The role of brokering in healthcare networks: what does it mean for reforms, practitioners and patients?

Well-integrated systems are required to deliver effective healthcare services. Research suggests misaligned organisational and functional boundaries still thwart effective patient care. Using social network theory and knowledge transfer framework we examine two long-term condition health networks where brokering occurs to bridge the gaps in provision or information exchange. The experiences of patients, relatives and healthcare practitioners illustrate where information/knowledge is transferred, translated and transformed across organisational and functional boundaries. We propose brokering is essential to the integrated healthcare system. Areas of further research include power of brokers and the value and cost of brokering

Transferring, Translating and Transforming knowledge: The role of brokering in healthcare networks

Purpose: This research examines how knowledge and information is managed within two care networks. We develop a conceptual framework drawing on the notion of brokering and the 3T framework, which is used to describe the relative complexity of boundaries (referred to in the framework as syntactic, semantic, and pragmatic) as well as capabilities and processes required to exchange information within the network. Previous research on brokering has focused on healthcare managers and professionals this research extends to patients and caregivers. Understanding knowledge exchange and brokering practices in healthcare is critical to the delivery of effective services. Design/methodology/approach: For this case research non-participant observation and experienced-based interviews were undertaken with healthcare professionals, patients, and caregivers within two care networks. Findings: Our findings reveal brokering roles occupied by healthcare professionals, patients and caregivers support the transfer, translation and transformation of knowledge and information across functional and organisational boundaries. Enablers and disablers to brokering and the exchange of knowledge and information are also identified. Research limitations/implications: The study is limited to two care networks for long term conditions within the UK. Further research opportunities exist to examine similar care networks that extend across professional and organisational boundaries. Practical implications: This research informs healthcare professionals of the brokering capabilities that occur within networks and the enabling and disabling factors to managing knowledge across boundaries. Originality: This paper provides a conceptual framework that categorises how increased levels of knowledge and information exchange and brokering practices are managed within care networks

Experiences of frontline nurse managers during the COVID-19: a qualitative study

Aim The aim of this study is to explore the experiences of Jordanian first-line nurse managers during COVID-19. Background Nurses are exposed to life-threatening occupational risks during COVID-19. Exploring the first-line nurse managers' experiences will help in designing health policies to better deal with such emerging crises. Methods A descriptive phenomenological study was conducted. A purposive sample was used to recruit 16 first-line nurse managers from Jordanian hospitals. Semistructured interviews were conducted. Phenomenological data analysis method was used to analyse the data. Results Four major themes emerged: (a) unprecedented pressure (first-line nurse managers revealed their suffering with the unprecedented demanding situations during COVID-19 pandemic); (b) strengthening system and resilience (nurse managers employed several strategies to strengthen the health system and enhance resilience); (c) building a supportive team (the presence of a robust supportive system is vital to deal with the pandemic); and (d) maturity during the crisis (exposure to a new experience developed nurse managers management skills and self-awareness). Conclusions The unprecedented pressure associated with COVID-19 drained first-line nurse managers physically and psychosocially. Providing adequately trained staff and medical equipment is important to better deal with crises. Implications for Nursing Management Strengthening emergency training and improving emergency response plans of hospitals are essential

Inflammatory signaling regulates embryonic hematopoietic stem and progenitor cell production

Identifying signaling pathways that regulate hematopoietic stem and progenitor cell (HSPC) formation in the embryo will guide efforts to produce and expand HSPCs ex vivo. Here we show that sterile tonic inflammatory signaling regulates embryonic HSPC formation. Expression profiling of progenitors with lymphoid potential and hematopoietic stem cells (HSCs) from aorta/gonad/mesonephros (AGM) regions of midgestation mouse embryos revealed a robust innate immune/inflammatory signature. Mouse embryos lacking interferon γ (IFN-γ) or IFN-α signaling and zebrafish morphants lacking IFN-γ and IFN-ϕ activity had significantly fewer AGM HSPCs. Conversely, knockdown of IFN regulatory factor 2 (IRF2), a negative regulator of IFN signaling, increased expression of IFN target genes and HSPC production in zebrafish. Chromatin immunoprecipitation (ChIP) combined with sequencing (ChIP-seq) and expression analyses demonstrated that IRF2-occupied genes identified in human fetal liver CD34(+) HSPCs are actively transcribed in human and mouse HSPCs. Furthermore, we demonstrate that the primitive myeloid population contributes to the local inflammatory response to impact the scale of HSPC production in the AGM region. Thus, sterile inflammatory signaling is an evolutionarily conserved pathway regulating the production of HSPCs during embryonic development

Reverse Exchange: Classifications for Public Service SCM

Purpose: To identify reverse flows and exchanges that support public service provision. Reverse flow literature has focused on manufacturing based supply chains utilising the lens of exchange (Recovery, Reuse, Repair, Recycle) to gain performance improvement in product flows. Limited research is available to support an understanding of customer derived reverse exchange (RE) service processes. We contribute to the service literature through the development of RE antecedents; derive new and revised definitions and the supporting constructs of RE service processes. Design/Methodology/Approach: This paper synthesises literature creating a framework of antecedents for RE. Antecedents reflect differences of service flow (level of service inseparability and ‘acting upon’). These antecedents are empirically tested within an illustrative pre-existing UK healthcare case study against the synthesised antecedents and existing RE definitions. Two teams of researchers reviewed the data generated from public service supply chain processes. Definitions of RE were either revised or derived from the empirical data by each team. Findings: The service concept of ‘acting upon’ for inseparable public service supply chain flows provides a basis for examining the existence of reverse flows and exchanges. Revised and new classifications to the RE model are proposed to stimulate contextual performance improvement and innovation in public service provision. Psychological utility is an additional feature to economic, environmental and social utility in public service RE. RE offers practitioners and academics a strategic operational competence to achieve improvement and innovation in public services and further advance this concept. Originality/Value: Extending the literature beyond the manufacturing derived RE concept to develop an understanding of the customer’s role in preserving and co-creating value in RE and flows in public service. New RE antecedents for public services, including the potential of psychological utility, are presented.</p

Experiences of frontline nurse managers during the COVID-19: a qualitative study

Aim The aim of this study is to explore the experiences of Jordanian first-line nurse managers during COVID-19. Background Nurses are exposed to life-threatening occupational risks during COVID-19. Exploring the first-line nurse managers' experiences will help in designing health policies to better deal with such emerging crises. Methods A descriptive phenomenological study was conducted. A purposive sample was used to recruit 16 first-line nurse managers from Jordanian hospitals. Semistructured interviews were conducted. Phenomenological data analysis method was used to analyse the data. Results Four major themes emerged: (a) unprecedented pressure (first-line nurse managers revealed their suffering with the unprecedented demanding situations during COVID-19 pandemic); (b) strengthening system and resilience (nurse managers employed several strategies to strengthen the health system and enhance resilience); (c) building a supportive team (the presence of a robust supportive system is vital to deal with the pandemic); and (d) maturity during the crisis (exposure to a new experience developed nurse managers management skills and self-awareness). Conclusions The unprecedented pressure associated with COVID-19 drained first-line nurse managers physically and psychosocially. Providing adequately trained staff and medical equipment is important to better deal with crises. Implications for Nursing Management Strengthening emergency training and improving emergency response plans of hospitals are essential