Experienced Clients Research Articles

Advanced HIV disease in Homa Bay County, Kenya: Characteristics of newly-diagnosed and antiretroviral therapy-experienced clients.

Advanced HIV disease (AHD) remains a significant burden, despite the widespread use of antiretroviral therapy (ART) programs. Individuals with AHD are at a high risk of death even after starting ART. We characterized treatment naïve and treatment experienced clients presenting with AHD in western Kenya to inform service delivery and program improvement. We conducted a retrospective study using routinely collected program data from October 2016 to September 2019 for AHD clients in eight facilities in Homa Bay County, Kenya. Demographic and clinical data were abstracted from the medical records of AHD clients, defined as HIV-positive clients aged ≥ 5 years with documented CD4 count < 200 cells/mm3 and/or WHO clinical stage II/IV. Associations were assessed using Pearson's chi-square and Mann-Whitney Rank-Sum tests at 5% level of significance. Of the 19,427 HIV clients at the eight facilities, 6649 (34%) had a CD4 count < 200 cells/mm3 or a WHO III/IV stage. Of these, 1845 were randomly selected for analysis. Over half (991) of participants were aged 45 + years and 1040 (56%) were female. The median age was 46.0 years (interquartile range: 39.2-54.5); 1553 (84%) were in care at county and sub-county hospitals; and 1460 (79%) were WHO stage III/IV at enrollment. At ART initiation, 241 (13%) had tuberculosis, 192 (10%) had chronic diarrhea, and 94 (5%) had Pneumocystis jiroveci pneumonia. At the time of data collection, 89 (5%) participants had died and 140 (8%) were lost to follow-up. Eighteen percent (330) of participants were ART-experienced (on ART for ≥ 3 months). The proportions of ART-experienced and -naïve clients regarding age, sex and marital status were similar. However, a higher proportion of ART-experienced clients received care at primary care facilities, (93(28%) vs. 199 (13%); P < .001); were WHO stage 3/4 at AHD diagnosis, 273 (84%) vs. 1187 (79%) (P = .041); and had died or been LTFU, (124 (38%) vs. 105 (7%); P < .001). With increasing prevalence of patients on ART, the proportion of AHD treatment-experienced clients may increase without effective interventions to ensure that these patients remain in care.

Relationship between Experience of Client Violence and Turnover Intention among Workers in Long-Term Care Facilities for Older Adults: Focusing on Nurses, Social Workers, and Care Workers

To prevent discontinuity of long-term care service and guarantee the quality of care, it is important to clarify the determinants of turnover intentions of long-term care workers. They are at a higher risk of experiencing violence-including physical, emotional, and sexual-from patients or their families, possibly leading to high turnover intention. This study aims to verify how having experienced client violence affect turnover intention of long-term care workers and to suggest implications to prevent frequent turnover in long-term care field. Logistic regression analysis was conducted between groups who have experienced client violence and who have not, using 2019 Korean LTC Survey data. Results revealed that, first, there were differences in determinants of turnover intention depending on groups. Second, having experienced client violence had a different effect on turnover intention based on personal characteristics. Third, gender and occupational differences were found. Based on our results, we highlighted the need for discussions on interventions to address client violence exposure among long-term care workers.

The single‐sourcing versus multisourcing decision in information technology outsourcing

AbstractAlthough using a single vendor when outsourcing information technology (IT) services (i.e., single‐sourcing) is commonplace, splitting the IT service package among multiple vendors (i.e., multisourcing) is an increasingly popular strategy. However, our understanding of the factors that contribute to this trend is limited. Guided by a thorough review of the extant literature and interviews with industry experts, we focus on the influence of emerging technologies (i.e., cloud‐based services and automation services), vendor location (i.e., offshore or domestic), and experiential learning (i.e., client and vendor experience) on the choice between single‐sourcing and multisourcing for IT services. The trend towards more multisourcing exemplifies a broader movement towards greater disaggregation and distribution of knowledge work. Thus, we utilize a knowledge‐based perspective to develop our hypotheses for how the aforementioned factors relate to the likelihood of multisourcing. Analyzing a large database of IT service contracts, we find that cloud‐based services are less likely to be multisourced, but automation services are not significantly associated with the likelihood of multisourcing. We also find that more experienced client firms are more likely to adopt multisourcing. Conversely, our results indicate that more experienced vendors and vendors located offshore are less likely to be part of multisourcing arrangements. Exploratory post hoc analyses yield additional interesting insights related to client and vendor location. These findings advance our understanding of the drivers of the single‐sourcing versus multisourcing decision in IT and more broadly contribute to the literature on technology sourcing. Our study has normative implications for both client and vendor management teams.

Coping with the burden of the COVID-19 pandemic: a cross-sectional study of community pharmacists from Serbia

BackgroundRapid spread of COVID-19 forced the public to turn to community pharmacies as the most accessible points of primary healthcare, overloading pharmacy services. The objectives of this research were to detect and describe the changes in work environment of community pharmacists in Vojvodina during the state of emergency due to COVID-19 pandemic. Moreover, the COVID-19 pandemic effects on job related stress were assessed.MethodsCommunity pharmacists from Vojvodina completed an online questionnaire on work environment changes related to COVID-19 (cross-sectional study).ResultsOut of the 1574 licenced pharmacists in Vojvodina, 392 completed the survey. Workload increase, reported by 90.8% of pharmacists, was caused mostly by higher demand for safety equipment, antiseptics and disinfectants, dietary products and medicines. Most pharmacists (93.1%) considered pharmacy workflow to be more complex than before the pandemic. Clients’ behavior was described as less pleasant since the start of the pandemic by 67.6% of the community pharmacists. Many were concerned for their health and the health of their families (68.9%). Community pharmacists rated their stress levels higher if they i) were working in larger chains, ii) experienced clients’ behavior as less pleasant or/and iii) were concerned for their/their family health.ConclusionsCurrent research pointed out the need for a more robust healthcare system which would allow rapid introduction of new activities and roles for community pharmacists that could possibly decrease job-related stress. Legal steps to improve the work environment in community pharmacies are necessary and urgent in order to fully utilize their skills and knowledge.

Monitoring of Fair Value Reliability by Third-Party Specialists: A Review and Integration of Empirical Research

This paper reviews the academic literature on the effectiveness of third-party specialists in monitoring the reliability of fair value measurements (FVMs). Management may lack the necessary valuation expertise for measuring fair values and has been shown to provide biased FVMs. The use of third-party specialists may compensate for these deficiencies. By integrating findings in the accounting, economics, and finance literature, this review provides novel insights into the monitoring role of third-party specialists and suggests directions for future research. Overall, the literature shows that third-party specialists are associated with more reliable FVMs across both financial- and nonfinancial assets or liabilities, supporting the notion that third-party specialists perform a valuable role in improving the reliability of FVMs and reducing investors’ information risk. Furthermore, research suggests third-party specialists monitoring effectiveness interact with corporate governance mechanisms such as independent board of directors, but financial statement audits seem to only marginally affect the reliability of FVMs above the contribution of third-party specialists. Third-party specialists monitoring effectiveness may, however, be moderated by specialists’ economic incentives and by experienced client pressure to inflate FVMs. Future research will benefit from gaining a better understanding of specialists’ economic incentives and how these influence specialists’ monitoring effectiveness, as well as investigate how specialists’ monitoring role interacts with relevant corporate governance mechanisms.

Procurement strategy and outcomes of a new universities project in South Africa

Purpose Construction project management outcomes in the literature typically portray significant deviations from expected outcomes. Various theories from studies that focus superficially on causes of project cost and time overruns rather than root causes have not addressed this problem. The need is for a better understanding of how procurement strategy provides a fundamental means to address this problem. The purpose of this paper is to examine the procurement strategy used to deliver a new universities project in South Africa within budget and to ascertain its influence on the outcomes. Design/methodology/approach A case study was designed to provide a comprehensive and intensive methodology to identify and examine the construction procurement strategy and its influence on the project outcomes. Document analyses and semi-structured interviews were used to collect data on the construction procurement strategy and outcomes from the client team. Findings The evidence brought forward demonstrates that the successful outcome was largely a consequence of the client team, procurement strategy and systems of delivery. However, the collaborative procurement strategy formed the basis of the successful project delivery and outcomes. A general observation from the data is that an appropriate construction procurement strategy developed by an experienced client team and proactively implemented by an integrated delivery team working collaboratively is likely to achieve the intended project outcomes. Practical implications The findings show three critical keys to achieving intended outcomes – people, procurement strategy and systems of delivery at the governance, portfolio, programme and project management levels. Originality/value The value of this paper lies in using a comprehensive methodology to study the relationship between procurement strategy and outcomes. The findings can be applied by client teams to achieve better outcomes and value for money in infrastructure projects.

Experiences of participation in goal setting for people with stroke-induced aphasia in Norway. A qualitative study

Purpose: The body of research into client participation in aphasia rehabilitation is increasing, but the evidence on how it is implemented into clinical practice is still scarce. Particularly, the importance of including the “insider's perspective” has been demanded. The aim of this study was to explore how people with aphasia experienced client participation during the process of goal setting and clinical decision making in language rehabilitation.Methods: Fifteen people with stroke-induced aphasia participated in semi-structured in-depth interviews. A qualitative analysis using Systematic Text Condensation was undertaken.Results: Analysis revealed four main themes: (1) pleased with services, (2) vagueness in language rehabilitation, (3) personal goals exist, and (4) desired level of participation.Conclusion: Even though people with stroke-induced aphasia overall are pleased with the language rehabilitation, there is a need for greater emphasis on making the framework of language rehabilitation less vague. Therapists should also spend more time on collaboration with people with stroke-induced aphasia and use available methods to support communication and collaboration. The findings underscore the need for further exploration of the potential outcomes of implementing client participation in goal setting and clinical decision making for persons with stroke-induced aphasia.Implications for rehabilitationAll persons with stroke induced aphasia should be asked about their goals for rehabilitation not only once, but during the whole continuum of their rehabilitation journey.Rehabilitation professionals should place greater emphasis on client participation by asking people with stroke induced aphasia how they prefer to participate at different stages of rehabilitation.To ensure active participation for those who wants it, existing tools and techniques which promoted collaborative goal setting should be better incorporated.

Successful Negotiations with Audit-Clients: Does Client Experience Matter?

We examine whether audit-clients’ experience level affects their reactions when auditors use different negotiation tactics to help resolve a material audit issue. Using business owners as experienced clients and accounting students as naive clients, we find that experienced clients react significantly when auditors compromise on an issue (i.e., split the difference), but naive clients do not. These results are driven by large negative reactions by experienced clients when auditors do NOT compromise .We attribute this effect to differences in expectations regarding negotiation outcomes. Experienced clients expect auditors to compromise, and are disappointed when they don’t. Since naive clients have no expectations, they don’t react significantly either way. We also find that both experienced and naive clients react positively when auditors use immaterial items to create integrative solutions (i.e., cost cutting, non-specific compensation) in resolving a material audit issue, but only when NOT used simultaneously with compromise. We interpret this as indicating that client reactions to integrative tactics are not related to expectations, but are instead likely to be interpreted as signals of auditor empathy or concern for the client’s position. Compromise appears to interfere with these signals.

Switching behaviour in property related professional services

Traditionally, when trying to understand property markets researchers have tended to take a positivist approach and assume rational decision‐making behaviour. More recently, however, alternative non‐positivist approaches have been used to understand the behaviour of the different participants within these markets. These approaches allow us to discover the importance of social structures and processes. This paper explores social processes within the context of clients and providers of professional property services within the Auckland market. Customer retention and loyalty is a major goal of property service providers because of the negative impact of lost customers on a company’s profit and market share. It is thus important for any service provider to ascertain the reasons for their clients’ decisions to leave them for their competitors. A considerable amount of work in the marketing literature has explored the customer’s decision to switch from one service provider to another. Little research, however, has been undertaken in the context of property service providers. This paper investigates customers’ reasons for switching property service providers within a business‐to‐business context. The method for this study is by means of in‐depth interviews with a number of experienced clients who regularly use the services of valuers, real estate agents, architects and lawyers. The results uncover several key reasons for switching across different types of service providers and clients within the context of property markets.

From Babes and Sucklings:: Management Consultants and Novice Clients

Although now awaiting a return to the heady years of the late 1990s, the modern management consultancy industry is still vast. So, too, is the number of managers experienced in the use of management consultants. But the expansion of management consultancy has also attracted new customers among managers who are yet to be blooded in the use of consultants. Conventional wisdom would have it that these novices are easy prey for the crafty consultant, that they will be less able than the old hands to stand up for themselves. This paper tests the proposition in a range of circumstances: it looks at the use of management consultants in the Church of England, in a couple of trade unions, and in Poland. The paper finds that these novice users are not quite as helpless as might have been anticipated, and that experienced clients of consultants, and even consultants themselves, may have something to learn from them. The paper explains the situation in terms of the close relationship that usually develops between management consultant and hiring manager. In the absence of this relationship, consultant and manager struggle to come to terms, but there are benefits for the hiring organisation.

Investigation of the early stages of project formulation

Investigates how large, experienced clients of the UK construction industry arrive at their decision to build. Explores the pre‐project stage, which begins within the organisation’s strategic planning process and concludes once a proposal has either been abandoned or has become a fully‐funded project. This complex process is shown with the aid of three decision models, shown as figures, that add layers of detail and shows other options such as rent, buy, lease and no‐go decisions in the context of the decision to build. Provides an overview of the decision‐making process and its structure, before explaining what typically happens within the various stages. Explains how clients arrive at their decision to build before the construction industry becomes involved and how client organisations divide the decision‐making process among managerial roles; decision‐approvers, decision‐takers, decision‐shapers. Also explores how paradigms and perspectives set the priorities by which those responsible for developing and approving proposals are influenced.

Achieving exemplary quality in the construction professions

Explores the nature of quality management in professional practices regarded as exemplary by experienced clients. Ten case studies of projects carried out by such firms were selected. Focuses on three areas: the view of professional clients; the approach to quality management taken by exemplary practices; and the approach taken to managing change taken by these practices. Reaches four main conclusions: quality culture was regarded by both clients and practitioners as more important than a formal quality system; clients tended to devote more effort to initial selection of professionals than to subsequently monitoring their performance; exemplary professionals were guided by their own strong principles rather than simply reacting to client instructions; briefing was a key element in project success.

The conditioning effect of objective decision-making on the client's capital proposal

This paper explains how the capital proposals of large experienced clients of the UK construction industry are influenced by paradigms and perspectives. It shows how those involved in the decision-to-build process react to stimuli caused by a need to demonstrate objective decision-making. The paper is taken from a 5-year PhD study undertaken by the first author, which investigated the origins of the decision to build undertaken by leading clients. The clients sampled had a total annual construction budget of between £700 million and £1000 million in the year that data were collected. The product of the research was an explanation of what happens in the pre-project stage, why it happens, and why it will change in the future. The significance of its conclusions is that any system designed to model or improve decision-making in the pre-project stage must be capable of adaptation and modification as influences and considerations shift. Moreover, the need to justify decisions as ‘objective’ empowers paradigms and perspectives that act as conditioning influences on the people making or shaping proposals. The paper concludes by showing that an understanding of the role played by paradigms and perspectives could allow management to ‘rethink construction’ and meet the challenges put forward by Sir John Egan (The Egan Report: Rethinking Construction, DETR, 1998).

The conditioning effect of objective decision‐making on the client's capital proposal

This paper explains how the capital proposals of large experienced clients of the UK construction industry are influenced by paradigms and perspectives. It shows how those involved in the decision‐to‐build process react to stimuli caused by a need to demonstrate objective decision‐making. The paper is taken from a 5‐year PhD study undertaken by the first author, which investigated the origins of the decision to build undertaken by leading clients. The clients sampled had a total annual construction budget of between £700 million and £1000 million in the year that data were collected. The product of the research was an explanation of what happens in the pre‐project stage, why it happens, and why it will change in the future. The significance of its conclusions is that any system designed to model or improve decision‐making in the pre‐project stage must be capable of adaptation and modification as influences and considerations shift. Moreover, the need to justify decisions as ‘objective’ empowers paradigms and perspectives that act as conditioning influences on the people making or shaping proposals. The paper concludes by showing that an understanding of the role played by paradigms and perspectives could allow management to ‘rethink construction’ and meet the challenges put forward by Sir John Egan (The Egan Report: Rethinking Construction, DETR, 1998).

Prevalence and Risk Factors for Client Violence toward Social Workers

The author reports findings from a random survey of National Association of Social Workers members from two states examining the prevalence, nature, and risk factors of client violence toward social workers. A majority of persons surveyed experienced client violence, with gender and setting as significant variables in determining risk. Implications for practice and policy are discussed.