toronto, Canada: A qualitative interview study
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  Authors: Kristina M Kokorelias, Sarah Gould, Tracey Das Gupta, Naomi Ziegler, Dan Cass, Sander L Hitzig
  Abstract: Journal of Health Services Research & Policy, Ahead of Print.
  Objectives:This study sought to identify the organisation and system level barriers and facilitators influencing the implementation of patient navigator programmes in one acute care hospital system in Toronto, Canada.Methods:A qualitative descriptive approach informed by the Consolidated Framework for Implementation Research. Data were collected using in-depth interviews and analysed thematically.Results:Thirty-eight individuals participated in interviews (17 community, 21 acute care hospital), including 24 frontline clinicians and 14 programme directors, health care leaders and managers. Implementation of patient navigator programmes was dependent on: (1) a clear consensus on the unique need for patient navigators; (2) champions to promote patient navigation; (3) programme ownership and accountability; (4) external system and organisational landscape and (5) implementation climate. Appropriate mechanisms of communication were found to have impacted each factor as a barrier or facilitator to programme implementation.Conclusion:Strategies for implementing patient navigator programmes into hospital clinical practice should include incorporating evidence to support the programme, considering mechanisms to enable collaborative communication, and the integration of frameworks to facilitate programme integration into the current practices within the organisation.
  Citation: Journal of Health Services Research & Policy
  PubDate: 2022-05-20T11:36:11Z
  DOI: 10.1177/13558196221103662
The experience of informal caregivers in providing patient care in
hospitals in low- and middle-income countries: A qualitative
meta-synthesis
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  Authors: Unarose Hogan, Amanda Bingley, Hazel Morbey, Catherine Walshe
  Abstract: Journal of Health Services Research & Policy, Ahead of Print.
  ObjectiveIn low- and middle-income countries, informal caregivers frequently stay in hospitals and perform patient care tasks typically performed by nurses in other contexts. This article reviews qualitative research on these informal caregivers, to gain insight and understanding of their experiences.MethodsWe undertook a qualitative meta-synthesis. Relevant literature was identified through searches of electronic databases in 2021. Thematic analysis was conducted to facilitate the identification of conceptual relationships to formulate synthesised findings.ResultsTwenty-four studies met the inclusion criteria – 13 from Sub-Saharan Africa, five from Bangladesh, two from India, two from Iran, one from Brazil and one from Peru. Three themes were generated from the meta-synthesis: (1) The unwelcome but tolerated guest, (2) Enduring personal sacrifice and (3) Fulfilling familial obligations. These themes emphasised the significant burden associated with the hospital caregiving experience and highlighted the implicit reliance on informal caregivers in low- and middle-income countries.ConclusionsInformal caregivers perform an essential caregiving role, yet occupy a peripheral and voluntary space in hospitals. There is a clear need to support informal caregivers so that they can safely perform their tasks.
  Citation: Journal of Health Services Research & Policy
  PubDate: 2022-05-20T06:14:49Z
  DOI: 10.1177/13558196221101968
Staff perspectives on barriers to and facilitators of quality of life,
health, wellbeing, recovery and reduced risk for older forensic
mental-health patients: A qualitative interview study
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  Authors: Kate Walker, Jen Yates, Tom Dening, Birgit Völlm, Jack Tomlin, Chris Griffiths
  Abstract: Journal of Health Services Research & Policy, Ahead of Print.
  ObjectivesThere is a lack of research informing service delivery for older forensic mental health patients. This study explored service provision in forensic mental health inpatient and community services in England, investigating what is required for progress in terms of quality of life, health, wellbeing, recovery and reduced risk, and the barriers and facilitators associated with this.MethodsSemi-structured interviews were undertaken with 48 members of staff working with older forensic mental health patients in secure inpatient units or the community in England. Data were analysed using thematic analysis.ResultsTwo global themes ‘What works’ and ‘What doesn’t work’ were identified comprising themes representing environmental, interpersonal and individual factors. ‘What works’ included: positive social support and relationships; individualised holistic patient-centred care; hub and spoke approach to patient care; and suitable environments. ‘What doesn’t work’ included: absence of/or maladaptive relationships with family and friends; gaps in service provision; and unsuitable environments.ConclusionsFor older patients to progress to improved quality of life, health, wellbeing and reduced risk, multilevel and comprehensive support is required, comprising a range of services, interventions, and multidisciplinary input, and individualised to each patient’s needs. The physical environment needs to be adapted for older patients and provide a social environment that seeks to include supportive families, friends and expert professional input. A clear patient progression pathway is required; this must be reflected in policy and provision.
  Citation: Journal of Health Services Research & Policy
  PubDate: 2022-05-18T08:07:47Z
  DOI: 10.1177/13558196221094512
Variations in policies for accessing elective musculoskeletal procedures
in the English National Health Service: A documentary analysis
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  Authors: Leila Rooshenas, Sharea Ijaz, Alison Richards, Alba Realpe, Jelena Savovic, Tim Jones, William Hollingworth, Jenny L Donovan
  Abstract: Journal of Health Services Research & Policy, Ahead of Print.
  ObjectiveThe overall aim of this study was to investigate how commissioning policies for accessing clinical procedures compare in the context of the English National Health Service. Our primary objective was to compare policy wording and categorise any variations identified. Our secondary objective was to explore how any points of variation relate to national guidance.MethodsThis study entailed documentary analysis of commissioning policies that stipulated criteria for accessing eight elective musculoskeletal procedures. For each procedure, we retrieved policies held by regions with higher and lower rates of clinical activity relative to the national average. Policies were subjected to content and thematic analysis, using constant comparison techniques. Matrices and descriptive reports were used to compare themes across policies for each procedure and derive categories of variation that arose across two or more procedures. National guidance relating to each procedure were identified and scrutinised, to explore whether these provided context for explaining the policy variations.ResultsThirty-five policy documents held by 14 geographic regions were included in the analysis. Policies either focused on a single procedure/treatment or covered several procedures/treatments in an all-encompassing document. All policies stipulated criteria that needed to be fulfilled prior to accessing treatment, but there were inconsistences in the evidence cited. Policies varied in recurring ways, with respect to specification of non-surgical treatments and management, requirements around time spent using non-surgical approaches, diagnostic requirements, requirements around symptom severity and disease progression, and use of language, in the form of terms and phrases (‘threshold modifiers’) which could open up or restrict access to care. National guidance was identified for seven of the procedures, but this guidance did not specify criteria for accessing the procedures in question, making direct comparisons with regional policies difficult.ConclusionsThis, to our knowledge, is the first study to identify recurring ways in which policies for accessing treatment can vary within a single-payer system with universal coverage. The findings raise questions around whether formulation of commissioning policies should receive more central support to promote greater consistency – especially where evidence is uncertain, variable or lacking.
  Citation: Journal of Health Services Research & Policy
  PubDate: 2022-05-15T04:27:26Z
  DOI: 10.1177/13558196221091518
Age-varying effects of repeated emergency department presentations for
children in Canada
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  Authors: Rhonda J Rosychuk, Anqi A Chen, Andrew McRae, Patrick McLane, Maria B Ospina, X iaoqiong Joan Hu
  Abstract: Journal of Health Services Research & Policy, Ahead of Print.
  ObjectivesRepeated presentations to emergency departments (EDs) may indicate a lack of access to other health care resources. Age is an important predictor of frequent ED use; however, age-varying effects are not generally investigated. This study examines the age-specific effects of predictors on ED presentation frequency for children in Alberta and Ontario, Canada.MethodsThis retrospective study used population-based data during April 2010 to March 2017. Data were extracted from the National Ambulatory Care Reporting System for children aged
  Citation: Journal of Health Services Research & Policy
  PubDate: 2022-05-06T10:13:07Z
  DOI: 10.1177/13558196221094248
Understanding the factors influencing implementation of a new national
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  Authors: Mirza Lalani, Sarah Morgan, Anamika Basu, Helen Hogan
  Abstract: Journal of Health Services Research & Policy, Ahead of Print.
  ObjectiveA new patient safety policy, ‘Learning from Deaths’ (LfD), was implemented in 2017 in National Health Service (NHS) organisations in England. This study examined how contextual factors influenced the implementation of LfD policy and the ability of the programme to achieve its goals.MethodsSemi-structured interviews were undertaken with key policymakers involved in the development of the policy, along with interviews with managers and senior clinicians in five NHS organisations responsible for implementing the policy at the local level. We also undertook non-participant observation of relevant meetings and documentary reviews of key organisation procedures and policies pertaining to LfD.ResultsThe study findings suggest several factors that hinder or support patient safety policy implementation at a local level. These include: (a) an organisation’s capacity and capability to support data collation, analysis and synthesis, (b) the dissemination of the resulting information, (c) the learning culture and hence perceptions of the purpose of LfD within an organisation, and (d) the extent of engagement in cross-organisational approaches to learning.ConclusionsExtra and intra-organisational contextual factors influence all stages of the policy implementation process from preparation and tracking to implementation support and review affecting its chances of success or failure. Successful adoption of a national patient safety policy within health care organisations can be informed by taking into consideration those factors.
  Citation: Journal of Health Services Research & Policy
  PubDate: 2022-05-06T10:11:56Z
  DOI: 10.1177/13558196221096921
The social networks of hospital staff: A realist synthesis
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  Authors: Claire Blacklock, Amy Darwin, Mike English, Jacob McKnight, Lisa Hinton, Elinor Harriss, Geoff Wong
  Abstract: Journal of Health Services Research & Policy, Ahead of Print.
  ObjectivesThe social ties people have with one another are known to influence behaviour, and how information is accessed and interpreted. It is unclear, however, how the social networks that exist in multi-professional health care workplaces might be used to improve quality in hospitals. This paper develops explanatory theory using realist synthesis to illuminate the details and significance of the social ties between health care workers. Specifically we ask: How, why, for whom, to what extent and in what context, do the social ties of staff within a hospital influence quality of service delivery, including quality improvement'MethodsFrom a total of 75 included documents identified through an extensive systematic literature search, data were extracted and analysed to identify emergent explanatory statements.ResultsThe synthesis found that within the hospital workforce, an individual’s place in the social whole can be understood across four identified domains: (1) social group, (2) hierarchy, (3) bridging distance and (4) discourse. Thirty-five context-mechanism-outcome configurations were developed across these domains.ConclusionsThe relative position of individual health care workers within the overall social network in hospitals is associated with influence and agency. As such, power to bring about change is inequitably and socially situated, and subject to specific contexts. The findings of this realist synthesis offer a lens through which to understand social ties in hospitals. The findings can help identify possible strategies for intervention to improve communication and distribution of power, for individual, team and wider multi-professional behavioural change in hospitals.
  Citation: Journal of Health Services Research & Policy
  PubDate: 2022-05-06T01:51:03Z
  DOI: 10.1177/13558196221076699
Processes supporting effective skill-mix implementation in general
practice: A qualitative study
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  Authors: Sharon Spooner, Imelda McDermott, Mhorag Goff, Damian Hodgson, Anne McBride, Katherine Checkland
  Abstract: Journal of Health Services Research & Policy, Ahead of Print.
  ObjectivesHealth policy and funding initiatives have addressed increasing workloads in general practice through the deployment of clinicians from different disciplinary backgrounds. This study examines how general practices in England operate with increasingly diverse groups of practitioners.MethodsFive general practices were selected for maximum variation of the duration and diversity of skill-mix in their workforce. Individual interviews were recorded with management and administrative staff and different types of practitioner. Patient surveys and focus groups gathered patients’ perspectives of consulting with different practitioners. Researchers collaborated during coding and thematic analysis of transcripts of audio recordings.ResultsThe introduction of a wide range of practitioners required significant changes in how practices dealt with patients requesting treatment, and these changes were not necessarily straightforward. The matching of patients with practitioners required effective categorization of health care patients’ reported problem(s) and an understanding of practitioners’ capabilities. We identified individual and organizational responses that could minimize the impact on patients, practitioners and practices of imperfections in the matching process.ConclusionsThe processes underpinning the redistribution of tasks from GPs to non-GP practitioners are complex. As practitioner employment under the Primary Care Network contracts continues to increase, it is not clear how the necessarily fine-grained adjustments will be made for practitioners working across multiple practices.
  Citation: Journal of Health Services Research & Policy
  PubDate: 2022-05-03T04:00:34Z
  DOI: 10.1177/13558196221091356
Loss associated with subtractive health service change: The case of
specialist cancer centralization in England
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  Authors: Georgia B Black, Victoria J Wood, Angus I G Ramsay, Cecilia Vindrola-Padros, Catherine Perry, Caroline S Clarke, Claire Levermore, Kathy Pritchard-Jones, Axel Bex, Maxine G B Tran, David C Shackley, John Hines, Muntzer M Mughal, Naomi J Fulop
  Abstract: Journal of Health Services Research & Policy, Ahead of Print.
  ObjectiveMajor system change can be stressful for staff involved and can result in ‘subtractive change’ – that is, when a part of the work environment is removed or ceases to exist. Little is known about the response to loss of activity resulting from such changes. Our aim was to understand perceptions of loss in response to centralization of cancer services in England, where 12 sites offering specialist surgery were reduced to four, and to understand the impact of leadership and management on enabling or hampering coping strategies associated with that loss.MethodsWe analysed 115 interviews with clinical, nursing and managerial staff from oesophago-gastric, prostate/bladder and renal cancer services in London and West Essex. In addition, we used 134 hours of observational data and analysis from over 100 documents to contextualize and to interpret the interview data. We performed a thematic analysis drawing on stress-coping theory and organizational change.ResultsStaff perceived that, during centralization, sites were devalued as the sites lost surgical activity, skills and experienced teams. Staff members believed that there were long-term implications for this loss, such as in retaining high-calibre staff, attracting trainees and maintaining autonomy. Emotional repercussions for staff included perceived loss of status and motivation. To mitigate these losses, leaders in the centralization process put in place some instrumental measures, such as joint contracting, surgical skill development opportunities and trainee rotation. However, these measures were undermined by patchy implementation and negative impacts on some individuals (e.g. increased workload or travel time). Relatively little emotional support was perceived to be offered. Leaders sometimes characterized adverse emotional reactions to the centralization as resistance, to be overcome through persuasion and appeals to the success of the new system.ConclusionsLarge-scale reorganizations are likely to provoke a high degree of emotion and perceptions of loss. Resources to foster coping and resilience should be made available to all organizations within the system as they go through major change.
  Citation: Journal of Health Services Research & Policy
  PubDate: 2022-04-26T02:42:40Z
  DOI: 10.1177/13558196221082585
Corrigendum to Measuring with quality: The example of person-centred care
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  Abstract: Journal of Health Services Research & Policy, Ahead of Print.
  
  Citation: Journal of Health Services Research & Policy
  PubDate: 2022-04-25T05:57:01Z
  DOI: 10.1177/13558196221096744
Examining organization and provider challenges with the adoption of
virtual domestic violence and sexual assault interventions in Alberta,
Canada, during the COVID-19 pandemic
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  Authors: Stephanie Montesanti, Winta Ghidei, Peter Silverstone, Lana Wells, Suzanne Squires, Allan Bailey
  Abstract: Journal of Health Services Research & Policy, Ahead of Print.
  ObjectivesIn Canada, calls to domestic violence and sexual assault hotlines increased during the COVID-19 pandemic as stricter public health restrictions took effect in parts of the country. Moreover, the public health measures introduced to limit the transmission of COVID-19 saw many health providers abruptly pivot to providing services virtually, with little to no opportunity to plan for this switch. We carried out a qualitative research study to understand the resulting challenges experienced by providers of domestic violence and sexual assault support services.MethodsTwenty-four semi-structured interviews were conducted to gather in-depth information from service providers and organizational leaders in the Canadian province of Alberta about the challenges they experienced adopting virtual and remote-based domestic violence and sexual assault interventions during the COVID-19 outbreak. Interview transcripts and field notes were analysed using a thematic analysis approach.ResultsOur findings highlighted multiple challenges organizations, service providers and clients experienced. These included: (1) systemic (macro-level) challenges pertaining to policies, legislation and funding availability, (2) organization and provider (meso-level) challenges related to adapting services and programmes online or for remote delivery and (3) provider perceptions of client (micro-level) challenges related to accessing virtual interventions.ConclusionsEquity-focused policy and intersectional and systemic action are needed to enhance delivery and access to virtual interventions and services for domestic violence and sexual assault clients.
  Citation: Journal of Health Services Research & Policy
  PubDate: 2022-04-24T03:45:27Z
  DOI: 10.1177/13558196221078796
Perceived impact of formulating, implementing and enacting national mental
health policies recommendations in practice: An exploratory qualitative
study within child and adolescent mental health services in Scotland
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  Authors: Madalina Toma, Julie Anderson, Sarah Forster, Paula Shiels, Shirley Windsor, Nicola M Gray
  Abstract: Journal of Health Services Research & Policy, Ahead of Print.
  Objective:To understand the process of formulating, implementing and enacting national recommendations into practice, by exploring the interactions between government policymakers and national and local organisations supporting and delivering policy implementation within a Child and Adolescent Mental Health Service (CAMHS) context in Scotland.Methods:Data collection involved 16 semi-structured individual and four focus group interviews with a purposeful sample of policymakers, national health and social care stakeholders and local outpatient and inpatient CAMHS teams representing three NHS health boards in Scotland. Results:Study participants highlighted the challenges of navigating through evolving and often conflicting policy agendas, seen to not acknowledging the current evidence base or experiential learning from services and prior evaluations. Accounts of transformation fatigue often emerged from increased expectations for staff to adopt new approaches to accommodate constantly changing recommendations. Participants also reported a lack of integration and implementation support from national health and social care organisations, leading to duplication of effort and gaps in provision or waste. Policy recommendations were perceived as sometimes vague, lacking clarity about how to deliver service transformation using a whole-system approach. The collective narratives reflected increased tension between the need for local autonomy to innovate and the limitations created vertically by the relative inflexibility of policy recommendations, and horizontally by the proliferation of national organisations delivering the same transformation aims using different approaches in a resource-constrained environment.Conclusion:The findings contribute to the wider literature by offering an exploration of importance of evaluation and evidence uptake in policy formulation; the roles and remits in supporting the implementation of policy recommendations; and how the dynamics of central control and local autonomy might impact on the local enactment of policy recommendations.
  Citation: Journal of Health Services Research & Policy
  PubDate: 2022-02-28T01:04:30Z
  DOI: 10.1177/13558196211072472
Inter-organisational collaboration enabling care delivery in a specialist
cancer surgery provider network: A qualitative study
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  Authors: Cecilia Vindrola-Padros, Angus I.G. Ramsay, Georgia Black, Ravi Barod, John Hines, Muntzer Mughal, David Shackley, Naomi J. Fulop
  Abstract: Journal of Health Services Research & Policy, Ahead of Print.
  ObjectiveTo explore the processes, challenges and strategies used to govern and maintain inter-organisational collaboration between professionals in a provider network in London, United Kingdom, which implemented major system change focused on the centralisation of specialist cancer surgery.MethodsWe used a qualitative design involving interviews with stakeholders (n = 117), non-participant observations (n = 163) and documentary analysis (n = 100). We drew on an existing model of collaboration in healthcare organisations and expanded this framework by applying it to the analysis of collaboration in the context of major system change.ResultsNetwork provider organisations established shared goals, maintained central figures who could create and sustain collaboration, and promoted distributed forms of leadership. Still, organisations continued to encounter barriers or challenges in relation to developing opportunities for mutual acquaintanceship across all professional groups; the active sharing of knowledge, expertise and good practice across the network; the fostering of trust; and creation of information exchange infrastructures fit for collaborative purposes.ConclusionCollaborative relationships changed over time, becoming stronger post-implementation in some areas, but continued to be negotiated where resistance to the centralisation remained. Future research should explore the sustainability of these relationships and further unpack how hierarchies and power relationships shape inter-organisational collaboration.
  Citation: Journal of Health Services Research & Policy
  PubDate: 2022-02-07T09:47:25Z
  DOI: 10.1177/13558196211053954
Unseen patterns of preventable emergency care: Emergency department visits
for ambulatory care sensitive conditions
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  Authors: Beth Parkinson, Rachel Meacock, Katherine Checkland, Matt Sutton
  Abstract: Journal of Health Services Research & Policy, Ahead of Print.
  ObjectiveAdmissions for ambulatory care sensitive conditions (ACSCs) are often used to measure potentially preventable emergency care. Visits to emergency departments with ACSCs may also be preventable care but are excluded from such measures if patients are not admitted. We established the extent and composition of this preventable emergency care.MethodsWe analysed 1,505,979 emergency department visits (5% of the national total) between 1 April 2015 and 31 March 2017 at six hospital Trusts in England, using International Classification of Diseases diagnostic coding. We calculated the number of visits for each ACSC and examined the proportions of these visits that did not result in admission by condition and patient characteristics.Results11.1% of emergency department visits were for ACSCs. 55.0% of these visits did not result in hospital admission. Whilst the majority of ACSC visits were for acute rather than chronic conditions (59.4% versus 38.4%), acute visits were much more likely to conclude without admission (70.3% versus 33.4%). Younger, more deprived and ethnic minority patients were less likely to be admitted when they visited the emergency department with an ACSC.ConclusionsOver half of preventable emergency care is not captured by measures of admissions. The probability of admission at a preventable visit varies substantially between conditions and patient groups. Focussing only on admissions for ACSCs provides an incomplete and skewed picture of the types of conditions and patients receiving preventable care. Measures of preventable emergency care should include visits in addition to admissions.
  Citation: Journal of Health Services Research & Policy
  PubDate: 2022-02-07T05:05:01Z
  DOI: 10.1177/13558196211059128
Village health worker motivation for better performance in a maternal and
child health programme in Nigeria: A realist evaluation
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  Authors: Chinyere Mbachu, Enyi Etiaba, Bassey Ebenso, Udochukwu Ogu, Obinna Onwujekwe, Benjamin Uzochukwu, Ana Manzano, Tolib Mirzoev
  Abstract: Journal of Health Services Research & Policy, Ahead of Print.
  BackgroundCommunity health workers play an important role in linking communities with formal health service providers, thereby improving access to and utilization of health care. A novel cadre of community health workers known as village health workers (VHWs) were recruited to create demand for maternal health services in the Nigerian Subsidy Reinvestment Programme (SURE-P/MCH). In this study, we investigated the role of contextual factors and underlying mechanisms motivating VHWs.MethodsWe used realist evaluation to understand the impact of a multi-intervention maternal and child health programme on VHW motivation using Anambra State as a case study. Initial working theories and logic maps were developed through literature review and stakeholder engagement; programme theories were developed and tested using focus group discussions and in-depth interviews with various stakeholder groups. Interview transcripts were analysed through an integrated approach of Context, Mechanism and Outcomes (CMO) categorisation and connecting, and matching of patterns of CMO configurations. Motivation theories were used to explain factors that influence VHW motivation. Explanatory configurations are reported in line with RAMESES reporting standards.ResultsThe performance of VHWs in the SURE-P maternal and child health programme was linked to four main mechanisms of motivation: feelings of confidence, sense of identity or feeling of acceptance, feeling of happiness and hopefulness/expectation of valued outcome. These mechanisms were triggered by interactions of programme-specific contexts and resources such as training and supervision of VHWs by skilled health workers, provision of first aid kits and uniforms, and payments of a monthly stipend. The monthly payment was considered to be the most important motivational factor by VHWs. VHWs used a combination of innovative approaches to create demand for maternity services among pregnant women, and their performance was influenced by health system factors such as organisational capacity and culture, and societal factors such as relationship with the community and community support.ConclusionThis paper highlights important contextual factors and mechanisms for VHW motivation that can be applied to other interventions that seek to strengthen community engagement and demand creation in primary health care. Future research on how to sustain VHW motivation is also required.
  Citation: Journal of Health Services Research & Policy
  PubDate: 2022-01-28T03:59:16Z
  DOI: 10.1177/13558196211055323
Person-centred care and measurement: The more one sees, the better one
knows where to look
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  Authors: Brendan McCormack
  First page: 85
  Abstract: Journal of Health Services Research & Policy, Ahead of Print.
  
  Citation: Journal of Health Services Research & Policy
  PubDate: 2022-01-27T07:20:23Z
  DOI: 10.1177/13558196211071041
What counts as a voiceable concern in decisions about speaking out in
hospitals: A qualitative study
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  Authors: Mary Dixon-Woods, Emma L Aveling, Anne Campbell, Akbar Ansari, Carolyn Tarrant, Janet Willars, Peter Pronovost, Imogen Mitchell, David W Bates, Christian Dankers, James McGowan, Graham Martin
  First page: 88
  Abstract: Journal of Health Services Research & Policy, Ahead of Print.
  ObjectivesThose who work in health care organisations are a potentially valuable source of information about safety concerns, yet failures of voice are persistent. We propose the concept of ‘voiceable concern’ and offer an empirical exploration.MethodsWe conducted a qualitative study involving 165 semi-structured interviews with a range of staff (clinical, non-clinical and at different hierarchical levels) in three hospitals in two countries. Analysis was based on the constant comparative method.ResultsOur analysis shows that identifying what counts as a concern, and what counts as a occasion for voice by a given individual, is not a straightforward matter of applying objective criteria. It instead often involves discretionary judgement, exercised in highly specific organisational and cultural contexts. We identified four influences that shape whether incidents, events and patterns were classified as voiceable concerns: certainty that something is wrong and is an occasion for voice; system versus conduct concerns, forgivability and normalisation. Determining what counted as a voiceable concern is not a simple function of the features of the concern; also important is whether the person who noticed the concern felt it was voiceable by them.ConclusionsUnderstanding how those who work in health care organisations come to recognise what counts as a voiceable concern is critical to understanding decisions and actions about speaking out. The concept of a voiceable concern may help to explain aspects of voice behaviour in organisations as well as informing interventions to improve voice.
  Citation: Journal of Health Services Research & Policy
  PubDate: 2022-01-03T03:33:49Z
  DOI: 10.1177/13558196211043800
An evaluation of five regional health information technology-based
programmes to improve health and social care coordination: A
quasi-experimental controlled before/after mixed design
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  Authors: Louis-Rachid Salmi, Tamara Roberts, Thomas Renaud, Sophie Buffeteau, Sandrine Cueille, Emmanuelle Fourneyron, Aurélie Gaillard, Maelys Abraham, Nora Arditi, Mathieu Castry, Fabien Daniel, N'deye Fatou N'gom, Orlane Guéry, Yannick L'Horty, Stéphane Pincemail, Sonia Purgues, Franz Thiessard, Viviane Ramel, Emmanuel Langlois, Florence Saillour-Glénisson, Matthieu Sibé, Jérôme Wittwer
  First page: 122
  Abstract: Journal of Health Services Research & Policy, Ahead of Print.
  ObjectivesHealth information technology (HIT) can help coordinate health and social actors involved in patients’ pathways. We assess five regional HIT-based programmes (‘Territoires de Soins Numériques’ or TSN) introduced in France, covering the period 2012–2018.MethodsThis was a quasi-experimental controlled before/after mixed design. We used data from the French National Health Insurance database, qualitative and quantitative surveys, and information extracted from project documents and databases. We assessed the impact of TSN using four main impact indicators: emergency room visits, unplanned hospitalizations, avoidable hospitalizations and rehospitalization within 30 days. We also collected qualitative and secondary quantitative data covering perceived needs, knowledge, use, satisfaction, adoption and understanding of projects, pathway experience, impact on professional practices and appropriateness of hospitalizations.ResultsTSN implemented a heterogeneous mix of HIT. Implementation was slower than expected and was not well documented. Users perceived the HIT as having a positive but weak overall effect. There were no significant differences in trends for the main impact indicators, nor on the appropriateness of hospitalizations, but favourable trends on secondary polypharmacy indicators.ConclusionsIf similar innovations take place in future, they should be based on a logical framework that defines causal, measurable links between services provided and expected impacts.
  Citation: Journal of Health Services Research & Policy
  PubDate: 2022-02-12T02:08:37Z
  DOI: 10.1177/13558196211065704
Barriers to early detection and management of oral cancer in the Asia
Pacific region
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  Authors: Sin Wi Ng, Sharifah Nur Syamim Syed Mohd Sobri, Rosnah binti Zain, Thomas George Kallarakkal, Rahmi Amtha, Felix A Wiranata Wong, Jyotsna Rimal, Callum Durward, Chanbora Chea, Ruwan Duminda Jayasinghe, Patravoot Vatanasapt, Nor Saleha binti Ibrahim Tamin, Lai Choo Cheng, Siti Mazlipah binti Ismail, Chher Tepirou, Zainal Ariff bin Abdul Rahman, Senthilmani Rajendran, Jananezwary Kanapathy, Chee Sun Liew, Sok Ching Cheong
  First page: 133
  Abstract: Journal of Health Services Research & Policy, Ahead of Print.
  ObjectiveOral cancer is amenable to early detection but remains a prominent cause of mortality in the Asia Pacific region. This study aimed to identify barriers to early detection and management of oral cancer in the Asia Pacific region.MethodsA mixed-methods approach was employed triangulating findings from a survey and focus groups. The survey was conducted among seven representative members of the Asia Pacific Oral Cancer Network (APOCNET) across six countries. Focus groups were conducted to gain deeper insights into the findings of the survey.ResultsThe identified barriers were a lack of national cancer control strategies and cancer registries and the limited availability of trained health care professionals. Overcoming these challenges in the Asia Pacific region where resources are scarce will require collaborative partnerships in data collection and novel approaches for continuous professional training including eLearning. Further, to overcome the lack of trained health care professionals, innovative approaches to the management of oral potentially malignant lesions and oral cancer including telemedicine were suggested.ConclusionThe findings of this study should be taken into account when charting national cancer control plans for oral cancer and will form the basis for future collaborative studies in evaluating effective measures to improve oral cancer detection and management in low- and middle-income countries.
  Citation: Journal of Health Services Research & Policy
  PubDate: 2022-01-22T10:07:32Z
  DOI: 10.1177/13558196211053110
‘It’s possibly made us feel a little more alienated’: How people
from ethnic minority communities conceptualise COVID-19 and its influence
on engagement with testing
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  Authors: Tushna Vandrevala, Lailah Alidu, Jane Hendy, Shuja Shafi, Aftab Ala
  First page: 141
  Abstract: Journal of Health Services Research & Policy, Ahead of Print.
  ObjectivesThe cultural beliefs, practices and experiences of ethnic minority groups, alongside structural inequalities and the political economy play a critical, but overlooked role in health promotion. This study aimed to understand how ethnic minority groups in the United Kingdom conceptualised COVID-19 and how this influenced engagement in testing.MethodBlack (African and Caribbean) and South Asian (Indian, Pakistani and Bangladeshi) community members were purposefully recruited from across the UK. Fifty-seven semi-structured interviews were conducted and analysed using principles of grounded theory.ResultsWe found that people of Black and South Asian ethnicity conceptualised COVID-19 as a disease that makes them visible to others outside their community and was seen as having more severe risk and suffering worse consequences, resulting in fear, stigmatisation and alienation. Views about COVID-19 were embedded in cultural beliefs, relating to culturally specific ideas around disease, such as ill-health being God’s will. Challenges brought about by the pandemic were conceptualised as one of many struggles, with the saliency of the virus contextualised against life experiences. These themes and others influenced engagement with COVID-19 testing. Testing was less about accessing timely and effective treatment for themselves and more about acting to protect the family and community. Testing symbolised a loss of income, anxiety and isolation, accentuated by issues of mistrust of the system and not being valued, or being treated unfairly.ConclusionHealth communications should focus on counterbalancing the mistrust, alienation and stigmatisation that act as barriers to testing, with trust built using local credible sources.
  Citation: Journal of Health Services Research & Policy
  PubDate: 2022-01-03T01:32:56Z
  DOI: 10.1177/13558196211054961
Measuring with quality: the example of person-centred care
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  Authors: Alan Cribb, Thomas Woodcock
  First page: 151
  Abstract: Journal of Health Services Research & Policy, Ahead of Print.
  Qualitative data analysis should be embedded in routine health service measurement, management and organizational practices. The rigorous use of such analyses should become an institutional norm, comparable to the routine use of quantitative data. Our case is intended to have general relevance, but we develop it by reference to person-centred care and patient-centred outcome measures (PCOMs). The increased use of qualitative data analysis of individualized PCOMs is a crucial complementary counterweight to steps towards the standardization of PCOMs. More broadly, our argument is that health care organizations cannot make confident judgements about whether they are offering appropriate care without collecting qualitative data on what matters to individual patients. Introducing properly supported and conducted qualitative data analyses is important in its own right, and also helps underpin the validity and usefulness of quantitative measurement.
  Citation: Journal of Health Services Research & Policy
  PubDate: 2022-03-02T02:43:14Z
  DOI: 10.1177/13558196211054278
Strategies to reduce waiting times in outpatient rehabilitation services
for adults with physical disabilities: A systematic literature review
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  Authors: Frédérique Dupuis, Julien Déry, Fabio Carlos Lucas de Oliveira, Ana Tereza Pecora, Rose Gagnon, Katherine Harding, Chantal Camden, Jean-Sébastien Roy, Josiane Lettre, Anne Hudon, Marie Beauséjour, Anne-Marie Pinard, Brenna Bath, Simon Deslauriers, Marie-Ève Lamontagne, Debbie Feldman, François Routhier, François Desmeules, Luc J. Hébert, Jordan Miller, Angel Ruiz, Kadija Perreault
  First page: 157
  Abstract: Journal of Health Services Research & Policy, Ahead of Print.
  ObjectiveIdentifying effective strategies to reduce waiting times is a crucial issue in many areas of health services. Long waiting times for rehabilitation services have been associated with numerous adverse effects in people with disabilities. The main objective of this study was to conduct a systematic literature review to assess the effectiveness of service redesign strategies to reduce waiting times in outpatient rehabilitation services for adults with physical disabilities.MethodsWe conducted a systematic review, searching three databases (MEDLINE, CINAHL and EMBASE) from their inception until May 2021. We identified studies with comparative data evaluating the effect of rehabilitation services redesign strategies on reducing waiting times. The Mixed Methods Appraisal Tool was used to assess the methodological quality of the studies. A narrative synthesis was conducted.ResultsNineteen articles including various settings and populations met the selection criteria. They covered physiotherapy (n = 11), occupational therapy (n = 2), prosthetics (n = 1), exercise physiology (n = 1) and multidisciplinary (n = 4) services. The methodological quality varied (n = 10 high quality, n = 6 medium, n = 3 low); common flaws being missing information on the pre-redesign setting and characteristics of the populations. Seven articles assessed access processes or referral management strategies (e.g. self-referral), four focused on extending/modifying the roles of service providers (e.g. to triage) and eight changed the model of care delivery (e.g. mode of intervention). The different redesign strategies had positive effects on waiting times in outpatient rehabilitation services.ConclusionsThis review highlights the positive effects of many service redesign strategies. These findings suggest that there are several effective strategies to choose from to reduce waiting times and help better respond to the needs of persons experiencing physical disabilities.
  Citation: Journal of Health Services Research & Policy
  PubDate: 2022-02-12T11:39:51Z
  DOI: 10.1177/13558196211065707