Healthcare Service System Research Articles

Communicative interventions for preventing the novel Coronavirus (Covid-19) outbreak: insights from Iran’s rural and farming communities

ABSTRACT Purpose The article explores how best agricultural extension and advisory services (AEAS) can contribute to communicative interventions in preventing the COVID-19 outbreak in rural and farming communities. Methodology An action research was conducted in Iran, as one of the top countries experiencing the COVID-19 outbreak. Findings A strategic communicative intervention campaign for preventing the COVID-19 outbreak was designed at national level through diagnosing the situation, planning, organising expert teams, producing appropriate information, and disseminating through social networks, mass media and interpersonal communications. Extension staff, many relevant institutions, most key rural informants, local leaders, facilitators, farmers and nomads received and exchanged this information. Practical Implications These communicative interventions can not only help health care service systems control the outbreak, but help rural communities increase their knowledge about the virus and health measures to participate in preventing further spreading of the virus, while continue their agricultural activities. Theoretical Implications Preventing and managing health-related crises require effective measures, including communicative intervention campaigns. The article shows how agricultural extension systems can contribute to crisis and emergency risk communication and can support health care efforts and enhance the competencies of rural communities during human health-related crises. Originality/Value The novel coronavirus (COVID-19) which has transmitted to all parts of the world, including rural areas, can threaten food security and rural communities’ livelihoods. The study generates important insights about the process of extension interventions for enhancing these communities’ knowledge and skills to prevent and manage the virus transmission.

Examining area-level variation in service organisation and delivery across the breadth of primary healthcare. Usefulness of measures constructed from routine data.

Australia has a universal healthcare system, yet organisation and delivery of primary healthcare (PHC) services varies across local areas. Understanding the nature and extent of this variation is essential to improve quality of care and health equity, but this has been hampered by a lack of suitable measures across the breadth of effective PHC systems. Using a suite of measures constructed at the area-level, this study explored their application in assessing area-level variation in PHC organisation and delivery. Routinely collected data from New South Wales, Australia were used to construct 13 small area-level measures of PHC service organisation and delivery that best approximated access (availability, affordability, accommodation) comprehensiveness and coordination. Regression analyses and pairwise Pearson's correlations were used to examine variation by area, and by remoteness and area disadvantage. PHC service delivery varied geographically at the small-area level-within cities and more remote locations. Areas in major cities were more accessible (all measures), while in remote areas, services were more comprehensive and coordinated. In disadvantaged areas of major cities, there were fewer GPs (most disadvantaged quintile 0.9[SD 0.1] vs least 1.0[SD 0.2]), services were more affordable (97.4%[1.6] bulk-billed vs 75.7[11.3]), a greater proportion were after-hours (10.3%[3.0] vs 6.2[2.9]) and for chronic disease care (28%[3.4] vs 17.6[8.0]) but fewer for preventive care (50.7%[3.8] had cervical screening vs 62.5[4.9]). Patterns were similar in regional locations, other than disadvantaged areas had less after-hours care (1.3%[0.7] vs 6.1%[3.9]). Measures were positively correlated, except GP supply and affordability in major cities (-0.41, p < .01). Application of constructed measures revealed inequity in PHC service delivery amenable to policy intervention. Initiatives should consider the maldistribution of GPs not only by remoteness but also by area disadvantage. Avenues for improvement in disadvantaged areas include preventative care across all regions and after-hours care in regional locations.

Key public health challenges of the Chinese elderly in a new situation

The results of the seventh national census in 2020 show that China is facing a severe new situation with a rapid increase in the number of the elderly, a huge base of oldest old population, a rapid rise in the elderly dependency ratio, empty-nest families gradually becoming the main form of elderly families, and a further intensification of aging in the future. The elderly has prominent health problems such as decline in physical health, impairment of functional status, malnutrition and mental health, which bring a series of challenges to public health system, geriatric friendly society and geriatric health standards in China. Facing the new situation, we should find out the health status and service needs of the elderly as soon as we can, and regularly monitor and evaluate the progress of response strategies, formulate laws, regulations and policies related to the elderly at the national level, establish a well-defined, innovative and coordinated health care service and long-term care service system for the elderly, promote the wide participation of the whole society to build age-friendly environments. Oriented to the health characteristics and needs of the elderly, we should carry out trials of health protection and intervention for the elderly, strengthen scientific research and technological innovation to serve the elderly multilayered health needs, take multiple measures to improve the guarantee capacity and level of health services for the elderly, and finally actively exploring the "Chinese experience" of Chinese public health system in dealing with population aging.

Digitalization as an Engine for Change? Building a Vision Pathway towards a Sustainable Health Care System by Using the MLP and Health Economic Decision Modelling

Grand social challenges, such as type 2 diabetes (T2D), are increasing, which creates sustainability problems for health care service systems. To reduce socio-economic burdens, changes are required in the socio-technical system. However, there is an uncertainty of the most cost-effective policy action that can create sustainability while providing health benefits. To find potential solutions to these challenges, the multi-level perspective (MLP) and health economic decision modelling was used to study socio-technical change and project potential health economic consequences of different scenarios. The study focuses on creating a vision pathway for reducing T2D in Finland. In total, 23 interviews were carried out and the results were analyzed utilizing the MLP model. As a result, five themes towards prevention of T2D were identified. Digitalization was found to be a cross-cutting theme for preventing T2D and was thus taken as the object of study and the main focus of this paper. As a result, this paper reports on the opportunities and barriers for using digital tools in a transition towards T2D prevention. A health economic decision modelling revealed that the highest expected savings could be obtained by prioritizing prevention programs based on T2D risk. Finally, the model was converted into a web-based online tool by combining vision pathway, transition-focused storylines and forward-looking health economic scenario analysis to give the policy makers an overall picture of the needed societal changes and support the impact assessment of alternative policies in a case of T2D prevention in Finland.

Is Laparoscopic Surgery Safe During the Pandemic Period?

Abstract Background: The COVID-19 pandemic has significantly affected healthcare service systems and personnel worldwide. Important decisions have been made such as surgical activity changes, recommendations to cancel elective surgery, and shifting surgeons to other medical activities. However, following the collection of new data and acceptance that this pandemic would last for at least a few years, firstly elective cases and then laparoscopic operations were started again. While it was reported that the COVID-19 virus was detected in the abdominal cavity in studies published in the form of series of a few cases, there is no clear information about the virulence of this detected virus yet. In guidelines published as recommendations by surgical associations, it is stated that it could be performed by taking the necessary precautions, but open surgery needs to be preferred in positive cases. We aimed in this study to show minimally invasive surgery is safe with all the precautions made preoperatively for both patients and surgical crew. Material and Method: We retrospectively examined the laparoscopic cases included between August 2020 and December 2020 at the General Surgery Clinic of the Hitit University Erol Olçok Research and Training Hospital from the hospital’s information system. We collected the ages of the found cases, their preoperative COVID diagnostic tests, and their COVID polyclinic visitation data in their postoperative follow-up. We also examined whether or not the surgical team involved in the surgeries of these patients was diagnosed with COVID-19 within 2 weeks following these surgeries. Results: A total of 124 laparoscopic cases were included at our clinic between August 2020 and December 2020. Most of these cases (68.5%) were laparoscopic cholecystectomy cases. A total of 124 laparoscopic cases were included at our clinic between August 2020 and December 2020. Most of these cases (68.5%) were laparoscopic cholecystectomy cases. The surgical team comprised the surgical nurse and operating room personnel under the leadership of the surgeon. Based on verbal questioning, it was determined that no person from the team involved in these surgeries was infected with SARS-CoV-2. Conclusion: In our study, as a result of our application of all these recommendations in the literature, we did not encounter any contamination in the 124 laparoscopic surgery cases we examined. In conclusion, we think that laparoscopic surgery may be performed safely with taking the necessary precautions during the COVID-19 pandemic period.

A Machine Learning Solution for Bed Occupancy Issue for Smart Healthcare Sector

The health care domain is a culmination and emergence of many other economic sectors that give different services from patient treatment to healing, protective, rehabilitation, and palliative care. The GDP consumes to facilitate health in terms of smart device development, clinical examinations, outsourcing, and tele-medication facilities. The Asian countries and less developed countries with a high population rate are facing health care services related issues. One of these countries is India. India has two types of health care services systems: (i) public service system and (ii) private system. The public health system, i.e., the government, provides facilities to patients as primary health centers (PHCs) through limited secondary and tertiary health institutions like hospitals in rural areas while the private service is owned by local practitioners and institutions. Both of these service providers are facing bed occupancy issues for patients due to a highly populated country. To overcome this issue, we propose a machine learning solution for patient admission scheduling autonomously. The proposed framework helps hospitals to enhance the decision process for bed occupancy for patients concerning their departments and their diseases. We have deployed our framework in real time environment and find that it facilitates the overall performance of bed allocation in the prescribed hospitals.

Private Blockchain-Cloud System (PBCS) for Healthcare Services

Blockchain in the recent times stands as a buzz word to deal with huge set of real time applications that function in a manual way rather than in an automated manner. There may be several intermediate phases involved to access legitimate records of significance in various sectors like financial industry, supply chain market, educational organizations, healthcare systems etc. But, when the amount of data is enormous, then manual steps to infer a conclusion after undergoing verification and validation phases, is a time-consuming approach. Hence, there is a necessity to automate the process flow using emerging tools and technologies such as blockchain. Towards this end, a novel Private Blockchain-Cloud System (PBCS) for Healthcare Services is proposed in this work. An model is presented to secure the patient records via e-block access platform where only the person holding the legitimate key can access the data. Security is further strengthened by deploying the blocks of a blockchain in cloud environment.

Need-based care of multi-morbid patients \u2013 supporting general practitioners with algorithm-generated recommendations of healthcare services (telemedicine-project ATMoSPH\xc4RE)

BackgroundThe patient-oriented and need-based care of multi-morbid patients with healthcare services and assistive products can be a highly complex task for the general practitioners (GPs). An algorithm-based digital recommendation system (DRS) for healthcare services was developed within the context of the telemedicine research project ATMoSPHÄRE. The plausibility of the DRS was tested and the results used to examine if, and to what degree, the DRS provides useful assistance to GPs.MethodsThe plausibility of the recommendations of the DRS were tested with the Delphi procedure (n = 8) and Interviews (n = 4) in collaboration with the GPs. They proposed services and assistive products they considered appropriate for two multi-morbid patients. Furthermore, GPs had to report whether, and to what degree they deemed the algorithm-generated recommendations appropriate. Significant quantitative differences between the GPs’, and the algorithm-generated, recommendations were evaluated with paired-samples-Wilcoxon-test.ResultsThe first Delphi round revealed a high variability regarding the amount and character of services recommended by the physicians (1 to 10 recommendations, mean = 5.6, sd = 2.8). These professional recommendations converged after consideration of the algorithm-generated recommendations. The number of algorithm-generated recommendations which were judged as appropriate ranged between 7 and 17 of a total of 20 (mean = 11.9, sd = 2.5). The interviews revealed that the additional algorithm-generated recommendations which were judged appropriate contained mainly social care services.ConlusionThe DRS provides GPs with additional appropriate recommendations for the need-based care of patients, which may not have been previously considered. It can therefore be assessed as a helpful complement in the primary care of multi-morbid patients.

Immigrant Communities and COVID-19: Strengthening the Public Health Response.

The COVID-19 pandemic has exposed the many broken fragments of US health care and social service systems, reinforcing extant health and socioeconomic inequities faced by structurally marginalized immigrant communities. Throughout the pandemic, even during the most critical period of rising cases in different epicenters, immigrants continued to work in high-risk-exposure environments while simultaneously having less access to health care and economic relief and facing discrimination. We describe systemic factors that have adversely affected low-income immigrants, including limiting their work opportunities to essential jobs, living in substandard housing conditions that do not allow for social distancing or space to safely isolate from others in the household, and policies that discourage access to public resources that are available to them or that make resources completely inaccessible. We demonstrate that the current public health infrastructure has not improved health care access or linkages to necessary services, treatments, or culturally competent health care providers, and we provide suggestions for how the Public Health 3.0 framework could advance this. We recommend the following strategies to improve the Public Health 3.0 public health infrastructure and mitigate widening disparities: (1) address the social determinants of health, (2) broaden engagement with stakeholders across multiple sectors, and (3) develop appropriate tools and technologies. (Am J Public Health. 2021;111(S3):S224-S231. https://doi.org/10.2105/AJPH.2021.306433).

A Stochastic Programming Model for Service Scheduling with Uncertain Demand: an Application in Open-Access Clinic Scheduling

This paper addressed a scheduling problem which handles urgent tasks along with existing schedules. The uncertainties in this problem come from random process of existing schedules and unknown upcoming urgent tasks. To deal with the uncertainties, this paper proposes a stochastic integer programming (SIP) based aggregated online scheduling method. The method is illustrated through a study case from the outpatient clinic block-wise scheduling system which is under a hybrid scheduling policy combining regular far-in-advance policy and the open-access policy. The COVID-19 pandemic brings more challenges for the healthcare system including the fluctuations of service time and increasing urgent requests which this paper is designed for. The schedule framework designed in the method is comprehensive to accommodate various uncertainties in the healthcare service system, such as: no-shows, cancellations and punctuality of patients as well as preference of patients over time slots and physicians.Supplementary InformationThe online version contains supplementary material available at 10.1007/s43069-021-00089-6.

"This Graft-vs.-Host Disease Determines My Life. That's It."-A Qualitative Analysis of the Experiences and Needs of Allogenic Hematopoietic Stem Cells Transplantation Survivors in Germany.

Background: Allogeneic hematopoietic stem cell transplantation (alloHSCT) is the only curative treatment modality for many patients affected by hematologic malignancies. However, it can cause debilitating long-term effects. Understanding the impact of alloHSCT on all aspects of the patients' life is required for optimal survivorship management.Aim: To explore in-depth HSCT-survivors' experiences and needs post-transplant. Partners were included to provide further information on survivors' needs and how care could be improved in this area.Methods: We conducted semi-structured face-to-face and phone interviews with alloHSCT-survivors and their partners referred to a survivorship clinic in Germany. Theoretical sampling was used to recruit participants. Data were analyzed using framework analysis.Results: Thirty-two survivors (consent rate: 100%, response rate: 100%) and eighteen partners (consent rate: 84%, response rate: 72%) participated. Survivors were aged between 25 and 68 years (Median: 48, IQR: 25.3) and partners were aged between 26 and 64 years (Median: 54, IQR: 16, SD: 12.8). The themes emerging from the data involved survivors' needs included (i) the diversity of long-term treatment side-effects; and (ii) time post discharge as a dynamic process with individual peaks of burden. Survivors and their partners also suggested strategies for mitigating these unmet needs, i.e., (iii) transparent communication and patient empowerment; and (iv) improvement in continuity of care system and help with claiming social benefits as cornerstones of optimal survivorship care.Conclusion: To our knowledge, this is one of the first qualitative studies focused on the views of German alloHSCT-survivors on the long-term effects of alloHSCT and the first study integrating the view of their partners. Healthcare providers could better support survivors with managing their symptoms and adhering to their prescribed care by ensuring comprehensive, transparent communication that helps increase survivors' understanding and involvement in their care. Further efforts should be made to provide patient-centered, continuous survivorship care that involves additional support with navigating the healthcare and social service system. Intervention studies are required to test the effectiveness of the suggested strategies.

Performance Measurement and Improvement of Healthcare Service Using Discrete Event Simulation in Bahir Dar Clinic

This paper deals with the service performance analysis and improvement using discrete event simulation has been used. The simulation of the health care has been done by arena master development 14-version software. The performance measurement for this study are patients output, service rate, service efficiency and it is directly related to waiting time of patients in each service station, work in progress, resource utilization. Simulation model was building for Bahir Dar clinic and then, prepared the proposed model for the system. Based on the simulation model run result, the output of the existing healthcare service system is low due to presence of bottlenecks on the service system. Moreover, the station with the largest queue and high resource utilization are identified as a bottleneck. The bottlenecks, which have identified are reduced by using reassigning the existing resources and add new resources and merging the similar services, which has under low resource utilization (nurses). Finally, the researchers have proposed a developed model from different scenarios. Moreover, the best scenario is developed by combining scenario 2 and 3. And then, service efficiency of the healthcare has increased by 9.86 percent, the work in progress (WIP) are reduced by 3 patients from the system and the service capacity of the system is increased 34 to 40 patients per day due to the reduction of bottleneck stations.

Clinical Nurses Research Priorities in Hospital Settings: A Delphi Survey.

This study aimed to identify the research priorities of clinical nurses to develop a research program at a health care services system that includes three hospitals. A Delphi survey was emailed to all clinical nurses in two rounds. The Delphi method was used to collect data from the nurses in regards to their priority research themes, and the data were analyzed using descriptive and comparative statistics. A total of 933 clinical nurses returned the first round of the Delphi survey and 543 nurses answered the second round. Clinical nurses identified 89 potential research themes. Patient safety and ethical challenges were the two highest ranked research priorities. The 40 highest ranked priority research themes were closely associated with issues concerning patient care and ethics. However, the nurses also gave high ratings to issues relating to the work environment, questions about technology implementation, and patient involvement in clinical care decisions.

The role of transformative healthcare technology on quality of life during the COVID-19 pandemic

PurposeThe purpose of this study is to investigate the role of the COVID-19 health-care system quality (HSQ) and its impact on the individual (satisfaction) and social (quality of life [QOL]) outcomes in the context of a transformative health-care delivery system using service-dominant logic (SDL).Design/methodology/approachA sample consisting of 1,008 individuals who have experienced the COVID-19 health-care system was drawn from four different regions of Saudi Arabia using the simple random sampling technique. The survey was conducted using an online survey and 1,008 respondents answered, based on their experience and knowledge of the COVID-19 health-care system. Partial least squares structural equation modeling was applied to test the proposed research model.FindingsThe study findings suggest that service system satisfaction (SAT) significantly mediates the role of the HSQ in delivering and enhancing the QOL. HSQ also has a significant role to play on the SAT as well as the QOL. These findings contribute to the body of knowledge on SDL in the context of HSQ in understanding the significant role of technologies can play in enhancing service satisfaction and better QOL during a crisis such as COVID-19. This study also improves the understanding of the importance of customer-centricity, real-time visibility through tracking and tracing of service flow, agile decision-making, fewer but better-defined service objectives, and finally shaping mindsets and behaviors of all the relevant parties involved in the HSQ service delivery process.Research limitations/implicationsOne of the major limitations of this study is that, although COVID-19 is an ongoing global pandemic, cross-sectional data were collected in only one country. The findings may not be generalizable across subsequent waves of the pandemic. The best practices of HSQ could be studied around the globe and the results used to support continuous improvement.Originality/valueThis study advances the understanding of the SDL in the context of a transformative health-care system for a transitional economy by focusing on individual and social well-being during an unexpected crisis such as the COVID-19 pandemic. This study also contributes toward the understanding of the roles of enabling technologies to improve the service delivery system which results in an improved SAT, as well as better QOL for the society at large. Based on SDL this research validates the HSQ model, relevant measures and its overall impact on SAT and QOL in the context of a transformative health-care service system in Saudi Arabia.

Facilitating inter-professional integration in palliative care: A service ecosystem perspective

A paradigm shift toward healthcare inter-professional collaboration is leading to searches for ways to better facilitate integration. However, policy rhetoric often fails to acknowledge the complexity of healthcare service systems, and the difficulties involved in achieving successful collaborations. Consequently, more research is called for. We utilize the concept of a service ecosystem, a perspective currently prominent in service science, which is transforming the ways service systems are studied. This research aims to examine palliative care provision through a service ecosystem lens in order to uncover previously unidentified insights and opportunities for improvement. The palliative care ecosystem under study encompasses a defined geographical area of the UK. Data comprises pathographies (i.e., narratives of illness) with patients and their families (n = 31) and in-depth interviews with a variety of palliative care providers (n = 21), collected between 2017 and 2018. Capability issues comprising collaboration, coordination, and resource integration, together with communicating value all emerged as common themes impacting palliative care services. Taking a service ecosystem perspective, we also found shared intentionality for better integration and collaboration, with a desire among palliative care providers for the ecosystem's hospice organization to take the role of leader and facilitator. Acting on these findings, we demonstrate the ways new institutional arrangements provide a foundation for value cocreation. We make a contribution to the burgeoning service ecosystem literature which currently lacks empirical insights, particularly in health. We argue that in complex service systems such as healthcare, the focus must be on service design rather than organizational design, approached from the perspective of aggregation of service providers. We demonstrate empirically how reconfiguring resources and developing new institutional arrangements at the meso level can change micro-macro level interaction, enabling the emergence of new and enhanced value cocreation in palliative care.

Australian Foster Carers' Views and Concerns Regarding Maternal Drug Use and the Safety of Breastmilk.

Parental substance misuse and mental health issues are major factors associated with infant placement into out-of-home care. Such placements may result in disruption and/or cessation of breastfeeding. Provision of breastmilk to infants in out-of-home care (OOHC) is desirable in terms of infant health and development, and also in supporting maternal caregiving. However, little is known about how breastfeeding is supported for infants in out-of-home care. This study used an online survey to explore the facilitation of breastfeeding in the context of OOHC and foster carers’ management of expressed breastmilk (EBM). Foster carers were generally open to the idea of maternal breastfeeding and infants in their care receiving EBM from their mothers. However, the majority of respondents expressed concern regarding the safety of EBM for infant consumption due to the possibility of harmful substances in the milk. Concerns regarding the safety of handling EBM were also prevalent. These concerns caused foster carers to discard EBM. Findings suggest foster carers’ may lack knowledge related to maternal substance use and breastmilk. Better integration between health care and social service systems, where the voices of mothers, foster carers and child protection workers are heard, is necessary to develop solutions enabling infants living in OOHC access to their mother’s breastmilk.

Nursing care toward older adults with dementia: An integrative review.

Dementia among older adults is receiving increase attention due to its neurodegenerative pathologies and poses a significant challenge for healthcare services systems. Caring for older adults with dementia is frequently challenging. This integrative review appraised and synthesised the existing literature describing the nursing care given to older adults with dementia. An integrative review was used using six electronic databases (CINAHL, Medline, Science direct-Elsevier, Proquest, Pubmed and Web of Science). The search terms that were included in various combinations using mesh terms were as follows: nurse* OR nursing staff* AND caring OR care OR caring behavior OR affectionate OR compassionate AND older person* OR aging* OR elder* OR geriatric patient* OR older adult* OR gerontology* OR aged* OR old age. A standardised review by Kmet et al. instrument was utilised for appraising the quality of selected 13 articles. The results were presented based on the two major themes: challenges in providing care and identifying and managing older adults' difficult behaviours. The findings of an integrative review can be used as a foundation for formulating recommendations for how dementia care by nurses can be improved and highlighting where policy development and further research are needed.

An efficient clustering-based anonymization scheme for privacy-preserving data collection in IoT based healthcare services

The healthcare services industry has seen a huge transformation since the prominent rise of the Internet of Things (IoT). IoT in healthcare services includes a large number of unified and interconnected sensors, and medical devices that generate and exchange sensitive information. Thus, an enormous amount of data is transmitted through the network which raises an alarming concern for the privacy of patient information. Therefore, privacy preserving data collection (PPDC) is on-demand to ensure the privacy of patient data. Several pieces of research on PPDC have been proposed recently. However, the research literatures have fallen short in privacy requirements and are prone to various privacy attacks. In this paper, we propose a novel privacy-preserving data collection scheme for IoT based healthcare services systems. A clustering-based anonymity model is utilized to develop an efficient privacy-preserving scheme to meet privacy requirements and to prevent healthcare IoT from various privacy attacks. We formulated the threat model as client-server-to-user to ensure privacy on both ends. On the client-side, a modified clustering-based k-anonymity model with α-deassociation is used to anonymize the data generated from the IoT nodes. The base-level privacy is then ensured through a bottom-up clustering method which generates clusters of records as per the privacy requirements. On the server-side, the cluster-combination method-UPGMA is utilized to reduce communication costs and to achieve a better level of privacy. The proposed scheme is efficient in tackling privacy attacks such as attribute disclosure, identity disclosure, membership disclosure, sensitivity attacks, similarity attacks, and skewness attacks. The effectiveness and efficiency of the proposed scheme are proven through theoretical and experimental analyses.

Barriers and facilitators for dental care among patients with severe or long-term mental illness.

BackgroundPersons who struggle with severe or long‐term mental illness (SMI) have a higher prevalence of oral health problems than the general population. Obtaining and continuing dental treatment is challenging for this patient group for many reasons, and many drop out of active treatment. Our study aimed to explore perceived barriers to obtaining optimal dental health care for patients with SMI. Further, we sought to identify possible ways to facilitate for providing true access to dental services for this population.MethodsThe study utilised a flexible qualitative design with data collected during ordinary clinical practice in a public dental clinic in Norway. We conducted semi‐structured face‐to‐face interviews with 51 persons with SMI twice: an initial interview before dental treatment and a final one after dental treatment. We applied the thematic analysis method.ResultsThematic analysis revealed two key themes in the participants’ experiences of access to dental health services: practical conditions and relationship with the dentist. Patients reported barriers and facilitators for access to care as factors associated with patients (patient factors), with the dentist (dentist factors) and with healthcare services (system factors).ConclusionsOur study indicates that persons with SMI appreciate oral health and want to obtain needed oral care and dental treatment, but they encounter barriers on several fronts. The participants offered suggestions for how to facilitate attendance and adherence. Our findings suggest that dental healthcare services require reorganisation to meet the needs of patients with SMI.

Coronavirus crisis and health care: learning from a service ecosystem perspective

PurposeThe COVID-19 pandemic has created a crisis for healthcare systems worldwide. There have been significant challenges to managing public and private health care and related services systems’ capacity to cope with testing, treatment and containment of the virus. Drawing on the foundational research by Frow et al. (2019), the paper explores how adopting a service ecosystem perspective provides insight into the complexity of healthcare systems during times of extreme stress and uncertainty.Design/methodology/approachA healthcare framework based on a review of the service ecosystem literature is developed, and the COVID-19 crisis in Australia provides an illustrative case.FindingsThe study demonstrates how the service ecosystem perspective provides new insight into the dynamics and multilayered nature of a healthcare system during a pandemic. Three propositions are developed that offer directions for future research and managerial applications.Practical implicationsThe research provides an understanding of the relevance of managerial flexibility, innovation, learning and knowledge sharing, which offers opportunities leading to greater resilience in the healthcare system. In particular, the research addresses how service providers in the service ecosystem learn from this pandemic to inform future practices.Originality/valueThe service ecosystem perspective for health care offers fresh thinking and an understanding of how a shared worldview, institutional practices and supportive and disruptive factors influence the systems’ overall well-being during a crisis such as COVID-19.