Devolved governance systems

This article assesses the extent, nature and outcomes of the recently devolved health service governance in the four countries which comprise the United Kingdom. This four-part configuration can be seen as a natural experiment in comparative governance which could therefore carry important lessons not only for the UK but in other countries too. While remaining under the aegis of the National Health Service, each constituent devolved administration has a developed a substantially different governance system. These systems reflect fundamental issues and priorities concerning the decentring of authority, the production and deployment of authority, the suite of incentives required and the preferred role of quasi-market mechanisms. The paper makes an evaluation of the strengths and weaknesses of each governance regime

Challenging the Enterprises' Business Model: helping entrepreneurs to understand and interpret opportunities and threats

Christopher Brown, Diane Morrad, ‘Challenging the Enterprises' Business Model: helping entrepreneurs to understand and interpret opportunities and threats’, paper presented at the 15th Annual Edineb Conference, Malaga, Spain, 15-18 June, 2008.Enterprises are presented with ever increasing challenges regarding marketplace uncertainty and ambiguity. They face competitive pressures from local and international sources, their competitors are constantly tweaking products and services to jostle ahead of them, and their customers expect responsiveness and innovativeness to their expressed and latent needs. The enterprises’ very success, and survival, depends on their ability to change their business, market and product strategies to fit these challenges. Underlying these business, market and product strategies is the enterprises’ business model. Simply, business models are an organisation’s understanding and interpretation of how they currently, and in the future, achieve their revenue and profit streams. These business models, used by the senior management and employees, are often based on outdated perspectives of both how the marketplace works and the changing business and customer values expected by their demanding stakeholders. In SMEs the creation, development and creative deconstruction of business models is most often driven by the founding entrepreneur, or subsequent corporate entrepreneurs brought in to provide professional management of these rapidly growing businesses. Interestingly, more recent research has strongly linked entrepreneurs’ mindset, or mental models (Zahra, Korri et al. 2005), associated with the challenges to the enterprise, with their drivers for innovation and changes in their enterprises’ business models. Certainly research has identified the potential value changes, business and customer, that can often facilitate the construction and deconstruction of business value-based innovations (Munive-Hernandez, Dewhurst et al. 2004), and then reflecting these in their overall business processes. This paper discusses the research study, undertaken by the authors, to explore the link between entrepreneurs’ understanding and interpretation of business opportunities and threats, and the potential influence in challenging their mindset business model. The paper begins by discussing the two broad approaches to modelling enterprise strategies and the resulting integrated business models: innovation and process orientations.Peer reviewedSubmitted Versio

Softer perspectives on enhancing the patient experience using IS/IT

Purpose – This paper aims to argue that the implementation of the Choose and Book system has failed due to the inability of project sponsors to appreciate the complex and far-reaching softer implications of the implementation, especially in a complex organisation such as the NHS, which has multifarious stakeholders. Design/methodology/approach – The authors use practice-oriented research to try and isolate key parameters. These parameters are compared with existing conventional thinking in a number of focused areas. Findings – Like many previous NHS initiatives, the focus of this system is in its obvious link to patients. However we find that although this project has cultural, social and organisational implications, programme managers and champions of the Connecting for Health programme emphasised the technical domains to IS/IT adoption. Research limitations/implications – This paper has been written in advance of a fully implemented Choose and Book system. Practical implications – The paper requests that more attention be paid to the softer side of IS/IT delivery, implementation, introduction and adoption. Originality/value – The paper shows that patient experience within the UK healthcare sector is still well below what is desired

Ensuring patients privacy in a cryptographic-based-electronic health records using bio-cryptography

Several recent works have proposed and implemented cryptography as a means to preserve privacy and security of patients health data. Nevertheless, the weakest point of electronic health record (EHR) systems that relied on these cryptographic schemes is key management. Thus, this paper presents the development of privacy and security system for cryptography-based-EHR by taking advantage of the uniqueness of fingerprint and iris characteristic features to secure cryptographic keys in a bio-cryptography framework. The results of the system evaluation showed significant improvements in terms of time efficiency of this approach to cryptographic-based-EHR. Both the fuzzy vault and fuzzy commitment demonstrated false acceptance rate (FAR) of 0%, which reduces the likelihood of imposters gaining successful access to the keys protecting patients protected health information. This result also justifies the feasibility of implementing fuzzy key binding scheme in real applications, especially fuzzy vault which demonstrated a better performance during key reconstruction

Sustainability Capacity of HIV/AIDS Programmes in YOGYAKARTA, Indonesia

The Indonesian government established the prevalence target of HIV <0.50% in 2019 to control the spreading of HIV through the National Medium Term Development Plan. To ensure the sustainability of this development plan, a study of the strategic capacity of HIV/AIDS programmes is needed to provide an overview so that the program can be sustained over time. This study aimed to explore the sustainability capacity of HIV/AIDS programmes in Yogyakarta. This was a descriptive study utilizing a qualitative approach. The study involved 42 participants as key informants selected by a purposive sampling technique, and the data were examined using content analysis. By setting priorities of the local government supported by the Provincial Health Office and with the coordination of the Yogyakarta Province AIDS Commission, the programs are able to maintain sustainable HIV and AIDS programmes in Yogyakarta. Funding capacity, evaluation, programme adaptation and communication have not been optimal to ensure the sustainability. Stability of funding is the main obstacle to achieving the sustainability of HIV and AIDS programs. However, with good planning, partnership structure and sufficient organizational capacity, this approach can ensure the HIV and AIDS programmes will continue with the targets set by the Yogyakarta Provincial Health Office. The government in Yogyakarta needs to increase funding capacity, and improve communication to ensure sustainability. The strategy should include adaptation and evaluation of programs through strengthening private sector financing, formulating a communication plan and improving the capacity to respond to change

An overview of the research evidence on ethnicity and communication in healthcare

• The aim of the present study was to identify and review the available research evidence on 'ethnicity and communication' in areas relevant to ensuring effective provision of mainstream services (e.g. via interpreter, advocacy and translation services); provision of services targeted on communication (e.g. speech and language therapy, counselling, psychotherapy); consensual/ participatory activities (e.g. consent to interventions), and; procedures for managing and planning for linguistic diversity

The role of user requirements research in medical device development

Aims and Objectives: This research aims to suggest a concise framework to help in the better conceptualisation and integration of users in the medical device development (MDD) process. The current economic, political and social climate concerning the matter of healthcare delivery has resulted in the emergence of numerous users and user groups for whom the healthcare system has not previously catered for. These users have created ambiguity for the designers and manufacturers of medical devices as the boundaries between their needs and requirements have blurred, outdating current methods of MDD to meet consumer needs. Research Design and Methodology: The research methodology begins primarily with conducting a literature search on the theories relating to user requirements and medical device development. The paper outlines these findings through initially describing users and user involvement and relating them to medical devices. The cross-disciplinary nature of healthcare influenced the investigation into multiple disciplines including; IT, Ergonomics – particularly participatory research, Psychology and Design. These disciplines expose various methods and processes, which are useful to user requirements research. These methods were analysed for their compatibility, and then used to construct a conceptual framework for user involvement in MDD. Results: The research insinuates the true significance of user involvement and hence resulted in the formation of a conceptual framework to aid user involvement in the MDD process. The framework is produced by the amalgamation of relevant methods examined across the disciplines, in a complimentary fashion. Conclusion: The originality of this research lies in its use of a multidisciplinary approach. Previous research claiming multi-methods has dealt with combining two disciplines or methods at a time i.e. Computer supported cooperative work (CSCW) with participatory research (Scandurra et al, 2008) for the needs analysis of healthcare professionals only. Collaboration across disciplines has also been investigated (Johnson et al, 2005), but this was for the purpose of redesign rather than initial designs. This framework can help medical device designers to fully access all user requirements through more extensive collaboration right at the start. It reduces the risk of high costs involved in device rejection, usually associated with belated recognition of user needs in the design cycle

Identity dynamics as a barrier to organizational change

This article seeks to explore the construction of group and professional identities in situations of organizational change. It considers empirical material drawn from a health demonstration project funded by the Scottish Executive Health Department, and uses insights from this project to discuss issues that arise from identity construction(s) and organizational change. In the course of the project studied here, a new organizational form was developed which involved a network arrangement with a voluntary sector organization and the employment of “lay-workers” in what had traditionally been a professional setting. Our analysis of the way actors made sense of their identities reveals that characterizations of both self and other became barriers to the change process. These identity dynamics were significant in determining the way people interpreted and responded to change within this project and which may relate to other change-oriented situations

Exploring knowledge management integration through EAI in local government domain

Information Technology (IT) infrastructure integration and knowledge management share communal objectives e.g. to make organisations more effective and efficient, agile and innovative, and more responsive to market changes. Such association when assimilates bona fide knowledge management philosophy, it offers the IT departments a headship opportunity for organisational transformation in affiliation with the rest of the establishment. Notwithstanding, in the context of Local Government Authorities (LGAs), the non-integrated nature of the IT infrastructure is associated with inefficient data and knowledge exchange and reduction in LGA services’ quality. Therefore, numerous data inconsistencies and redundancies occur that impact LGA services to their citizenry. LGAs have deployed Enterprise Application Integration (EAI) technological solutions to integrate their legacy with new developed Information Systems (IS). Literature indicates that EAI achieves integration at five layers namely: (a) connectivity, (b) transportation, (c) transformation, (d) process integration and (e) knowledge integration. This research adapts a Revised Model for Integration Layers (REAL) and tests through a case study in a local authority. The results indicate that cases leading to data inconsistencies and replication can be prevented by integrating knowledge through EAI