Aspects Of Service Provision Research Articles

Competition for and in the passenger rail market: Comparing open access versus franchised train operators' costs and reliability in Britain

The liberalisation of passenger rail markets across Europe in recent years has focussed not only on competition for the market, but increasingly on competition in the market in the form of entry by open access operators. The possible benefits of such competition in terms of innovation and demand growth must, however, be balanced against concerns regarding possible revenue abstraction and the costs of operating at a small scale. This paper focusses on the latter aspect, comparing the unit costs of open access and franchised operators in Great Britain, and exploring the variation in terms of input price differences and aspects of service provision including train length and service reliability. This paper updates the analysis of Wheat et al. [Transp. Res. A, 113, pp. 114–124, (2018)] incorporating more recent data on open access and franchised intercity operators in Great Britain. In addition, we include new comparisons of punctuality and reliability metrics, and of passenger satisfaction survey results. We find that the unit costs and input prices of both groups are broadly comparable whilst open access operators perform significantly worse in terms of punctuality and cancellations – despite significantly higher passenger satisfaction scores – suggesting that open access operators offer low-cost, low-quality services.

191 A Multi-Country Survey to Explore What Key Stakeholders Consider to be Important in a Model of Dementia Palliative Care

Abstract Background The Model for Dementia Palliative Care Project will develop a service delivery model for community-based dementia palliative care in Ireland. This responds to palliative care now being recognised as a priority in care for people with dementia. Various dementia palliative care services exist internationally, however little is known about what the service providers would deem to be the most important aspects of service provision. The aim of this study was to identify what key stakeholders consider to be essential components of a model of dementia palliative care. Methods A web-based survey was developed, piloted (n=5), and revised. It was distributed electronically within five healthcare jurisdictions, in the Republic of Ireland, Northern Ireland, England, Scotland, and Wales. The target population was healthcare professionals, policy-makers, and academics, with an interest in dementia and palliative care. Content analysis of open ended questions was used to identify common themes within the data. Results Complete surveys were received from 112 stakeholders. The majority of respondents were female (86%). Identified key principles of care incorporated the philosophies of palliative care and good dementia care, with many describing ‘holistic’ and ‘person-centred care’ as core. Important individual components were identified, including support for carers, advanced care planning, information, education and training, activities for ‘meaningful living’, comprehensive disease management, coordinated case management, and linking in with community health services and social activities. Barriers to the model were identified at three levels: ‘(mis)understanding of dementia palliative care’, ‘application of dementia palliative care’ and ‘wider service organisation’. Conclusion Numerous components of a ‘good’ model were identified, along with possible barriers to implementation of the model. This study, as part of the larger project, will inform a model of dementia palliative care for the Irish Healthcare system with the potential to improve the experiences of people with dementia and their families.

Translating perceptions and managing expectations: an analysis of management and production perspectives on machine translation

ABSTRACTThe use of machine translation (MT) in professional translation tasks can change not only how translators work, but also how projects are managed and the expectations they entail across translation supply chains. Previous research has looked extensively into translators’ attitudes to MT but has often ignored important aspects of how translators’ views interact with those of other language industry stakeholders. This article presents a contrastive analysis of attitudes to MT which covers management and production perspectives. The discussion draws on semi-structured interviews which were thematically coded and qualitatively examined. The study shows how MT adds uncertainty to translation production networks. It argues that the challenges posed by MT are exacerbated by how the current makeup of the language industry restricts translators’ field of influence to texts while possibly alienating them from wider aspects of business strategy. The article makes two suggestions. First, it calls for increased translator involvement in the management aspects of service provision. Second, it emphasises the need for a deeper discussion of MT which, rather than framing the technology itself as a potential ‘threat’, addresses broader societal issues involving misguided perceptions and mismatched expectations.

Relationship between models of care and key rehabilitation milestones following unilateral transtibial amputation: a national cross-sectional study

ObjectivesTo identify different models of care (MOC) post transtibial amputation (TTA) and relate these to achievement of rehabilitation milestones. DesignRetrospective analysis of rehabilitation milestone data and a survey of MOC in 10 vascular centres. SettingNHS Scotland vascular centres. ParticipantsAll unilateral TTA between January 2011 and December 2014 (n = 643). Main outcome measuresTime (in days) to achieve the following rehabilitation milestones: compression therapy, early walking aid, casting for a prosthetic limb, prosthetic delivery, inpatient discharge and final discharge from rehabilitation. MOC were scored according to seven key aspects of service provision. ResultsThe mean age of the cohort was 67 [standard deviation (SD) 13] years, 76% were male and 63% had peripheral arterial disease and diabetes. The median number of days to achieve rehabilitation milestones varied between centres {compression therapy six [interquartile range (IQR) 0–12], early walking aid 14 (IQR 10–27), prosthetic casting 39 (IQR 27–71), prosthetic delivery 53 (IQR 36–87), inpatient discharge 53 (IQR 29–85) and final discharge from rehabilitation 141 (IQR 92–209)}. Only two centres included all seven key aspects of service provision within their MOC. Vascular centres that achieved the optimal MOC achieved the rehabilitation milestones more quickly than other vascular centres. ConclusionsA positive association was found between optimal MOC and early achievement of rehabilitation milestones post TTA. Key aspects of service provision associated with a quicker time to achieve rehabilitation milestones included: use of a postoperative rigid dressing, specialist physiotherapy input in the early postoperative period, daily inpatient gym sessions and inpatient prosthetic provision. To the authors’ knowledge, this is the first study to document MOC following TTA and to relate these to the achievement of rehabilitation milestones.

Validation of a questionnaire for consumers' perception of service quality in community pharmacy.

Consumer insights are vital to gain an understanding of service quality and enable its accurate measurement. Our team has previously developed a theory-based, qualitatively and quantitatively-informed service quality questionnaire for Australian community pharmacies with a price-focused marketing strategy (PFMS). The questionnaire assess 6 domains of service quality: Health and Medicines Advice, Non-Prescription Service, Relationship Quality, Technical Quality, Environmental Quality, and Health Outcomes. The aim of this study was to validate the questionnaire through confirmatory factor analysis (CFA) using data from customers attending pharmacies with a service-focused marketing strategy (SFMS). A 31 item questionnaire was administered to convenience sample of customers from 3 SFMS pharmacies. The collected data was analysed using CFA. Model parameters were estimated using the full information maximum likelihood (FIML) method. The model was revised on inspection of modification indices and fit statistics and tested for construct validity, construct reliability and measurement invariance. A total of 319 responses were collected for CFA. On examination of the modification indices, 4 items were deleted. The fit statistics for the final model were as follows: Satorra-Bentler scaled χ2 = 211.4, df = 155, CFI = 0.96, TLI = 0.95, RMSEA = 0.031 (90% confidence interval = 0.016-0.042). Construct validity of all constructs was established from positive convergent and discriminant validity tests. The composite reliability values for all constructs were ≥0.7, thus confirming construct reliability. A positive test for strong invariance confirmed that the model constructs are comparable across regional and metropolitan settings, gender, age and education level. This study has established the validity of the questionnaire as a measure of consumer perceptions of community pharmacy service quality. The tool can be applied in Australian community pharmacies in both metropolitan and regional settings to guide improvements in aspects of service provision.

Experiences of Sustainable Abstinence-Based Recovery: an Exploratory Study of Three Recovery Communities (RC) in England

Contemporary recovery-models of treatment for substance misuse prioritise community-based support systems that focus on developing individuals’ strengths and quality of life. The research project aimed to explore the perceived mechanisms and processes that underpinned support in three abstinence-based recovery communities (RCs) across England. Focus groups and telephone interviews were conducted with 44 individuals. This was to identify self-prioritised outcomes for members and other key factors contributing to the delivery of an effective recovery community. Data were thematically analysed. Along with a number of other key outcomes, the achievement and maintenance of abstinence by participants was considered to be a key indicator of an effective RC. RC processes were also viewed as underpinning the development of recovery capital. The study provides an insight into the processes of RCs and highlights that development and support of recovery capital is an important aspect of service provision and delivery for those in abstinence-based recovery.

AROC–The Australasian rehabilitation outcomes centre–Using outcome data to improve quality and value of rehabilitation

Clinical-quality registries have an important role to play in improving quality of care via monitoring and benchmarking of clinical care outcomes. The inclusion of process measures in the data collection enables exploration of variations in additional aspects of service provision, such as timeliness of access to care and clinical approaches. Additionally, registries which provide outcome reports for specific patient populations (“disease” registries) have been demonstrated to act as a catalyst for improving the quality of care provided, often at a lower cost. AROC commenced operations on the first of July 2002, a joint initiative of the Australian rehabilitation sector and the Australasian Faculty of Rehabilitation Medicine. Now, 15 years later, AROC holds data describing more than a million episodes of inpatient rehabilitation care in its database, collected from 280 rehabilitation units across Australia and New Zealand. AROC provides regular benchmarking reports to all members, supported by annual quality benchmarking workshops. The use of benchmarking and decision support tools has improved the efficiency of care whilst introducing a common language and increasing standardisation in practice. In addition, the less direct aspects of registry operations such as the facilitation of networking across the sector, the facilitation of translation of benchmarking results into practice and process changes, the access to the registry data to underpin research in the sector, provide added value and extend the registry from a single dimension initiative to a powerful platform for improving the quality and value of rehabilitation. The AROC clinical registry is a valuable resource for the rehabilitation sector, and provides an example of how clinical registries can function as powerful platforms for improving health outcomes, potentially lowering health care costs, and increasing health care value. In addition they can act as a data spine to facilitate more efficient, less expensive clinical research studies.

Surveying Climate Services: What Can We Learn from a Bird’s-Eye View?

AbstractBilled as the creation and provision of timely, tailored information for decision-making at all levels of society, climate services have garnered a great deal of attention in recent years. Despite this growing attention, strategies to design, diagnose, and evaluate climate services remain relatively ad hoc—and while a general sense of what constitutes “good practice” in climate service provision is developing in some areas, and with respect to certain aspects of service provision, a great deal about the effective implementation of such service remains unknown. This article reviews a sample of more than 100 climate service activities as a means to generate a snapshot of the state of the field in 2012. It is found that a “typical climate service” at this time was provided by a national meteorological service operating on a national scale to provide seasonal climate information to agricultural decision-makers online. The analysis shows that the field of climate services is still emerging—marked by contested definitions, an emphasis on capacity development, uneven progress toward coproduction, uncertain funding streams, and a lack of evaluation activities—and stands as a signpost against which the development of the field can be measured. The article also reflects on the relative contribution of this sort of sampling activity in informing “good practice” and offers suggestions for how both sampling and case study efforts can be better designed to increase the potential for learning. This article concludes with some observations on the relative contribution that broad-based analyses can play in informing this emerging field.

Urban Warfare Ecology: A Study of Water Supply in Basrah

This article assesses the impact of armed conflict on the drinking water service of Basrah from 1978 to 2013 through an ‘urban warfare ecology’ lens in order to draw out the implications for relief programming and relevance to urban studies. It interprets an extensive range of unpublished literature through a frame that incorporates the accumulation of direct and indirect impacts upon the hardware, consumables and people upon which urban services rely. The analysis attributes a step‐wise decline in service quality to the lack of water treatment chemicals, lack of spare parts, and, primarily, an extended ‘brain‐drain’ of qualified water service staff. The service is found to have been vulnerable to dependence upon foreign parts and people, ‘vicious cycles’ of impact, and the politics of aid and of reconstruction. It follows that practitioners and donors eschew ideas of relief–rehabilitation–development (RRD) for an appreciation of the needs particular to complex urban warfare biospheres, where armed conflict and sanctions permeate all aspects of service provision through altered biological and social processes. The urban warfare ecology lens is found to be a useful complement to ‘infrastructural warfare’ research, suggesting the study of protracted armed conflict upon all aspects of urban life be both deepened technically and broadened to other cases.

Improved limb salvage for patients with vascular disease and tissue loss associated with new model of provision targeted at the diabetic foot

AimsThe establishment of a vascular surgeon-led emergency diabetic foot service in 2006 has evolved to provide lower limb wound care for patients with and without diabetes. We aimed to determine whether the service was associated with sustained, improved limb salvage rates for the whole population, analyse key aspects of service provision and compare outcomes against published studies. MethodsThe vascular unit serves a largely rural population of approximately 240,000. Data was collected prospectively on lower limb amputations, arterial and minor surgical interventions from 2006 to 2015, and retrospectively retrieved for 2004–2005, prior to service commencement. Data was also collected on referral patterns, volume of patient admissions and attendances, and delays. Lower limb amputation rates were compared against published data and analysis of admission trends and delays employed non-parametric tests. ResultsAge/gender adjusted major lower limb amputations for the populations with and without diabetes were 412/100,000 in 2004 and 15/100,000 in 2005 respectively. Following service introduction, major amputations reduced and since 2012 have been sustained at between 15–44/100,000 and 1–3/100,000 for patients with and without diabetes respectively, comparing favourably with published data. Vascular interventions have remained static, but referrals of patients directly to the service and numbers of minor procedures have increased. ConclusionsThe sustained decreases in all major lower limb amputations that have coincided with the development of a core team approach to providing rapid access and comprehensive care for patients with emergency diabetic foot problems may indicate that this service design benefits patients with and without diabetes.

The organisation of physiotherapy for people with multiple sclerosis across Europe: a multicentre questionnaire survey.

BackgroundUnderstanding the organisational set-up of physiotherapy services across different countries is increasingly important as clinicians around the world use evidence to improve their practice. This also has to be taken into consideration when multi-centre international clinical trials are conducted. This survey aimed to systematically describe organisational aspects of physiotherapy services for people with multiple sclerosis (MS) across Europe.MethodsRepresentatives from 72 rehabilitation facilities within 23 European countries completed an online web-based questionnaire survey between 2013 and 2014. Countries were categorised according to four European regions (defined by United Nations Statistics). Similarities and differences between regions were examined.ResultsMost participating centres specialized in rehabilitation (82 %) and neurology (60 %), with only 38 % specialising in MS. Of these, the Western based Specialist MS centres were predominately based on outpatient services (median MS inpatient ratio 0.14), whilst the Eastern based European services were mostly inpatient in nature (median MS inpatient ratio 0.5). In almost all participating countries, medical doctors - specialists in neurology (60 %) and in rehabilitation (64 %) - were responsible for referral to/prescription of physiotherapy. The most frequent reason for referral to/prescription of physiotherapy was the worsening of symptoms (78 % of centres). Physiotherapists were the most common members of the rehabilitation team; comprising 49 % of the team in Eastern countries compared to approximately 30 % in the rest of Europe. Teamwork was commonly adopted; 86 % of centres based in Western countries utilised the interdisciplinary model, whilst the multidisciplinary model was utilised in Eastern based countries (p = 0.046).ConclusionThis survey is the first to provide data about organisational aspects of physiotherapy for people with MS across Europe. Overall, care in key organisational aspects of service provision is broadly similar across regions, although some variations, for example the models of teamwork utilised, are apparent. Organisational framework specifics should be considered anytime a multi-centre study is conducted and results from such studies are applied.

Enhancing client loyalty of advertising agencies: the influence of creativity and inter-firm relationships

This study develops a model for the drivers of loyalty, drawing literature from both service quality and relationship marketing. It investigates how advertising agencies’ creativity and inter-firm relationships influence their clients’ perceived value and overall satisfaction, and in turn how these influence clients’ loyalty towards advertising agencies. A validated survey instrument was used to collect quantitative data. Responses from 119 clients of advertising agencies were analysed using the Partial Least Square (PLS) technique. The model was robust in that inter-firm relationships, overall satisfaction and value followed by creativity explained 72% of variation in loyalty. The findings reveal that the inter-firm relationship is a more important determinant of satisfaction with an advertising agency than creativity, however this relationship is reversed when considering clients’ value perceptions. Service providers such as advertising agencies need to ensure that they focus on all the aspects of service provision to fulfil varying needs and expectations of their clients.

Understanding the Impact of Online Reviews on Hotel Performance

Understanding consumers’ needs and wants has been a major source of success for hotel organizations. Notwithstanding, investigating the valence of online reviews and modeling hotel attributes and performance is still a rather novel approach. Using partial least squares path modeling, Swiss country-level data for online reviews from 68 online platforms, together with data from 442 hotels, we test 11 hypotheses. Our research model includes three distinctive areas of the hotel: physical aspects, quality of food and drink, and human aspects of service provision. RevPAR and occupancy are employed as performance metrics. We also test for mediation effects. Results indicate that hotel attributes, including the quality of rooms, Internet provision and building show the highest impact on hotel performance, and that positive comments have the highest impact on customer demand. This study contributes to theories of valence on hotel performance and presents salient implications for practitioners to enhance performance.

Mental health service changes, organisational factors, and patient suicide in England in 1997–2012: a before-and-after study

Research into which aspects of service provision in mental health are most effective in preventing suicide is sparse. We examined the association between service changes, organisational factors, and suicide rates in a national sample. We did a before-and-after analysis of service delivery data and an ecological analysis of organisational characteristics, in relation to suicide rates, in providers of mental health care in England. We also investigated whether the effect of service changes varied according to markers of organisational functioning. Overall, 19 248 individuals who died by suicide within 12 months of contact with mental health services were included (1997-2012). Various service changes related to ward safety, improved community services, staff training, and implementation of policy and guidance were associated with a lower suicide rate after the introduction of these changes (incidence rate ratios ranged from 0·71 to 0·79, p<0·0001). Some wider organisational factors, such as non-medical staff turnover (Spearman's r=0·34, p=0·01) and incident reporting (0·46, 0·0004), were also related to suicide rates but others, such as staff sickness (-0·12, 0·37) and patient satisfaction (-0·06, 0·64), were not. Service changes had more effect in organisations that had low rates of staff turnover but high rates of overall event reporting. Aspects of mental health service provision might have an effect on suicide rates in clinical populations but the wider organisational context in which service changes are made are likely to be important too. System-wide change implemented across the patient care pathway could be a key strategy for improving patient safety in mental health care. The Healthcare Quality Improvement Partnership commissions the Mental Health Clinical Outcome Review Programme, National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, on behalf of NHS England, NHS Wales, the Scottish Government Health and Social Care Directorate, the Northern Ireland Department of Health, Social Services and Public Safety, and the States of Jersey and Guernsey.

Conducting service research that matters

Purpose – The purpose of this paper is to encourage the reader to think differently about service-related issues and to strive to conduct service research that makes a transformational impact on individuals, organizations and society. The authors suggest that service researchers are in an excellent position to develop research that matters by making stronger connections with theory and elevating purely applied research to research that is higher in both practical relevance and methodological rigor. Design/methodology/approach – This paper takes a conceptual approach, connecting pertinent literature with new ideas highlighted in this special issue. Findings – This paper proposes that service researchers look beyond traditional service applications, take a multi-disciplinary approach to problem-solving and make greater strides towards connecting theory and practice. The authors propose a Model of Rigorous and Relevant Research, and call for fresh thinking across a wide range of research areas, including enhancing the customer experience, crafting innovation, integrating technology and measuring service outcomes. Originality/value – The originality of this essay lies in its focus on revitalizing the discussion on relevance and rigor as a path forward for service research. Additionally, this paper offers new insights on core management aspects of service provision that provide a solid platform for future work in service research.

Visible light communications in heterogeneous networks: Paving the way for user-centric design

At the time of this writing, there is substantial research interest in the subject of visible light communications (VLC) owing to its ability to offer significant traffic offloading potential in highly crowded radio frequency (RF) scenarios. We introduce the user-centric design of VLC for heterogeneous networks (HetNet), where three key aspects are identified and elaborated on: signal coverage quality, system control, and service provision aspects. More explicitly, the concepts of amorphous cell formation as well as separated up-link (UL) and down-link (DL), decoupled data and control, dynamic load balancing (LB), etc., all demand radically new thinking. The advocated user-centric VLC design is of key significance in the small-cell scenarios of the emerging 5G design philosophy.

Assessing patient satisfaction with a multidisciplinary gender dysphoria clinic in Melbourne.

The Gender Dysphoria Clinic in Melbourne, Australia, assessed patient outcome by focusing on patients' subjective evaluation of the healthcare services they received through the clinic. A satisfaction survey, which was previously used in two established gender clinics in the US and UK, was adapted and then administered to consecutive patients who attended the Gender Dysphoria Clinic during a 1-month period. A total of 127 surveys were available for analysis: 88% of patients reported being satisfied with the services they received. Patients' perceived level of distress reduced significantly, following their involvement with the Gender Dysphoria Clinic. Feeling understood and heard in a non-judgmental manner by a specialist in the field of gender dysphoria was the most positive aspect of service provision. The most negative aspect of the clinic was a lengthy waiting list. Although the majority of trans-and-gender-diverse patients attending the Gender Dysphoria Clinic were satisfied with the service they received, there is a need to identify strategies to facilitate timely access to the clinic.

Barriers and facilitators related to use of prenatal care by inner-city women: perceptions of health care providers.

BackgroundSocioeconomic disparities in the use of prenatal care (PNC) exist even where care is universally available and publicly funded. Few studies have sought the perspectives of health care providers to understand and address this problem. The purpose of this study was to elicit the experiential knowledge of PNC providers in inner-city Winnipeg, Canada regarding their perceptions of the barriers and facilitators to PNC for the clients they serve and their suggestions on how PNC services might be improved to reduce disparities in utilization.MethodsA descriptive exploratory qualitative design was used. Semi-structured interviews were conducted with 24 health care providers serving women in inner-city neighborhoods with high rates of inadequate PNC. Content analysis was used to code the interviews based on broad categories (barriers, facilitators, suggestions). Emerging themes and subthemes were then developed and revised through the use of comparative analysis.ResultsMany of the barriers identified related to personal challenges faced by inner-city women (e.g., child care, transportation, addictions, lack of support). Other barriers related to aspects of service provision: caregiver qualities (lack of time, negative behaviors), health system barriers (shortage of providers), and program/service characteristics (distance, long waits, short visits). Suggestions to improve care mirrored the facilitators identified and included ideas to make PNC more accessible and convenient, and more responsive to the complex needs of this population.ConclusionsThe broad scope of our findings reflects a socio-ecological approach to understanding the many determinants that influence whether or not inner-city women use PNC services. A shift to community-based PNC supported by a multidisciplinary team and expanded midwifery services has potential to address many of the barriers identified in our study.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-015-0431-5) contains supplementary material, which is available to authorized users.

Variations in the hospital management of self-harm and patient outcome: A multi-site observational study in England

IntroductionStudies have shown wide variations in delivery of self-harm services but it is unclear how these relate to important outcomes such as self-harm repetition. MethodsData were collected on self-harm presentations and hospital management from 31 hospitals in England. Key staff were interviewed about service provision for self-harm patients and responses were mapped to a 21-item service quality scale. Our main outcome was repeat hospital-presenting self-harm within six months. Results6347 individuals presented with 7599 episodes of self-harm during a three month period in 2010–2011. Re-attendance with self-harm within six months of index episode occurred in 21% (1308/6347) of individuals (range between hospitals 9–27%). We found little association between clinical management at hospital level (i.e. proportion of episodes receiving psychosocial assessment, medical or psychiatric admission, and referral to statutory or non-statutory services) and repetition rate. The median score on service quality scale was 14.5 (range between hospitals 10.5–19). There was no evidence of correlation between total service quality score and repetition of self-harm (Spearman׳s r=−0.06, p=0.73) or between individual service items and repetition. LimitationsWe did not explore certain aspects of service provision e.g. quality of psychosocial assessments and length of admission. Hospital presentation for repeat self-harm may not be the most reliable measure of service quality. ConclusionAt aggregate level aspects of management and service structures did not appear to be associated with self-harm repetition rates. Future research should focus on better understanding the processes underlying the delivery of services at hospital level and their relationship to outcome.

Access to basic health services and associated factors: a population-based study

This study sought to identify factors involved in access to the services of a basic health unit. It is a cross-sectional, population-based study involving 101 randomly-selected families residing in the area covered by the health unit. An adult resident of each household was interviewed. The response variable was whether or not the resident frequented the health unit if he/she or anyone in the family required assistance to resolve a health issue. The independent variables investigated were service provision aspects, demographic and socio-economic characteristics, individual habits, morbidities and use of the health unit. In addition to descriptive and univariate analysis, logistic regression was applied in the multivariate analysis. The results show that access to the basic health unit is associated with the treatment received previously (OR = 3,224) with accessibility (OR = 0,146) and micro-area of residence (OR = 10,918). These findings suggest that access is related to the impressions created by the care received at the health unit and is based on experiences with the service, but can also be strongly modulated by individual aspects and factors related to the territory.