Quality Function Deployment and operational design decisions – a healthcare infrastructure development case study

The purpose of this paper is to demonstrate how QFD can enhance a healthcare organisation’s strategic operational alignment, by synchronising the infrastructure design with the service intention. In this empirical paper, a case study of a £15 million infrastructure development has been used as the unique context to assess and test the experimental findings. QFD was utilised in order to capture and transform the requirements of decision-makers, providers, patients and local communities into both service and building design for Project K, a healthcare infrastructure, in the U.K. Two full iterations of the QFD results are presented. Using QFD generated effectiveness and efficiency by creating an information exchange platform and providing the stakeholders with a framework to optimise the decision-making. This paper makes a practical contribution by empirically testing the QFD modelling and providing evidence of its implementation within the complex, dynamic and evolving nature of the healthcare built environment sector.     

Healthcare for men and women with learning disabilities: understanding inequalities in access

Healthcare for men and women with learning disabilities (known internationally as intellectual disabilities) has risen up the political agenda in the United Kingdom, propelled by a report from the charity Mencap. This report has resulted in renewed efforts, set out in Valuing People Now, to ensure that people with learning disabilities receive the healthcare they are entitled to. This paper, drawing upon experience in England, describes the challenges of providing healthcare to men and women with learning disabilities; reviews Death by Indifference and the reports produced in its aftermath; presents findings from a small-scale study of access to healthcare undertaken in the East of England; and concludes with a discussion of whether the policies in Valuing People Now will improve healthcare for men and women with learning disabilities.     

International female students’ experiences of navigating the Canadian health care system in a small town setting

Abstract

This pilot study explored the international female (IF) students’ (n = 17) lived experiences of health care accessibility while studying in a small town in Canada. Analysis guided by a phenomenological method resulted in three major themes – (1) after arriving to attend university, IF students experienced challenges in staying healthy, such as learning how Canadian medical insurance works and how to access medical help, (2) IF students developed a support system over time, consisting of their university’s student advisors, host families and friends and (3) as IF students became familiar with living in Canada, they developed self-directed care strategies such as taking care of each other if they became sick. They also became comfortable reaching out through social media to ask questions and connect with others who were also new to Canada. Recommendations included providing (1) alternative times for IF students to access medical care on campus, (2) a fund where IF students could borrow the upfront costs to see a doctor and (3) health care knowledge dissemination through various media throughout the school year. The outcomes of this study are generally encouraging and may assist IF students to make effective health care decisions while in Canada resulting in a less stressful academic experience.     

Client experiences with perinatal healthcare for high-risk and low-risk women

Problem

It is unknown if client experiences with perinatal healthcare differ between low-risk and high-risk women.

Governing the coordination of care for older people: Comparing care agreements in Denmark and Norway

Increasing specialisation and demands to decrease the length of hospital stays have important consequences for the integration of specialised health and local care services. Based on case studies of care agreements in Denmark and Norway, this article compares subnational governance strategies for coordinating care services for older people discharged from hospitals. The question is how, and to what degree, national government regulations have an impact on local service coordination strategies. The analysis reveals that the numerous subnational procedures for coordination are somewhat more itemised in Denmark, and that regional variation in care agreements is greater in Norway. The identified differences can partly be accounted for by national differences in regulation, which is tighter in Denmark than in Norway. The study suggests that despite decentralisation of responsibility, subnational procedures to facilitate coordination are heavily influenced by national government policy.     

日本公共医疗保险制度的互助共济机制

在世界上老年人口抚养比较高的国家之中,日本公共医疗保险制度的医药费支出占GDP的比例相对较低。本文详尽地介绍日本独特的、完整成熟的跨年龄、地区和职业的医保互助机制及其背景和理念。因职业、年龄等不同,每个人所参保的制度不同,但是在待遇方面,所有的制度对于医药服务的种类和报销政策都相同。患者可以在任何时候、选择任何医院就诊。筹资模式因制度不同而不同,当一个制度所覆盖的群体主要是低收入者时,政府用财政的一般预算收入来资助。由于年龄分布不同所造成的各个制度的医药费支出负担的不同,本着公平的原则进行了调整。调整了年龄差距之后的人均医药费支出总额相同的话,不管在哪个地区,收入相同的人应当缴纳相同数额的保费。     

The effects of transformational leadership on followers' perceived work characteristics and psychological well-being: A longitudinal study

Transformational leaders employ a visionary and creative style of leadership that inspires employees to broaden their interest in their work and to be innovative and creative. There is some evidence that transformational leadership style is linked to employee psychological well-being. However, it is not clear whether this is due to (1) a direct relationship between leadership behaviour and affective well-being outcomes, or (2) a relationship between leadership behaviour and well-being that is mediated by followers' perceived work characteristics. (Such characteristics include role clarity, meaningfulness, and opportunities for development.) This study aims to extend previous work by examining the validity of these two mechanisms in a longitudinal questionnaire study. The study was carried out within the elderly care sector in a Danish local governmental department. A theory-driven model of the relationships between leadership, work characteristics, and psychological well-being was tested using Structural Equation Modelling. The results indicated that followers' perceptions of their work characteristics did mediate the relationship between transformational leadership style and psychological well-being. However, there was only limited evidence of the existence of a direct path between leadership behaviour and employee well-being. These findings have implications for design, implementation, and management of efforts to improve employee well-being.     

Increasing conflict in times of retrenchment? Attitudes towards healthcare provision in Europe between 1996 and 2002

Public opinion is considered a major obstacle to changing the status quo of welfare state policies. Yet some far‐reaching reforms and gradual changes of European welfare states prompt the reverse question: Have increased reform pressures and restructuring efforts led to changes in individual attitudes? In line with previous research, I found that the strong support for a public provision of healthcare remains unchanged. But what about the structure of attitudes? Testing core assumptions of the new politics theory and power resources theory, I looked at conflict lines within society and how they change in times of retrenchment. Analysing individual attitudes in 14 European countries between 1996 and 2002, I moved beyond static comparisons across countries to provide a dynamic account of trends over time. Observing stability, not change, I found no evidence that the relevance of old cleavages is in decline. Both old and new cleavages shape individual attitudes.     

Social policy in sub-Saharan Africa: a glance in the rear-view mirror

In this article we take a retrospective look at social policy in post-colonial sub-Saharan Africa and account for two distinct phases. The first phase, from 1960 to 1980, is the nationalist phase; the second, framed by the neoliberal policy regime, marked the last two decades of the 20th century. We argue that social policy in the nationalist phase played a transformative role – intrinsic and instrumental. Investment in education and healthcare, rather than social protection, was the key policy instrument. The weaknesses of the period included a growing authoritarianism and failure to transform the inherited colonial political economies. The retrenchment of the public realm under the neoliberal regime led to massive entitlement failure, and the crisis of citizenship and statehood. We argue for a return to a broader vision of social policy, underpinned by the ethos of democratic and socially inclusive development.