Expansion Of Services Research Articles

Quality and customer loyalty in the port services of Manzanillo

The customs industry, particularly within the Mexican context, plays a significant role both domestically and internationally, owing to its contribution to the global economy. With the expansion and standardization of customs clearance services, there has emerged a necessity for providers of these services to seek customer loyalty. Grounded in the principles of quality, the study examines the elements of the SERVQUAL model: tangibles, reliability, responsiveness, assurance, and empathy. Goals:The aim of the study was to extend the SERVQUAL model by incorporating customer attitude as an additional component within the three primary dimensions for measuring service quality. Methodology: A survey was employed to gather data from 100 customs brokerage firms through simple random sampling. Given the utilization of structural equation modeling (SEM) methodology to assess the theoretical model, Partial Least Squares (PLS) analysis technique was applied using Smart PLS 3.3.0 software. The findings indicated that the extended model had a significant impact on both customer satisfaction and loyalty within the customs facilities of Manzanillo, Colima. The coefficients of determination were 61.5% for customer satisfaction and 54% for customer loyalty, with a root mean square error of approximation (SRMR) of 0.065, confirming the model's predictive validity. Contributions: Customs facilities should focus their strategies on addressing issues that may be impacting service quality, particularly concerning sensitivity, empathy, and reliability factors, as these have a moderate level of influence on quality determination, according to customs agencies' perceptions. Regarding the inherent limitations of online surveys and their application in specialized groups, it is crucial to expand the research to include other clients of the customs facility.

Effect of Agency Banking Services Provision on Performance of Small Business Entrepreneurs at Chamwino District

Purpose: This study endeavours to examine effects of agency banking services provision in rural area on performance of small business entrepreneurs at Chamwino District, Dodoma Region. Urban settings have been the main areas of concentration, leaving out the dynamics and challenges rural entrepreneurs encounter while using agency banking services to expand their businesses, hence the essence of undertaking this study. Design/Methodology/Approach: Cross sectional research design was used, and a sample of 108 respondents were involved in this study. Data were analysed using descriptive and multiple linear regression analysis. Findings: The study findings show that, variables of accessibility, privacy and reliability of agency banking services have positive and statistically significant impacts on the performance of small business entrepreneurs in rural areas. Implications/Originality/Value: The study recommends banking industry in Tanzania to establish standardized fee structures and transaction charges for agency banking services. Also ensure transparency and prevent excessive costs to users of agency banking services. By so doing, it can ease provision and expansion of various online banking services to majority of the underserved communities in rural areas of Tanzania

Mendorong Pertumbuhan Pangsa Pasar B2B untuk Sektor Ride-Hailing Menggunakan Segmentasi Pasar Strategis

The expansion of Indonesia's ride-hailing sector has been considerable, fueled by technological advancements and the widespread embrace of smartphones. Despite its swift growth, the industry faces difficulties concerning long-term viability, safety issues, and compliance with governmental regulations. Nevertheless, the integration of advanced technologies and strategic plans for service expansion into new regions presents significant opportunities. The competitive environment in Indonesia's ride-hailing market not only stimulates innovation but also shapes a lively and evolving market atmosphere. Originally designed for consumers, the ride-hailing sector has evolved into a versatile transportation solution for various business needs, including employee transportation and goods delivery. These services offer advantages for companies, such as enhanced operational efficiency and reduced logistics costs. Recognizing the diversity of the business market, segmentation becomes vital in comprehending customer needs. Through tailored marketing approaches, companies can deliver more pertinent solutions, boosting competitiveness and enlarging B2B market share. By using K-means clustering, it yields 5 clusters, namely cluster 1: Tech Innovators and Financial Players, cluster 2: Logistics Singular Focus, cluster 3: Logistics, Retail, and Automotive Synergy, cluster 4: Culinary, Logistics, and Travel Dynamics, cluster 5: Tech Titans, Healthcare Giants, and Financial Leaders. The analysis of user clusters on the B2B Ride Hailing Indonesia platform provides useful insights that guide strategic recommendations for improving service offerings, refining marketing strategies, and optimizing business operations. Targeting the millennial demographic through digital channels and influencers, examining marginal costs for high-traffic clusters to identify optimization opportunities, exploring expansion possibilities in clusters with growth potential, and tailoring business solutions for clusters with unique needs are among the recommendations. Keywords: K-means Clustering, Market Innovation, Market Share Expansion, Ride-Hailing Sector, Segmentation, Strategic Decisions.

Economic evaluation of the effect of needle and syringe programs on skin, soft tissue, and vascular infections in people who inject drugs: a microsimulation modelling approach

BackgroundNeedle and syringe programs (NSP) are effective harm-reduction strategies against HIV and hepatitis C. Although skin, soft tissue, and vascular infections (SSTVI) are the most common morbidities in people who inject drugs (PWID), the extent to which NSP are clinically and cost-effective in relation to SSTVI in PWID remains unclear. The objective of this study was to model the clinical- and cost-effectiveness of NSP with respect to treatment of SSTVI in PWID.MethodsWe performed a model-based, economic evaluation comparing a scenario with NSP to a scenario without NSP. We developed a microsimulation model to generate two cohorts of 100,000 individuals corresponding to each NSP scenario and estimated quality-adjusted life-years (QALY) and cost (in 2022 Canadian dollars) over a 5-year time horizon (1.5% per annum for costs and outcomes). To assess the clinical effectiveness of NSP, we conducted survival analysis that accounted for the recurrent use of health care services for treating SSTVI and SSTVI mortality in the presence of competing risks.ResultsThe incremental cost-effectiveness ratio associated with NSP was $70,278 per QALY, with incremental cost and QALY gains corresponding to $1207 and 0.017 QALY, respectively. Under the scenario with NSP, there were 788 fewer SSTVI deaths per 100,000 PWID, corresponding to 24% lower relative hazard of mortality from SSTVI (hazard ratio [HR] = 0.76; 95% confidence interval [CI] = 0.72–0.80). Health service utilization over the 5-year period remained lower under the scenario with NSP (outpatient: 66,511 vs. 86,879; emergency department: 9920 vs. 12,922; inpatient: 4282 vs. 5596). Relatedly, having NSP was associated with a modest reduction in the relative hazard of recurrent outpatient visits (HR = 0.96; 95% CI = 0.95–0.97) for purulent SSTVI as well as outpatient (HR = 0.88; 95% CI = 0.87–0.88) and emergency department visits (HR = 0.98; 95% CI = 0.97–0.99) for non-purulent SSTVI.ConclusionsBoth the individuals and the healthcare system benefit from NSP through lower risk of SSTVI mortality and prevention of recurrent outpatient and emergency department visits to treat SSTVI. The microsimulation framework provides insights into clinical and economic implications of NSP, which can serve as valuable evidence that can aid decision-making in expansion of NSP services.

Digital twin-driven intelligent operation and maintenance platform for large-scale hydro-steel structures

Large-scale hydro-steel structures (LS-HSS) are pivotal in hydraulic engineering, boasting high lift, expansive apertures, and discharge capacities. Conventional methods of operation and maintenance for LS-HSS require a digital revolution to ensure safety, reliability, and durability. This study introduces a novel approach, harnessing the power of a digital twin (DT) to integrate physical and virtual elements in LS-HSS operation and maintenance seamlessly. A digital twin modeling framework of LS-HSS operation and maintenance is first presented, incorporating five levels of a physical entity, a virtual entity, DT data, services, and connections. Subsequently, a DT-driven intelligent operation and maintenance (DT-IOM) platform is constructed and applied, which features real-time mapping, closed-loop control, dynamic health assessment, and intelligent decision-making. This platform provides a pathway for digitally transforming conventional LS-HSS operation and maintenance and paves the way for a new era of intelligent infrastructure management. The proposed approach has been successfully implemented and validated with multiple engineering projects, including radial gates of reservoir spillways, plain gates of flood discharge orifices, and emergency gates of pumped storage power stations. The impressive results demonstrate a significant anomaly response and processing efficiency improvement of over 60%. Moreover, the platform has substantially reduced field inspection time and equipment failure rate by approximately 50% and 20%, respectively. These tangible benefits further highlight the platform’s functional advantages, including its capability for IoT connection, modeling and integration, virtual-real interaction, 2D/3D visualization, and service expansion. The results demonstrate the unique features in the closed loop of perception, analysis, decision-making, and optimization for DT-IOM, especially for integrating data, models, knowledge, and services in LS-HSS intelligent operation and maintenance.

Antimicrobial Stewardship Practices in Outpatient Parenteral Antimicrobial Therapy Programs in the United States.

Outpatient parenteral antimicrobial therapy (OPAT) regimens typically prioritize ease of antimicrobial administration, tolerability, safety, and accessibility over using the narrowest-spectrum antimicrobial. In light of this, OPAT providers often utilize different techniques to promote antimicrobial stewardship (AMS) in their OPAT programs. This study aims to characterize the AMS practices of OPAT programs across the United States that might meet The Joint Commission requirements for outpatient AMS metrics. This is a cross-sectional electronic survey of the Vizient AMS network. A total of 95 possible questions were designed to inquire about demographics, OPAT program structure, AMS initiatives, performance metrics, and resources. Seventy-four survey responses were received, with 58 (78.4%) of the respondents indicating their institution offered OPAT services. Respondents reported having at least 1 AMS protocol and tracking at least 1 metric in 91% and 74% of OPAT programs, respectively. Only 40% of programs reported billing for OPAT-related services. Approximately 45% of respondents disagreed or strongly disagreed that their OPAT program had the resources needed to care for the population it serves. Respondents identified data analytics (69%), funding for expansion of services (67%), and pharmacists (62%) as resources of greatest need for their OPAT programs. This survey collectively describes the AMS practices currently employed by OPAT programs across the United States. The results provide specific examples of AMS initiatives, metrics, and resources that institutions may reference to advance the practices of their OPAT programs to meet The Joint Commission Outpatient Antimicrobial Stewardship standards.

Integration of a nurse practitioner and physician associate leadership structure within an academic cancer center.

Nurse practitioners and physician associates are an essential part of the multidisciplinary cancer care team with expanding and evolving roles within cancer specialties. As these clinicians flourish, a parallel need for leadership rises to optimize scope of practice, mentor, and retain this crucial workforce. The purpose of this quality improvement project was to development a nurse practitioner and physician associate leadership structure within an academic cancer center. Development of this nurse practitioner and physician associate leadership structure was guided by transformational leadership theory. In collaboration with nursing, business, and physician leadership, a quad structure was supported. Implementation of a leadership structure included the establishment of eight team leaders and two managers. These leaders identified multiple opportunities for improvement including improved communications, offload of nonbillable work, development of incentive programs, provision of equipment, specialty practice alignment, hematology/oncology fellowship, and professional development. Overall, a nurse practitioner and physician associate leadership structure allowed for representation across the cancer center. Such inclusion supported multiple quality improvement projects developed in partnership with nursing, business, and physician leaders. Cumulatively, these interventions yielded efficient workflows and expansion of services. Consistent with reported evidence, these efforts contributed to nurse practitioner and physician associate retention as well as improved job satisfaction. Advanced practice leadership is essential to recruiting, developing, supporting, and retaining nurse practitioner and physician assistant colleagues in cancer care.

Exploration On the Construction of Smart Campus All-Optical Network

With the rapid development of information technology, the construction of education informatization is urgent, and it is particularly important to promote the gradual development of colleges and universities towards digital transformation. Among them, the construction of smart campus has become an important means to enhance the level of education informatization and improve the quality of education and teaching. As an important part of the new generation of information technology, all-optical network has been widely used in the construction of smart campus. This paper first summarizes the existing network bottlenecks of traditional networks under the trend of digital campus transformation, including the problems of operation and maintenance management, network bandwidth, service expansion and weak current security, then introduces the necessity of all-optical network construction from the aspects of network bandwidth, stability and maintenance cost, and finally demonstrates the construction value of all-optical network through application scenarios. It provides a useful reference for the construction of smart campus all-optical network.

Assessing the understanding and utilization of integrative oncology among patients with a history of cancer.

e23231 Background: Integrative oncology (IO) is an evidence-informed field of cancer care the utilizes mind-body practices, natural products, lifestyle medicine from different traditions alongside conventional therapies. Many of these components have growing evidence of benefit and are part of guideline recommendations. The Sidney Kimmel Cancer Center (SKCC) at Thomas Jefferson University has an integrative oncology program that sought to identify patients’ understanding of integrative health, assess their utilization of integrative medicine approaches, and define interest in IO consultations. Methods: Patients with a history of cancer or at high risk for cancer who presented for care at an SKCC clinical site received an electronic record invitation to complete a brief survey with binary and free-response questions regarding current knowledge, experiences, and interest in IO. At the end of the survey, patients also had the option to express interest in an IO consultations at SKCC. Results: Among 1327 responders, 900 (67.8%) were female, and 998 (75.2%) were between 45-75 years of age. Most were white (980, 73.9%), followed by Black or African American (279, 21.0%). Breast cancer (435, 32.8%) and hematologic cancers (277, 20.9%) were the most reported malignancies. Overall, 340 (26.4%) and 123 (9.27%) had previously utilized in-person IO services and virtual IO services, respectively. 887 (66.8%) patients reported that IO was never discussed during their care. 946 (71.3%) expressed interest in an IO consultation. Conclusions: Approximately a third of patients who completed the survey had previously used an IO modality. More than double that number expressed interest in and IO consultation. With the increasing evidence of benefit for IO care and the inclusion of these recommendations in clinical guidelines, expansion of IO services is indicated. IO consultations would address knowledge gaps, enhance implementation of guideline-based care, and, perhaps, improve clinical outcomes.

Past-Year HIV Testing, Current Antiretroviral Therapy Use, and Participation in Services for People Who Inject Drugs.

Evaluating routine HIV testing and treatment and use of services for people who inject drugs (PWID) is critical to curb the ongoing HIV epidemic. We analyzed data from the 2018 National HIV Behavioral Surveillance of PWID aged 18years or older, recruited using respondent-driven sampling and offered anonymous HIV testing after survey. We performed bivariate and multivariable analyses with log-linked Poisson regression of the generalized linear models to examine the associations between demographics and PWID service use, past-year HIV testing, and current antiretroviral therapy (ART) use. Among 10,311 HIV-negative PWID, 56% reported past-year HIV testing, and of the 553 HIV-positive PWID, 69% reported current ART use. Of the HIV-negative PWID, 64% (2874/4482) in drug treatment and 62% (3386/5440) who used syringe service programs (SSPs) reported past-year HIV testing. Among HIV-positive PWID, 75% (187/248) in drug treatment and 67% (200/298) SSP participants were on ART. In the adjusted multivariable model, past-year HIV testing was associated with drug use treatment (aPR 1.26, 95% CI 1.23-1.31) and SSP participation (aPR 1.19, 95% CI 1.13-1.26) among HIV-negative PWID. Current ART use was associated with drug use treatment (aPR 1.13, 95% CI 1.00-1.28) but the link was not significant probably due to small sample size. Findings support the expansion and improvement of PWID-targeted services, into comprehensive programs, including drug use treatment, SSP, and HIV testing and treatment.

Establishing palliative care in tribal and rural Indian setting: A participatory action research approach.

e24085 Background: We established a palliative care center in the tribal area of Santhal Pargana, India, under a tertiary care facility, as a crucial step in addressing the palliative needs of oncology patients. This study assesses the center's inaugural year, focusing on referral patterns, morphine consumption, and pain management. Methods: Data from all patients visiting the palliative care outpatient department (OPD) in 2023 were prospectively collected and analyzed. The study focused on key palliative care indicators, including morphine consumption, patient referrals, and the mean Numeric Rating Scale (NRS) pain score after initial consultation. The PAR approach was utilized to tailor services to the community's needs. Results: The center observed an increase in patient referrals, from 8 new patients in January to 19 by December. The patient demographic primarily comprised individuals with head and neck cancer (43%), followed by breast cancer (28%) and gall bladder cancer (12%), alongside other types such as cervix, sarcomas, lung, and adult hematolymphoid malignancies. Bone metastasis was present in 46 (55.4%) patients at initial presentation. Morphine consumption demonstrated a notable rise, from 840 mg in May to 2860 mg in December, totaling 9800 mg for the year. The mean NRS pain score improved significantly from 6.5 in January to 4.3 post-initial consultation. The center maintained an overall median of 3 consultations per patient, and bereavement support was provided to 13 (15.7%) patients. Conclusions: The integration of the Participatory Action Research approach, specifically the CTC-5, was instrumental in the successful initiation and expansion of palliative care services within the center. The structured training, mentorship, and organizational restructuring, facilitated by the program, were crucial in establishing a modest palliative care infrastructure. This comprehensive approach not only enhanced care delivery but also ensured the sustainability and adaptability of palliative services, effectively addressing the gap in palliative care in rural, tribal settings.

Assurance Practices for Ethical and Sustainable Business Practices

The purpose of this study is to examine the role of assurance practices in promoting ethical and sustainable business conduct within contemporary organizations. Through a qualitative research design and methodology, the study systematically analyzes existing literature to identify key insights and trends in assurance practices related to business ethics and sustainability. Findings indicate that assurance mechanisms, such as external audits and third-party certifications, play a crucial role in bolstering stakeholders' confidence in corporate disclosures concerning ethical conduct and sustainability performance. Additionally, the study highlights the evolving nature of assurance practices, particularly in response to emerging challenges and opportunities in the realm of business ethics and sustainability. Implications of the findings suggest that organizations can leverage assurance practices to enhance transparency, accountability, and trustworthiness, thereby fostering a culture of integrity and responsible conduct. Furthermore, the integration of technology and the expansion of assurance services offer opportunities to strengthen the effectiveness and relevance of assurance practices in addressing contemporary sustainability challenges.

Location optimization of emergency medical services: Considering joint service coverage of ambulances and emergency centers

Emergency Medical Services (EMS) play an essential role in saving lives and improving health outcomes by offering immediate medical care to individuals who experience sudden illnesses or injuries. A complete EMS journey consists of two related trips: one from an EMS station to a scene (Trip 1), and the other from a scene to a definitive care location (Trip 2), where the service is coordinately provided by two types of facilities: EMS stations/ambulances and emergency centers (e.g., trauma centers or stroke centers) that are often affiliated with general hospitals. Current work on EMS location optimization considers only one trip (Trip 1 or Trip 2) which ignores the coordination between EMS stations and emergency centers, or the overall trip alone that overlooks the response time requirement. This paper proposed a spatial optimization model, the maximal coverage location problem based on joint coverage (MCLP-JC), for siting EMS stations and emergency centers simultaneously with a consideration of the two related trips. An empirical study of stroke center planning in Wuhan, China, is implemented to compare the proposed approach with the maximal coverage location problem based on overall coverage (MCLP-OC). The results demonstrate that the MCLP-JC can ensure more people being able to receive the first care from an ambulance within the response time requirement, which is critical to subsequent treatment at emergency centers and the odds of survival. The findings from the two scenarios regarding service relocation and expansion offer insights for future health facility planning.

Making a Difference One Night at a Time: An Annual Fundraiser for a Student-Run Free Clinic Raises Over $25,000

Introduction: The Lighthouse Free Medical Clinic (LFMC) is a student-run clinic (SRC) in Buffalo, NY, providing free healthcare to uninsured and underserved patients. The LFMC relies primarily on community fundraising events for financial support, with the Annual Winter Gala serving as its main source of funding. In February 2023, the Gala successfully raised over $25,000.00 in profit, surpassing previous records by adopting several new fundraising strategies. These funds will significantly exceed the clinic's annual operating budget, enabling the expansion of patient services and the continued delivery of high-quality healthcare. Planning & Night of Gala: The student leaders of the LFMC meticulously planned the Gala, which involved soliciting donations from local businesses for basket raffles, organizing entertainment during the cocktail hour, and arranging a live auction featuring items donated by community members. Gala Impact: The 2023 Gala attracted 376 guests and generated a profit of $25,973.40. The event featured 47 basket raffles and 21 live auction donations. The resulting profit will be allocated to various expenses of the LFMC’s operations, including laboratory supplies, outsourced laboratory procedures, provider insurance policies, a food delivery initiative, patient transportation services, miscellaneous costs, and the expansion of future clinic initiatives. Conclusion: This descriptive report details the planning, implementation, and future directions of the Gala fundraising event. It serves as a valuable template for other SRCs across the nation, offering guidance on funding strategies to support their clinic operations.

#1899 Transitional care clinic for incident hemodialysis patients : the Singapore experience

Abstract Background and Aims The period of transition from chronic kidney disease (CKD) to End stage kidney disease (ESKD) presents significant morbidity and mortality risk to the patients. This higher mortality risk is largely contributed by cardiovascular factors and infection. The last 2 decades have seen a remarkable succession of programs to improve outcome in incident dialysis patients. One such initiative is the use of ‘fistula first’ policy. In Singapore, pre-emptive access creation among ESKD patients continues to be low, with up to 80% of incident dialysis patients being commenced on hemodialysis (HD) via a dialysis catheter. Ensuring that incident dialysis patients have definitive vascular access, early referral to transplantation and adequate psychosocial support, amongst other factors, is an important consideration in their journey towards improved health outcomes. In order to achieve this, meticulous care coordination and a multifaceted approach is required. This realization is what led to the inception of our transition care clinic (TCC) in 2019. Conducted bi-monthly by a multidisciplinary team of nephrologists and renal coordinators, with inputs from pharmacists and medical social workers as needed, the TCC engages patients within 4-6 weeks post-hospital discharge. Its focus includes vascular access, dietary and fluid compliance, blood pressure control, HD adherence, transplantation referral, and medication reconciliation. Method A retrospective analysis of 314 ESKD patients who initiated HD between September 2019 and September 2022 compared outcomes between TCC attendees (n=164) and non-attendees Results TCC attendees exhibited a lower 1- year mortality rate (p=0.002) and higher rates for vascular access creation within first 6 months (p=0.001) as compared to non-attendees. However, no statistical differences were observed in hospitalization rates in the first year (p=0.760) and kidney transplantation referrals (p=0.20) between the two groups. Conclusion While notable improvements were observed in mortality rates and vascular access creation, there was no significant difference in hospitalization rates or kidney transplantation referrals between the two groups. In spite of the limitations due to its retrospective nature, this study clearly demonstrates the effectiveness of TCC in enhancing patient outcomes during the critical initial phase of hemodialysis. The study highlights the importance of setting up, refinement and expansion of such services in improving the outcome of this vulnerable patient group.

Strategi Pengambilan Keputusan Terhadap Perluasan Layanan Bus Trans Jatim Ke Lamongan dan Bangkalan

The expansion of the East Java Trans Bus service to Lamongan and Bangkalan is a process of forming and setting a strategy for developing public transportation services that are safe, comfortable and affordable for the people of East Java. It is hoped that this expansion will make it easier for workers to obtain adequate transportation facilities and help the community to reach the economic and government center of Surabaya. Trans Jatim has been a mainstay of the community since its launch and is always in demand. With the expansion of the route to Lamongan and Bangkalan, it is hoped that it can provide much better public transportation services to meet the community's needs. The expansion of the East Java Trans Bus service to Lamongan and Bangkalan aims to determine the increase in public transportation services and also to determine the increase in Regional Original Income (PAD). This research uses the literature study method with the process of collecting data, journals, articles and information related to the topic under study. The presence of this service is expected to reduce road congestion, reduce pollution, reduce the number of accidents and reduce exhaust emissions. With the expansion of this service, it is hoped that it can become a milestone for efficient and sustainable transportation in East Java Province.

Is more better? A multilevel analysis of percutaneous coronary intervention hospital openings and closures on patient volumes.

It is unknown how changes in the percutaneous coronary intervention (PCI) "built environment" have impacted PCI volumes at the community, hospital, and patient levels. This study sought to determine how PCI hospital openings and closures effect community- and hospital-level PCI volumes as well as the likelihood of receiving PCI at a low-volume hospital. We conducted a retrospective cohort study of 3,966,025 Medicare Fee-For-Service patients in 37,451 zip codes and 2564 U.S. hospitals who underwent PCI from 2006 to 2017. We conducted community-, hospital-, and patient-level analyses using ordinary least squares regressions with fixed effects to determine changes in PCI volumes after PCI hospital openings or closures. Between 2006 and 2017, a total of 17% and 7% of patients lived in communities that experienced PCI hospital openings and closures, respectively. Openings were associated with a 10% increase in community PCI volume, a 2% increase in the share of elective PCI, and a doubling in the likelihood of receiving PCI at a low-volume hospital. In communities with low baseline PCI capacity, openings were associated with a 12% increase in community PCI volume, and in high-capacity communities, an 8% increase. PCI closures were associated with a 9% decrease in community PCI volume in high-capacity communities but no measurable change in low-capacity communities. PCI service expansion is associated with increased PCI at low-volume hospitals and a greater number of elective procedures. Increased governmental oversight may be necessary to ensure that openings and closures of these specialized services yield the desired benefits.

The future of hospital at home: a qualitative interview study of healthcare staff.

Hospital at Home (HaH) services are expanding to provide acute multidisciplinary care in an individual's home. In this pilot study, we interviewed HaH staff to understand challenges and opportunities for service development. We conducted 23 semi-structured interviews with multidisciplinary staff working across three HaH services in Scotland. The questions focussed on service strengths and challenges. Four themes emerged: raising referral awareness, service design and efficiency, staff security on home visits, and sustainability. HaH staff described Emergency Department posters, experience days for non-HaH staff, and daily communication of virtual bed capacity to raise awareness for referrals. Ideas for maximising clinician time were prioritised to improve service efficiency and investment in electric vehicles was strongly supported to mitigate climate impact. We found high job satisfaction and engagement amongst HaH staff. Our interviews suggest enthusiasm for further development of HaH while raising important challenges to address during service expansion.

Beyond the formal economy. Social cooperatives for labour integration under the pressure of market competitiveness

PurposeUsing the theoretical framework of the substantive economy, this study aims to point out the main aspects of the substantive mode of operation that help the integration of disadvantaged people while at the same time shedding light on the barriers that hinder economically efficient functioning in a market economy.Design/methodology/approachResearch focuses on Hungarian rural work integration social cooperatives, which are engaged in producing activity by the employment of disadvantaged people. In the research, mixed methods were applied: results of a questionnaire survey covering 102 cooperatives, as well as 20 semi-structured interviews and experiences from the field. A total of 17 indicators were used to explore the substantive operational features, promoting mechanisms and problems in the following areas: organisational goals and outcomes; integrating roles and functions; productive functions; and the embeddedness of cooperatives.FindingsAs for results, substantive operational mechanisms and tools that support the integration of disadvantaged people have been identified such as mentoring, social incentives, the ability to create local value or the expansion of local community services. At the same time, several barriers have been detected that make it difficult to operate economically, such as cooperatives being a stepping stone for workers, excessive product heterogeneity or the lack of vertically structured bridging relationships.Originality/valueThe value of the study is to counterpoint the mechanisms promoting social purposes of work-integration social cooperatives and the obstacles to their long-term sustainability within the framework of the substantive economy, to better understand their functioning and the less quantifiable factors of their performance.

The impact of nurse’s sense of calling, organizational commitment, job stress, and nursing work environment on patient safety management activities in comprehensive nursing care service units during the covid-19 pandemic

BackgroundAs the number of COVID-19 patients rises, there has been a notable increase in the workload for nurses. However, medium-sized hospitals lacked standardized protocols or consistent approaches to address the specific working conditions of nurses. Furthermore, concerns about patient care have heightened as the issue of nursing shortages coincides with the expansion of the comprehensive nursing care services project.PurposeThis study aimed to investigate the factors that influence patient safety management activities, such as calling, organizational commitment, job stress, and nursing work environment, among comprehensive nursing care service unit nurses during the COVID-19 pandemic.MethodsA conceptual framework based on the Job Demand-Resource model and literature review of patient safety management activities was used to develop structured questionnaires that were distributed to 206 participants working in 7 comprehensive nursing care service units of small and medium-sized hospitals with at least 300 beds in the S and K provinces. Data analysis was conducted using descriptive statistics, chi-squared tests, t-tests, ANOVA, and hierarchical regression with the SPSS/WIN 23.0 program.ResultsThe results showed that calling (β =.383, p<.001) and job stress (β= -.187, p=.029) significantly influenced patient safety nursing activities in comprehensive care service ward nurses. The explanatory power of the model was 26.0% (F= 6.098, p<.001).ConclusionsOur findings suggest that comprehensive care service ward nurses' career, income, COVID-19 patient nursing anxiety, calling, and job stress were important factors that influence patient safety nursing activities. Therefore, it was essential to develop calling education programs and improve the nursing work system and establish a fair compensation system during the pandemic situation.