bluuebunny/crossref_metadata_2025_split huggingface dataset:
Enterprising health
Authors: Exton Rosemary 
Published: November 2014

PurposeThis paper seeks to investigate conditions under which entrepreneurs emerge as agents of effective and sustainable change in UK National Health Service Trusts.Design/methodology/approachThe research synthesises literature on changing regulatory structures (“post‐bureaucracy”) and entrepreneurial behaviour to understand how individual identity construction is informed both by context and by individual attributes. Thematic analysis of interview data involving managers from 11 NHS Trusts, including detailed analysis of six transcripts, focuses on regulatory processes, the emergence of entrepreneurial behaviour and outcome variations in workplace innovation and improvement.FindingsThis study identifies co‐existing modes of regulation, which interact with individual behaviour, generating strategies differentiated as entrepreneurial or conformist. Four ideal types are identified: organisational entrepreneurship, resisted or dissonant entrepreneurship, conformity, and symbolic entrepreneurship. Analysis reinforces those literature findings, which suggest that the interaction of regulatory structures and the identity work of individuals influence the emergence of entrepreneurial behaviour and the effectiveness of change.Practical implicationsThe ability to achieve effective and sustainable outcomes varies considerably even between NHS Trusts faced with comparable challenges in implementing nationally prescribed targets. This variance is explained in terms of the organisation's ability to generate the structures, processes, individual competence and motivation which enable employees at all levels to act entrepreneurially with the ability and legitimacy to achieve strategic goals by working creatively in the spaces between formal organisational structures.Originality/valueThe study identifies specific conditions, which stimulate the emergence of entrepreneurs as agents of effective and sustainable change in the NHS, identifying factors that policymakers should consider when implementing change.
Learning practice? Exploring the links between transitions and medical performance
Authors: Kilminster Sue , Zukas Miriam , Quinton Naomi , Roberts Trudie 
Published: November 2014

PurposeThe aims of this paper are to understand the links between work transitions and doctors' performance and to identify the implications for policy, regulation, practice and research.Design/methodology/approachThe paper explains transitions in terms of the inseparability of learning, practice and performance and introduces the concept of the transition as a critically intensive learning period to draw attention to this phenomenon. It also identifies implications for practice, research and regulationFindingsDrawing on empirical data in relation to prescribing and case management, the paper will show that, in contrast to current assumptions of, understanding about and practice in doctors' transitions, doctors can never be fully prepared in advance for aspects of their work.Originality/valueTransitions are explained in terms of the inseparability of learning, practice and performance and we introduce the concept of the transition as a critically intensive learning period to draw attention to this phenomenon. Also identified are implications for practice, research and regulation.
A new workforce in the making?
Authors: Macfarlane Fraser , Greenhalgh Trish , Humphrey Charlotte , Hughes Jane , Butler Ceri , Pawson Ray 
Published: November 2014

PurposeThis paper seeks to describe the exploration of human resource issues in one large‐scale program of innovation in healthcare. It is informed by established theories of management in the workplace and a multi‐level model of diffusion of innovations.Design/methodology/approachA realist approach was used based on interviews, ethnographic observation and documentary analysis.FindingsFive main approaches (“theories of change”) were adopted to develop and support the workforce: recruiting staff with skills in service transformation; redesigning roles and creating new roles; enhancing workforce planning; linking staff development to service needs; creating opportunities for shared learning and knowledge exchange. Each had differing levels of success.Practical implicationsThe paper includes HR implications for the modernisation of a complex service organisation.Originality/valueThis is the first time a realist evaluation of a complex health modernisation initiative has been undertaken.
Offshoring of healthcare services: the case of US‐India trade in medical transcription services
Authors: Kshetri Nir , Dholakia Nikhilesh 
Published: November 2014

PurposeThe issue of offshore outsourcing of healthcare services is a critical but little‐examined problem in healthcare research. The purpose of this study is to contribute to filling this void.Design/methodology/approachA library‐based study was carried out of the development of the Indian medical transcription offshoring industry.FindingsCost‐saving potential and the degree of outsourceability are higher for medical transcription compared with most services. Offshoring experience, typically in a low‐value BPO, helps to enhance productivity and international linkages required for the success of medical transcription.Research limitations/implicationsAn important area of future research concerns comparing India's factor endowments in medical transcription outsourcing with other services. Further research is also needed to examine how India differs from its regional competitors in terms of factors endowments associated with these services. Another extension would be to investigate the drivers of offshoring of higher value services such as radiological readings.Practical implicationsICT infrastructures needed for outsourcing require much less investment compared with leading capital‐intensive industries. The development patterns of the Indian medical and offshoring industries indicate that India may attract higher skilled medical functions in the future. The Indian offshoring industry is shifting its focus from BPO to knowledge process outsourcing (KPO). Developing countries need to shift to greater automation and greater levels of skill training to retain and reinforce their comparative advantages.Originality/valueThis paper's greatest value stems from the fact that it examines the drivers of a new but rapidly growing healthcare industry.
Financing public healthcare institutions in Ghana
Authors: Akosua Akortsu Mercy , Aseweh Abor Patience 
Published: November 2014

PurposeThe financing of healthcare services has been of a major concern to all governments in the face of increasing healthcare costs. For developing countries, where good health is considered a poverty reduction strategy, it is imperative that the hospitals used in the delivery of healthcare services are well financed to accomplish their tasks. The purpose of this paper is to examine how public hospitals in Ghana are financed, and the challenges facing the financing modes adopted.Design/methodology/approachTo achieve the objectives of the study, one major public healthcare institution in Ghana became the main focus.FindingsThe findings of the study revealed that the main sources of financing the public healthcare institution are government subvention, internally‐generated funds and donor‐pooled funds. Of these sources, the internally generated fund was regarded as the most reliable, and the least reliable was the donor‐pooled funds. Several challenges associated with the various financing sources were identified. These include delay in receipt of government subvention, delay in the reimbursement of services provided to subscribers of health insurance schemes, influence of government in setting user fees, and the specifications to which donor funds are put.Originality/valueThe findings of this study have important implications for improving the financing of public healthcare institutions in Ghana. A number of recommendations are provided in this regard.
Operational and contextual drivers of hospital costs
Authors: Stock Gregory N. , McDermott Christopher 
Published: November 2014

PurposeThe purpose of this paper is to examine empirically how operational performance and contextual factors contribute to differences in overall patient care costs across different hospitals.Design/methodology/approachAdministrative data are employed from a sample of hospitals in New York State to construct measures of contextual factors, operational performance, and cost per patient. Operational performance and cost variables are adjusted to account for case mix differences across hospitals. Hierarchical regression is used to analyze the effects of contextual and operational variables on cost performance.FindingsIncreased length of stay, increased patient volume, and educational mission were associated with higher cost per patient. Mortality performance was associated with lower cost per patient. However, it was not found that location, size, or ownership status had a significant relationship with cost performance.Practical implicationsThis paper identifies several significant relationships between contextual and operational variables and hospital costs. From a managerial perspective, these findings highlight the fact that some drivers of cost in hospitals are under the control of managers. One of the primary cost drivers in the study is length of stay, which implies that there is significant room for improvement in healthcare performance through a focus on operational excellence.Originality/valueFor researchers, the present study highlights the relative importance of operational versus contextual factors, with respect to cost performance in hospitals. The results of this study also provide direction for additional research into the role operational performance might play in determining the overall organizational performance in a hospital.
Mind the gap
Authors: Gkeredakis Emmanouil , Swan Jacky , Powell John , Nicolini Davide , Scarbrough Harry , Roginski Claudia , Taylor‐Phillips Sian , Clarke Aileen 
Published: November 2014

PurposeThe paper aims to take a reflective stance on the relationship between policy/evidence and practice, which, the authors argue, is conceptually under‐developed. The paper aims to show that current research perspectives fail to frame evidence and policy in relation to practice.Design/methodology/approachA qualitative study was conducted in the English NHS in four Primary Care Trusts (PCTs). Seventy‐five observations of meetings and 52 semi‐structured interviews were completed. The approach to data analysis was to explore and reconstruct narratives of PCT managers' real practices.FindingsThe exploratory findings are presented through two kinds of narratives. The first narrative vividly illustrates the significance of the active involvement, skills and creativity of health care practitioners for policy implementation. The second narrative elucidates how problems of collaboration among different experts in PCTs might emerge and affect evidence utilisation in practice.Practical implicationsThe findings exemplify that policies are made workable in practice and, hence, policy makers may also need to be mindful of practical intricacies and conceive policy implementation as an iterative process.Originality/valueThe contribution of this paper lies in offering an alternative and important perspective to the debate of utilisation of policy/evidence in health care management and in advancing existing understanding of health care management practice. The paper's rich empirical examples demonstrate some important dimensions of the complexity of practice.
Organizational culture based on the example of an Estonian hospital
Authors: Saame Iisi , Reino Anne , Vadi Maaja 
Published: November 2014

PurposeThe concept of organisational culture (also referred to later as OC) is one of the approaches in modern organisational analysis exploring the values, attitudes and beliefs behind human behaviour in the workplace. OC as a social phenomenon is considered to be important for the sustainability of every organisation. In the service sector, OC may affect the nature and quality of the services provided. The aim of this paper is twofold: on the one hand, to highlight the patterns of OC in a hospital; and, on the other hand, to outline relationships between OC and patient satisfaction. The study was conducted in Tartu University Hospital, one of the most influential health care organisations in Estonia. This paper has original value by presenting an insight into organisational culture in the Estonian health care sector, and the findings of the study will expand knowledge of OC in the health care sector in general.Design/methodology/approachThe OC instrument applied in a quantitative cross‐sectional study was earlier developed according to the Competing Values Framework (CVF). Data from 456 medical and non‐medical professionals were analysed using non‐parametric tests of descriptive statistics. A factor analysis was performed to assess the instrument's compatibility for analysing the OC pattern in the health care sector.FindingsThe dominant culture type in all the groups investigated was the Internal Processes type, mainly followed by the Rational Goal type, while different cultural patterns were observed in professional groups. The factor analysis yielded a three‐subscale solution. Clinics with high patient satisfaction did not score more than clinics with low patient satisfaction in terms of the Human Relations type.Originality/valueIn future studies a random sample design and a multidisciplinary approach to OC research should be followed in order to further explore OC patterns in hospitals and their consequences for different aspects of hospital performance.
The trade‐off between efficiency and quality in hospital departments
Authors: Mennicken Roman , Kuntz Ludwig , Schwierz Christoph 
Published: November 2014

PurposeHospital managers are confronted with decisions that have to account for multiple objectives, which may be in conflict with regard to efficiency and quality of care. In empirical studies occupancy and staffing ratios as well as in‐hospital mortality are frequently used measures for efficiency and quality‐of‐care, respectively. Efficiency and quality measures vary on a daily basis. However, most empirical studies fail to take this variation into account, especially because data of daily staffing levels are lacking. The paper seeks to exploit the notion that staffing levels are planned according to expected occupancy levels, i.e. estimated daily occupancy levels account for unobserved daily staffing levels.Design/methodology/approachUsing administrative data from 2004 for a sample of 62 departments in 33 German hospitals, the relation between daily occupancy levels and in‐hospital mortality count on the department level is analyzed. In an OLS‐framework the paper estimates daily occupancy level for all departments and then uses the predicted occupancy levels in a zero‐inflated Poisson (ZIP) regression framework to explain in‐hospital mortality count.FindingsThe results show a potential trade‐off relation between predicted occupancy rates and mortality. More specifically, the paper finds that the trade‐off relation is less pronounced in hospitals with a higher number of available staff per bed.Originality/valueFirst, the paper shows evidence for a negative trade‐off between measures of managerial and medical performance on a day‐to‐day basis. Second, interactions between single measures of efficiency are modeled, namely predicted occupancy rate and staff per bed ratios, and policy implications are developed. Third, first empirical results in this respect using German data are presented.
Steering whilst rowing: governing and managing health services from the centre
Authors: Storey John 
Published: November 2014

PurposeThe article seeks to explore the practical and theoretical implications of the ways in which senior figures in the National Health Service (NHS) interpret the role of the centre in relation to the delivery units of the health service. This is important in the light of recent plans for reorganisation of the NHS advanced by the new Conservative‐Liberal coalition government.Design/methodology/approachThe article is based on interviews with civil servants and NHS staff at senior levels in the centre and in the strategic health authorities (SHAs).FindingsIt is found that, in practice, despite numerous attempts to separate out policy making from implementation/management, the two continue to be closely coupled and intertwined. Central staff and regional officials are found to be both steering and rowing.Research limitations/implicationsOnly a small selection of senior officials at the centre and only a small proportion of SHA senior managers and directors were interviewed.Practical implicationsThe implications are far‐reaching. Unless special steps are taken, it seems likely that these senior officials, despite the creation of some new institutions and the curtailment of others, will continue to behave in broadly similar ways to those described here.Originality/valueEmpirical studies of the thinking, assumptions and behaviour of very senior officials in the health service are rare. The analysis in this paper explores the organisational conditions that shape the actions of these senior players.
Molecular dynamics simulations of the shape memory effect in a chain of Lennard‐Jones crystals
Authors: Kastner Oliver , Eggeler Gunther 
Published: November 2014

PurposeShape memory alloys are a fascinating class of materials because they combine both structural and functional properties. These properties strongly depend on temperature. One consequence of this dependency yields the characteristic shape‐memory effect: shape memory alloys can recover processed reference configurations after significant plastic deformations simply upon a change of temperature. For real materials, such processes incorporate characteristic hysteresis. This paper aims at an understanding of these materials from an atomistic point of view.Design/methodology/approach2D molecular‐dynamics (MD) simulations describing a chain consisting of 32 linked Lennard‐Jones crystals are presented. The crystals consist of nested lattices of two atom species. Distinct lattice structures can be identified, interpreted as austenite and (variants of) martensite. Temperature and/or load‐induced phase transitions between these configurations are observed in MD simulations. Previously, the thermal equation of state of one isolated crystal was investigated and its phase stability was discussed in detail. In the multi‐crystal chain considered in the present paper, individual crystals contribute collectively to the thermo‐mechanical behavior of the assembly.FindingsThe paper presents the results of numerical experiments with this polycrystalline chain under strain‐, load‐ and/or temperature‐control. The results show that with the assumption of simple Lennard‐Jones potentials of interaction between atoms in individual crystals and linking these crystals allows to reproduce the features associated with the fascinating behavior of shape memory alloys, including pseudo‐plasticity, pseudo‐elasticity and the shape memory effect.Originality/valueOwing to the special setup chosen, interfaces are missing between adjacent crystals in the chain assembly. The paper shows that in this situation load‐induced austenite/martensite transitions do not exhibit hysteresis in tension/compression cycles. This observation indirectly supports mesoscopic‐level work in the literature which explicitly introduces interface energy to model such hysteresis.
Effect of rotation on plane waves in generalized thermo‐microstretch elastic solid with one relaxation time
Authors: Othman Mohamed I.A. , Lotfy Kh. 
Published: November 2014

PurposeThe present paper aims to study the effect of rotation on the general model of the equations of generalized thermo‐microstretch for a homogeneous isotropic elastic half‐space solid whose surface is subjected to a thermal shock is considered. The problem is in the context of the generalized thermoelasticity Lord‐Şhulman's theory with one relaxation time, as well as the classical dynamical coupled theory.Design/methodology/approachThe normal mode analysis is used to obtain the exact expressions.FindingsFor the displacement components, force stresses, temperature, couple stresses and microstress distribution.Originality/valueThe variations of the considered variables through the horizontal distance are illustrated graphically. Comparisons are made with the results in the presence and absence of rotation and in the presence and absence of microstretch constants between the two theories.
Theory and finite element implementation of orthotropic and transversely isotropic incompressible hyperelastic membrane
Authors: Abdessalem Jarraya , Kammoun Kallel Imen , Fakhreddine Dammak 
Published: November 2014

PurposeThe purpose of this paper is to describe a general theoretical and finite element implementation framework for the constitutive modelling of biological soft tissues.Design/methodology/approachThe model is based on continuum fibers reinforced composites in finite strains. As an extension of the isotropic hyperelasticity, it is assumed that the strain energy function is decomposed into a fully isotropic component and an anisotropic component. Closed form expressions of the stress tensor and elasticity tensor are first established in the general case of fully incompressible plane stress which orthotropic and transversely isotropic hyperelasticity. The incompressibility is satisfied exactly.FindingsNumerical examples are presented to illustrate the model's performance.Originality/valueThe paper presents a constitutive model for incompressible plane stress transversely isotropic and orthotropic hyperelastic materials.
A study of the blast‐induced brain white‐matter damage and the associated diffuse axonal injury
Authors: Grujicic M. , d'Entremont B. , Pandurangan B. , Grujicic A. , LaBerge M. , Runt J. , Tarter J. , Dillon G. 
Published: November 2014

PurposeBlast‐induced traumatic brain injury (TBI) is a signature injury of the current military conflicts. Among the different types of TBI, diffuse axonal injury (DAI) plays an important role since it can lead to devastating effects in the inflicted military personnel. To better understand the potential causes associated with DAI, this paper aims to investigate a transient non‐linear dynamics finite element simulation of the response of the brain white matter to shock loading.Design/methodology/approachBrain white matter is considered to be a heterogeneous material consisting of fiber‐like axons and a structure‐less extracellular matrix (ECM). The brain white matter microstructure in the investigated corpus callosum region of the brain is idealized using a regular hexagonal arrangement of aligned equal‐size axons. Deviatoric stress response of the axon and the ECM is modeled using a linear isotropic viscoelastic formulation while the hydrostatic stress response is modeled using a shock‐type equation of state. To account for the stochastic character of the brain white matter microstructure and shock loading, a parametric study is carried out involving a factorial variation of the key microstructural and waveform parameters.FindingsThe results obtained show that the extent of axon undulations and the strength of axon/ECM bonding profoundly affect the spatial distribution and magnitude of the axonal axial normal and shear stresses (the stresses which can cause diffuse axonal injury).Originality/valueThe present approach enables a more accurate determination of the mechanical behavior of brain white matter when subjected to a shock.