Implications For Organisation Of Services Research Articles

The role of market-based transformative service initiatives in service inclusion of refugees

PurposeThis paper aims to empirically investigate the role of market-based transformative service initiatives (TSIs) during the refugee crisis and shed light on how such TSIs increase inclusion of refugees in service systems by using market forces while creating broader benefits for service organizations themselves.Design/methodology/approachThis paper uses the case of the World Food Program’s (WFP) Dalili smartphone application targeting Syrian refugees in the context of Lebanon. A mixed-methods approach, including in-depth interviews with the retail managers of the local supermarkets and statistical cross- and intra-regional analysis on the retailing mix elements of the local supermarkets was adopted for the empirical investigation.FindingsThe results show that the WFP’s Dalili TSI increases service inclusion of refugees by facilitating their access to the essential food services easier and at affordable prices and helps them integrate into the host community. Furthermore, such market-based TSIs were shown to have broader benefits for other stakeholders in the food retail ecosystem including retailers and nonrefugee shoppers as they are successful in improving the retailing management standards of the participating supermarkets by decreasing the average retail price of the merchandise, increasing their variety and assortment, increasing promotional offers and improving the customer service level.Research limitations/implicationsThis research fills the gap in the literature for empirical investigation on the impact mechanism of market-based TSIs on service inclusion and well-being of refugees. In contrast to the majority of TSIs studied in the literature that are designed by governments or nonprofit organizations in the areas such as higher education, health care and humanitarian aids, this study focuses on the case of TSIs developed by supranational organizations using market forces in the food retail ecosystem. Furthermore, the findings suggest that TSIs could also benefit the service organizations that offer such initiatives.Practical implicationsThe findings of this paper have implications for service organizations and policymakers and their ability to design effective market-based TSIs during the refugee crisis.Originality/valueThe studied case in the context of TSIs in the food retail ecosystem and the empirical approach used are academically novel. Moreover, focusing on the refugee crisis in the Middle East region is rather understudied in the service research literature.

Self-harm and the COVID-19 pandemic: A study of factors contributing to self-harm during lockdown restrictions

IntroductionThe COVID-19 pandemic and resulting public health measures may have major impacts on mental health, including on self-harm. We have investigated what factors related to the pandemic influenced hospital presentations following self-harm during lockdown in England. MethodMental health clinicians assessing individuals aged 18 years and over presenting to hospitals in Oxford and Derby following self-harm during the period March 23rd to May 17, 2020 recorded whether the self-harm was related to the impact of COVID-19 and, if so, what specific factors were relevant. These factors were organized into a classification scheme. Information was also collected on patients’ demographic characteristics, method of self-harm and suicide intent. ResultsOf 228 patients assessed, in 46.9% (N = 107) COVID-19 and lockdown restrictions were identified as influencing self-harm. This applied more to females than males (53.5%, N = 68/127 v 38.6%, N = 39/101, χ2 = 5.03, p = 0.025), but there were no differences in age, methods of self-harm or suicide intent between the two groups. The most frequent COVID-related factors were mental health issues, including new and worsening disorders, and cessation or reduction of services (including absence of face-to-face support), isolation and loneliness, reduced contact with key individuals, disruption to normal routine, and entrapment. Multiple, often inter-connected COVID-related factors were identified in many patients. ConclusionsCOVID-related factors were identified as influences in nearly half of individuals presenting to hospitals following self-harm in the period following introduction of lockdown restrictions. Females were particularly affected. The fact that mental health problems, including issues with delivery of care, predominated has implications for organisation of services during such periods. The contribution of isolation, loneliness and sense of entrapment highlight the need for relatives, friends and neighbours to be encouraged to reach out to others, especially those living alone. The classification of COVID-related factors can be used as an aide-memoire for clinicians.

Understanding employee sabotage while serving refugees: the case of Syrian refugees in Turkey

PurposeService providers can potentially play a critical role in responding to the global refugee crisis. However, recent evidence suggests that local service employees’ negative and inappropriate behavior is hindering efforts to alleviate the problems faced by refugees. As a response to the call to action to engage with the global refugee crisis in service context and adopting the transformative service research perspective, this paper aims to understand service employees’ motivations to engage in sabotage when they interact with refugees in service settings.Design/methodology/approachThis paper focuses on the case of Syrian refugees in Turkey as a context. Using a netnographic study, this study analyzes comments by Turkish service employees in different social media groups and newspapers’ online platforms to reveal the motivations of those employees to engage in sabotage behavior.FindingsThe findings of this study revealed employees use five emerging themes as potential motivations to justify their sabotage behavior when serving refugees: perceived scarcity of resources, perceived fairness, perceived identity mismatch, perceived role of government and perceived role of other nations.Research limitations/implicationsThe findings of this study have implications for service organizations, communities and governments to manage, change and even remove some of those perceptions that lead to employee sabotage resulting in increased suffering of refugees.Originality/valueTo the best of the author’s knowledge, this is the first study to examine the employee sabotage behavior in the context of serving refugees.

A mixed-methods study exploring the characteristics and needs of long-stay patients in high and medium secure settings in England: implications for service organisation

BackgroundForensic psychiatric services provide care for those with mental disorders and offending behaviour. Concerns have been expressed that patients may stay for too long in too high levels of security. The economic burden of these services is high, and they are highly restrictive for patients. There is no agreed standard for ‘long stay’; we defined a length of stay exceeding 5 years in medium secure care, 10 years in high secure care or 15 years in a combination of both settings as long stay.ObjectivesTo (1) estimate the number of long-stay patients in secure settings; (2) describe patients’ characteristics, needs and care pathways and the reasons for their prolonged stay; (3) identify patients’ perceptions of their treatment and quality of life; and (4) explore stakeholders’ views on long stay.DesignA mixed-methods approach, including a cross-sectional survey (on 1 April 2013) of all patients in participating units to identify long-stay patients [work package (WP) 1], file reviews and consultant questionnaires for long-stay patients (WP2), interviews with patients (WP3) and focus groups with other stakeholders (WP4).SettingAll three high secure hospitals and 23 medium secure units (16 NHS and 9 independent providers) in England.ParticipantsInformation was gathered on all patients in participating units (WP1), from which 401 long-stay patients were identified (WP2), 40 patients (WP3), 17 international and 31 UK experts were interviewed and three focus groups were held (WP4).ResultsApproximately 23.5% of high secure patients and 18% of medium secure patients were long-stay patients. We estimated that there are currently about 730 forensic long-stay patients in England. The source of a patient’s admission and the current section of the Mental Health Act [Great Britain.Mental Health Act 1983 (as Amended by the Mental Health Act 2007). London: The Stationery Office; 2007] under which they were admitted predicted long-stay status. Long-stay patients had complex pathways, moving ‘around’ between settings rather than moving forward. They were most likely to be detained under a hospital order with restrictions (section 37/41) and to have disturbed backgrounds with previous psychiatric admissions, self-harm and significant offending histories. The most common diagnosis was schizophrenia, but 47% had been diagnosed with personality disorder. Only 50% had current formal psychological therapies. The rates of violent incidents within institutions and seclusion were high, and a large proportion had unsuccessful referrals to less secure settings. Most patients had some contact with their families. We identified five classes of patients within the long-stay sample with different characteristics. Patients differed in their attribution of reasons for long stay (internal/external), outlook (positive/negative), approach (active/passive) and readiness for change. Other countries have successfully developed specific long-stay services; however, UK experts were reluctant to accept the reality of long stay and that the medical model of ‘cure’ does not work with this group.LimitationsWe did not conduct file reviews on non-long-stay patients; therefore, we cannot say which factors differentiate between long-stay patients and non-long-stay patients.ConclusionsThe number of long-stay patients in England is high, resulting in high resource use. Significant barriers were identified in developing designated long-stay services. Without a national strategy, these issues are likely to remain.Future workTo compare long-stay patients and non-long-stay patients. To evaluate new service models specifically designed for long-stay patients.Study registrationThe National Institute for Health Research (NIHR) Clinical Research Network Portfolio 129376.FundingThe NIHR Health Services and Delivery Research programme.

Freedom to think – the value of multiple clinical narratives in women’s prisons

The merits of being multi-lingual are widely recognised. This paper considers the application of this metaphor to the conceptualisation of clinical work in a women’s prison. We suggest that sharing ‘languages’ from different theoretical orientations in open fora enables teams to build deep and nuanced understandings of clinical and systemic complexity, of particular value in secure settings. This discussion reflects the service model developed and used within HMP/YOI Holloway, a large women’s prison in London, which has recently been closed. We utilise a case example, with formulations and recommendations from several perspectives, to illustrate the value of maintaining a rich, inclusive discourse. We describe the benefits of such an approach to staff teams, to institutions and to those we serve, and consider the implications for organisation of services to maximise potential for change and recovery.

Service Productivity: What Stops Service Firms from Measuring It?

Productivity measurement poses a challenge for service organizations. Conventional management wisdom holds that this challenge is rooted in the difficulty of accurately quantifying service inputs and outputs. Few service firms have adequate service productivity measurement (SPM) systems in place and implementing such systems may involve organizational transformation. Combining field interviews and literature-based insights, the authors develop a conceptual model of antecedents of SPM in service firms and test it using data from 276 service firms. Results indicate that one out of five antecedents affects the choice to use SPM, namely, the degree of service standardization. In addition, all five hypothesized antecedents and one additional antecedent (perceived appropriateness of the current SPM) predict the degree of SPM usage. In particular, the degree of SPM is positively influenced by the degree of service standardization, service customization, investments in service productivity gains, and the appropriateness of current service productivity measures. In turn, customer integration and the perceived difficulty of measuring service productivity negatively affect SPM. The fact that customer integration impedes actual measurement of service productivity is a surprising finding, given that customer integration is widely seen as a means to increase service productivity. The authors conclude with implications for service organizations and directions for research.

EPA-0119 – Characteristics and needs of long stay patients in high and medium secure forensic psychiatric care - implications for service organisation

Introduction Forensic-psychiatric services are costly and very restrictive for patients. Clinical experience and the limited research available indicate that some patients stay for too long in these settings. A proportion of patients may, however, require long-term, potentially life-long, secure forensic-psychiatric care but their needs may not be met by existing service provision designed for faster throughput. Here we report the initial findings of a three year study on long-stay patients in forensic care conducted in England. Objectives The overall objective of this project is to improve the quality and cost-efficiency of the care and management of patients who stay for prolonged periods in secure forensic-psychiatric settings. Aims 1. Estimate the number of long-stay patients in secure settings in England (length of stay over 5 years in medium secure care or 10 years in high secure care) 2. Describe their characteristics, needs, care pathways and reasons for prolonged stay 3. Identify patients’ perceptions of their treatment pathways, long-term needs, service provisions and quality of life 4. Develop recommendations following the exploration of international models for this patient group Methods This project uses a mixed-methods approach including analysis of administrative data, case file reviews, patient interviews, interviews with clinicians and commissioners and a Delphi survey. Results Initial findings indicate that up to 25% of the forensic population fulfill criteria for long-stay, a much greater number than originally estimated. Conclusions The high number of long-stay patients in high and medium secure services calls for specific service provision for this patient group, which we will explore further.

Pattern of psychiatric inpatient admission in ibadan: implications for service organisation and planning.

Reports from different parts of the world has shown a seasonal pattern in psychiatric admission. Seasonal changes in climatic and social situations have been attributed. Such audit of psychiatric services is not a popular research venture in Nigeria. The study aims to describe the pattern of old psychiatric admissions in a tertiary health facility and the socio-cultural and environmental factors that may influence the pattern. Data on monthly admissions over a 5-year period were extracted from the admission and discharge records kept by the nursing services unit. The data was processed using Microsoft excel and the pattern over the 5-year period was examined using graphical representations. There were 2140 admissions during the review period, comprising 1138 ( 53.2%) females and 1002 males. The mean new admission per month was 34.55 (M:16.7, F:18.96) with a standard deviation of 7.49 for all admissions. There was a seasonal pattern in admission. Some socio-cultural and environmental factors that may explain the pattern were examined. This study suggests a seasonal pattern of psychiatric admission in a tertiary health facility in Ibadan. Recommendations were made on how to make use of the knowledge of the seasonal pattern of admission to mitigate disruptions in workload that may be occasioned by the observed pattern.

Changing the strategy formation process in a service cooperative

PurposeThe purpose of this paper is to concern the strategic changes a firm needs to incorporate in order to deliver a complex service such as providing assistance to the socially disadvantaged. The paper seeks to analyze the development of such a process considering the ability of managers to exploit resources and foster new opportunities for the firm.Design/methodology/approachThe qualitative methodology applied is that of a case study. The organization analyzed was a service cooperative. A semi‐structured questionnaire was used to gather the information along with documents and additional information thereafter, thus facilitating the triangulation process.FindingsNon‐profit service organizations that provide assistance services for the disadvantaged population have to compete in a complex and turbulent environment. The strategic process adopted by those organizations requires more participation and involvement from organizational members; but, simultaneously, this process should be more rational and planned. The strategic content involves the adoption of a hybrid strategy. The function of managers that act as intrapreneurs exploiting existing resources and capabilities (through human resource practices, such as training or reward systems) and promoting change plays an essential role. Decentralization and socialization are necessary for the successful development of those strategic changes.Originality/valueThe paper draws implications for service organizations suggesting, as the main strategic changes for improving competitiveness, the establishment of incentive regulation systems relevant to job characteristics and the establishment of a larger number of cooperation agreements and cooperation networks.

Oral versus self‐administered vaginal misoprostol at home before surgical termination of pregnancy by Oppegaard et al.

Sir, I read with interest the article by Oppegaard et al.1 on oral versus self-administered vaginal misoprostol at home before surgical termination of pregnancy (TOP). In my opinion, this emphasises what many gynaecologists already know; oral prostaglandins are not as effective in cervical priming in early pregnancy as they are in late pregnancy and are also associated with more adverse effects, particularly gastrointestinal. TOP is a very common operation in the UK, with about 185 400 procedures performed in the year 2004 and only 19% of cases were performed using the medical option.2 In my view, we should be aiming to demedicalise TOP, especially now that we have a variety of options for procuring it. As many parts of the procedure should be performed in familiar surroundings away from the hospital, I suggest that we should be looking for means of increasing the uptake of medical TOP. A previous study has shown the efficacy of self-administration of misoprostol vaginally in the hospital for medical TOP.3 The present study has shown the efficacy of self-administered vaginal misoprostol at home for cervical ripening in surgical TOP. The natural evolution should therefore be to study the results of self-administered vaginalmisoprostol at home formedical TOP, asmanywomen may prefer to undergo the process in familiar surroundings. This will, however, have significant implications for organisation of services and costs, both positive (saving of theatre and operating time) and negative (need for more scans to investigate the possibility of retained products). If medical terminations are performed at home, we will have to organise follow up to confirm completion of the process. However, in an audit of medical TOP performed in my previous unit, we found that follow-up ultrasound scans were not required in most women, indeed, only 17/111 women (15.3%) required scanning. Persistent bleeding 2–3 weeks after the procedure was, in our experience, a better predictor of the need for surgical evacuation of the uterus than ultrasound scan. j

Stepping into the kitchen: lay clients as co-producers of a professional service

This study examines the implications for service organizations and their staff of clients’ involvement as co-producers of a professional service. Two female infertility clinics were analysed, one using micro-surgery (MS) and the other in-vitro fertilization (IVF) techniques. These differed on the dimension of patients’ involvement in the delivery of treatment. In the MS clinic patients were ‘passive’ recipients of treatment, whereas in the IVF clinic patients were required to partake as co-producers in the delivery of the medical service. Thus, reflected here are two different forms of client–provider interface, which the results show to have different implications. Bringing the clients, as co-producers, ‘into the kitchen’ where service is prepared (IVF) was found to involve issues associated with the lay client–professional provider work interactions, like perceptions of performance, functional work behaviour (conflicts, poor co-ordination, etc.), lower work/service satisfaction of staff and clients, and coping with service uncertainty. These and other implications for front-line service are examined and discussed.

Child Guidance as a Community Service

Child guidance was originally developed as a way to deal with delinquency. Recently, clinics have been concerned much more broadly with treatment of children's behavior problems. The clinic team made up of the psychia trist, psychologist, and social worker has become more flexible, and group techniques of various kinds have been developed. Serious problems result from scarcity and maldistribution of services. Child guidance services are being provided by gen eral mental-health clinics and family agencies as well as by the traditional children's clinic. This trend has implications for organization of services in the future. There is now an increased interest in service to disadvantaged groups including, among others, the delinquent, the mentally retarded, and children in foster care.