What does it take to make integrated care work? A ‘cookbook’ for large-scale deployment of coordinated care and telehealth

The Advancing Care Coordination & Telehealth Deployment (ACT) Programme is the first to explore the organisational and structural processes needed to successfully implement care coordination and telehealth (CC&TH) services on a large scale. A number of insights and conclusions were identified by the ACT programme. These will prove useful and valuable in supporting the large-scale deployment of CC&TH. Targeted at populations of chronic patients and elderly people, these insights and conclusions are a useful benchmark for implementing and exchanging best practices across the EU. Examples are: Perceptions between managers, frontline staff and patients do not always match; Organisational structure does influence the views and experiences of patients: a dedicated contact person is considered both important and helpful; Successful patient adherence happens when staff are engaged; There is a willingness by patients to participate in healthcare programmes; Patients overestimate their level of knowledge and adherence behaviour; The responsibility for adherence must be shared between patients and health care providers; Awareness of the adherence concept is an important factor for adherence promotion; The ability to track the use of resources is a useful feature of a stratification strategy, however, current regional case finding tools are difficult to benchmark and evaluate; Data availability and homogeneity are the biggest challenges when evaluating the performance of the programmes

An integrative model of the management of hospital physician relationships

Hospital Physician Relationships (HPRs) are of major importance to the health care sector. Drawing on agency theory and social exchange theory, we argue that both economic and noneconomic integration strategies are important to effective management of HPRs. We developed a model of related antecedents and outcomes and conducted a systematic review to assess the evidence base of both integration strategies and their interplay. We found that more emphasis should be placed on financial risk sharing, trust and physician organizational commitment

What health care for undocumented migrants in Belgium?

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Il costo dell’intervento chirurgico in laparoscopia con l’Activity Based Costing

The purpose of this research is to analyze the role of the Management Control System (MCS) and of the Management Accounting System (MAS) in healthcare (HC) organizations. It aims at studying if and how managerial considerations affect the clinical culture. Results are based on the findings of a research developed within 12 Local Health Authorities (Aziende Sanitarie Locali LHAs) and 4 Teaching Hospital (Aziende Ospedaliere Universitarie THs) in Italian Tuscany Region and address the possibility to develop an alternative model from those of accountingization or legitimation proposed in literature to understand the role of these systems in healthcare. Results highlight that the economic language may assume a great importance in clinicians’ decision making and penetrates into clinical culture. Most important factor affecting results is the development of an alliance between controllers and clinicians, based trust and collaboration. The paper is a contribution to the literature about the role of MCS and MAS in healthcare and it is developed within the schemes traced by Habermas and refined by Laughlin and by Broadbent and Laughlin. The original value stands on the individuation of a model where the “integrative interactive” management model is able to penetrate clinical discourse and the conditions at which it can be developed.Management Accounting Change, Management Control Change, Healthcare Accounting, Professional organization, accountinization, legitimation, Habermas

Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science

Abstract Background Many interventions found to be effective in health services research studies fail to translate into meaningful patient care outcomes across multiple contexts. Health services researchers recognize the need to evaluate not only summative outcomes but also formative outcomes to assess the extent to which implementation is effective in a specific setting, prolongs sustainability, and promotes dissemination into other settings. Many implementation theories have been published to help promote effective implementation. However, they overlap considerably in the constructs included in individual theories, and a comparison of theories reveals that each is missing important constructs included in other theories. In addition, terminology and definitions are not consistent across theories. We describe the Consolidated Framework For Implementation Research (CFIR) that offers an overarching typology to promote implementation theory development and verification about what works where and why across multiple contexts. Methods We used a snowball sampling approach to identify published theories that were evaluated to identify constructs based on strength of conceptual or empirical support for influence on implementation, consistency in definitions, alignment with our own findings, and potential for measurement. We combined constructs across published theories that had different labels but were redundant or overlapping in definition, and we parsed apart constructs that conflated underlying concepts. Results The CFIR is composed of five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. Eight constructs were identified related to the intervention (e.g., evidence strength and quality), four constructs were identified related to outer setting (e.g., patient needs and resources), 12 constructs were identified related to inner setting (e.g., culture, leadership engagement), five constructs were identified related to individual characteristics, and eight constructs were identified related to process (e.g., plan, evaluate, and reflect). We present explicit definitions for each construct. Conclusion The CFIR provides a pragmatic structure for approaching complex, interacting, multi-level, and transient states of constructs in the real world by embracing, consolidating, and unifying key constructs from published implementation theories. It can be used to guide formative evaluations and build the implementation knowledge base across multiple studies and settings.http://deepblue.lib.umich.edu/bitstream/2027.42/78272/1/1748-5908-4-50.xmlhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/2/1748-5908-4-50-S1.PDFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/3/1748-5908-4-50-S3.PDFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/4/1748-5908-4-50-S4.PDFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/5/1748-5908-4-50.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/6/1748-5908-4-50-S2.PDFPeer Reviewe

Do management accounting systems influence organizational change or vice-versa? Evidence from a case of constructive research in the Healthcare Sector

The paper aims to analyze the process of change of management accounting system (MAS) as a consequence of changes in the complexity of organizational structure in healthcare. It analyzes the process of change of MAS according with the theoretical frameworks of Habermas (1987) and Laughlin (1991).In this organizational changes are seen as the consequence of the interaction between tangible and intangible elements of the organization and between the organization and the external environment. The process of change was not studied from an external standpoint, but through an active participation and contribution of the researchers in the process of change itself. Using a constructive approach, the researchers were actively involved with the actors of the change in developing the process of change, and in facilitating the overcoming of some cultural gaps and resistance which could arise in professional organization. The paper provides empirical insights of the characteristics of the process of change of MAS in a Heath Care setting with a particular focus on aspects characterizing the process of change itself. Finding suggests the importance of putting high attention in the development of the process of change and underlines how the attention to peculiarities of the organization, in to this phase, could make the MAS able to impact on the behaviours and culture of professionals.Management Accounting Change, Healthcare Accounting, Habermas

Human experience in the natural and built environment : implications for research policy and practice

22nd IAPS conference. Edited book of abstracts. 427 pp. University of Strathclyde, Sheffield and West of Scotland Publication. ISBN: 978-0-94-764988-3

The chaotic nature of healthcare information systems: The need for transdisciplinary collaboration

Copyright @ 2013 EMCIS.This paper demonstrates one of the challenges of the healthcare information systems development, namely the chaotic nature of healthcare systems. Although the reliable evidence demonstrating the positive effects of health information systems on safety and quality remains inconclusive (a growing body of research revealing the unintended consequences and potentially error producing effects of health information systems’ implementation. Different arguments from the literature concerning the chaotic nature of healthcare, including but not limited to the nature of patients and disease have been presented. The requirements of new ways of systems design and the need for transdisciplinary dynamic teams within the requirements engineering phase as a start has been discussed. These arguments have been investigated in the context of an exploratory case addressing one of the advanced oncology centres in the US. This paper concludes that there is an important need to rethink healthcare information systems development method, which has to be in a dynamic ongoing manner for some major issues