In-house Services Research Articles

NHS frontline staff experiences of an in-house psychological support service during the COVID-19 pandemic

ABSTRACT The COVID-19 pandemic has led to enormous practical and emotional challenges for healthcare workers globally, including NHS staff. Psychological support provisions have been established by an NHS healthcare trust in the North of England, including 1:1 psychological support provided by the in-house psychology team. This study sought to understand how staff experienced the service, what worked well and what could be improved. Five participants who had accessed the staff support service took part in semi-structured interviews. Data were analysed using Interpretative Phenomenological Analysis (IPA). Three main themes emerged from the data: ‘The need for a flexible, responsive approach’, ‘Individual and group benefits’ and ‘The future of staff support: “we need to invest in staff mentally”’. Accessing the service was seen as personally and professionally rewarding for the NHS staff interviewed. These findings are discussed in relation to the relevant literature. Clinical implications, methodological limitations and directions for future research are discussed.

Analysis of Standardization and Guidelines for Facility Condition Assessments

ABSTRACT Facility Condition Assessments (FCA's) in the facility management (FM) profession is a growing area of research. However, delivery methods of FCA projects and studies on standardization has largely not been a focus of further exploration. Thus, this research aims to identify a current state of academic research on standardization of condition assessments and FM practitioner perspectives on FCA delivery methods and standardization. Results revealed 75% of participants indicated that no standards were used in conducting their FCA. This study identifies underutilization of standards and guidelines to conduct an FCA and leads to the proposal of three FCA project delivery methods; 1. Conduct FCA's with in-house personnel and resources; 2. Outsource the FCA to a service provider; 3. Hybrid the approach with both in-house and contracted FCA service providers. This research contributes to the body of knowledge by proposing FCA project delivery methods for owners and or operators to consider when deciding to pursue an FCA project. Further, the apparent absence of standards and guidelines use in the practice of FCA's in the FM profession presents an opportunity for future research efforts towards FCA standardization.

A Study on the Association between Customer Satisfaction and Customer Loyalty in the Inhouse Restaurant in Selected Hotels of Ludhiana City

In today’s hospitality market scenario so many new budget hotels are emerging. In this competitive market and tough times, hotels are finding difficulty in retaining customers and maintain a suitable standard of hotels' food outlets facilities. The extent of Customers' enjoyment and dedication towards any organization depends on the level of services provided by them. Loyal customers are valuable assets for the company as they keep on repeat visits which lead to the growth of the firm. Therefore, the objective of this research is to look out the association between customer delight and customer returning intention in the food and beverage outlets of budget hotels. A quantitative research methodology was applied to find out the effect of quality of services upon customers' contentment.150 respondents participated in this survey. Correlation and descriptive analysis were conducted to test the hypothesis. Our results show that respondents aren’t satisfied with the services provided by the in-house food service outlets of budget hotels. Additionally, price, food quality, and waiting time is not up to the mark. This research result has many practical implications for budget category hotels food outlets of Ludhiana city. It will guide them to improve the areas of weak performance and will further guide them to achieve customer satisfaction and retention.

Temporary Contractors & Full-Time Employees:

Colleges and universities face an increased number of technology-reliant events and activities yet often do not have the in-house event services staff to meet the demand for technology support. Many institutions hire contractors temporarily to fill this gap, as opposed to hiring additional permanent staff. The issue with contracted labor is that such personnel are temporary, implying a perpetual state of newness. Contractors will not have the institutional knowledge of their permanent staff counterparts and will not be empowered to make the same decisions. Additionally, contractors will not have the same keys, access, or geographical knowledge of the campus. They will likely not be invested in the college community to the same degree as their permanently employed colleagues. Furthermore, institutions often cannot invest in temporary contractors in the ways they can with permanent full-time employees. Customer service, engagement, relationship building, and overall quality of service often suffer as a result.
 Customer engagement is an integral part of any higher education institution. The interface between staff and clientele within information technology services and event support is crucial to a college campus's successful operation and is cited in academic sources as among the most critical drivers of clientele satisfaction and student/customer retention. This research project aims to explore a primary factor impacting customer service within higher education information technology as well as the positive and negative effects that full-time employees and temporary contractors can have on the higher education customer experience.

The Application of the Sales Comparison Affiliate Transaction Provision to New, In-House Streaming Transactions Involving Historical Television Programs, and Their Impact on Profit Participants

In this Article, the Authors discuss how the rise of in-house streaming services will impact profit participation.  Specifically, this Article discusses: (1) the vertical integration of the television industry, including the recent advent of in-house streaming services exhibiting content produced by their related-party studios; (2) the context in which the Sales Comparison ATP became a standard provision in profit participant agreements and how this history aids in its interpretation; (3) the meaning and purpose of each sentence and term in the Sales Comparison ATP; and (4) a roadmap for how profit participants may be able to leverage the Sales Comparison ATP to preserve their rights as entertainment conglomerates increasingly use their own streaming platforms to exhibit the valuable library television programs that they own.

Use of social service counseling by cancer patients: an analysis of quality assurance data of 6339 breast cancer patients from 13 certified centers in Germany treated between 2015 and 2017

BackgroundIntegrated social care may help to mitigate social risk factors in order to achieve more equitable health outcomes. In cancer centers certified according to the criteria set out by the German Cancer Society, every patient must be given low-threshold access to qualified social workers at the center for in-house social service counseling (SSC). Previous analyses have demonstrated large variation in the utilization of these services across individual centers. Therefore, this research aims at investigating whether SSC utilization varies regarding breast cancer patient characteristics and center characteristics presenting a unique approach of using routine data.MethodsMultilevel modeling was performed using quality assurance data based on 6339 patients treated in 13 certified breast cancer centers in Germany in order to investigate whether SSC utilization varies with patient sex, age, and disease characteristics as well as over time and across centers.ResultsIn the sample, 80.3% of the patients used SSC. SSC use varies substantially between centers for the unadjusted model (ICC = 0.24). Use was statistically significantly (P < .001) more likely in women, patients with invasive (in comparison to tumor in situ/ductal carcinoma in situ) diseases (P < .001), patients with both breasts affected (P = .03), patients who received a surgery (P < .001), patients who were diagnosed in 2015 or 2017 compared to 2016 (P < .001) and patients older than 84 years as compared to patients between 55 and 64 years old (P = .002).ConclusionThe analysis approach allows a unique insight into the reality of cancer care. Sociodemographic and disease-related patient characteristics were identified to explain SSC use to some extent.

PCN153 Physicians’ Perceptions and Use of IDH1/2 Mutational Testing and Treatment Selection among Patients with Relapsed or Refractory Acute Myeloid Leukemia in Routine Clinical Practice

In the treatment of acute myeloid leukemia (AML), molecularly targeted therapy guided by timely mutational testing can lead to improved patient outcomes. This study assessed how IDH1/2 mutational testing and results are accessed, used and adopted, and factors associated with treatment selection for patients with relapsed or refractory (RR) AML. US hematologists/oncologists from the Cardinal Health Oncology Provider Extended Network (OPEN) who had treated patients with AML completed a 23-item questionnaire in February/March 2020 assessing perceptions and experiences involving mutational testing and AML treatment selection. Responses were summarized using descriptive statistics. Nearly all physicians (95%) responded that they perform IDH1/2 mutational testing at AML diagnosis, 75% at relapse/progression, and 15% at completion of induction/remission. Approximately one-third (35%) utilized in-house pathology services, while the rest sent the sample off-site. Most (75%) received IDH1/2 mutational test results within 10 days, and the remainder (25%) within 11–20 days. The results were most often (75%) and sometimes (20%) used to select the AML treatment regimen; 5% reported results took too long and did not impact treatment selection. The majority of respondents (55%) were willing to wait (median=10 days) for mutational status results before starting treatment; 20% would not wait but would change treatment based on IDH mutation status; 20% would not wait and would not change treatment based on IDH mutation status. The majority (85%) preferred enasidenib as first therapy in patients with IDH2-mutated RR AML, while 15% preferred high-dose cytarabine (10%) or low-dose cytarabine (5%). The results demonstrate that for those AML treatments targeting specific mutations, mutational testing and its appropriate timing does guide physicians’ treatment selection. Physicians recognize the value of testing, and when results are timely, the results are used in determining appropriate treatment for patients with AML.

Reducing treatment machine downtime with a preventative MLC maintenance procedure.

The persistent use of MLCs through VMAT and IMRT is causing additional wear and tear on these mechanical parts, leading to an increase in MLC interlocks, breakdowns and failures. This study investigates the effect of an MLC clean and service procedure on MLC performance and positional accuracy demonstrated through in-house service logbook reports, Varian MLC backlash test results, daily MLC position QC results and Varian TrueBeam trajectory log file data. A service and clean of each individual MLC leaf was carried out on 3 standard MLC and 2 high definition MLC (HDMLC) Varian TrueBeam linacs. In-house service logbook reports, Varian backlash test results, daily MLC picket fence QC results and beam hold data from patient delivery trajectory log files were analysed for up to 6months pre and 2years post the MLC service/clean to assess the impact on unplanned MLC maintenance work and MLC performance. The median (range) of hardware faults reduced from 12 (1-17) pre clean to 0 (0-1) and 4 (1-11) at 12 and 24months respectively for all linacs with the exception of a HDMLC linac where faults increased from 4 pre-clean to 13 and 20 again at 12 and 24months respectively. The reduction in faults in the alternative 4 linacs was consistent with the reduction in the number of MLCs reaching the 0.3mm and the 0.4mm backlash recommendations in the first 12 and 24months following the service/clean. The increase in faults in the HDMLC linac was also consistent with the increase in MLCs reaching the 0.3mm backlash recommendation in the first 12 and 24months. The median (range) of MLCs reaching a daily picket fence QC position tolerance of 0.25mm reduced from 14 (1-40) pre clean to 0 (0) at both 12 and 24months post-clean. This demonstrates the improvement in MLC performance caused by the MLC service/clean but also reveals factors other than MLC position accuracy influence hardware faults. Additionally, the number of beam hold-offs determined from patient delivery trajectory log files were found to have no correlation with the MLC service/clean. The MLC service/clean improves MLC performance and MLC position accuracy, reducing reactive repair work for engineering and physics staff. The results were maintained for 1year post the MLC service/clean, with a trend back towards pre-clean levels in the subsequent 12-24months. This suggests this preventative maintenance work could be performed at a frequency of>2years. This period of reduced faults and improved performance is significant given the 10year expected lifespan of a linac.

Needs and barriers of medical personnel in Catalonian occupational health services

to identify the difficulties and needs of medical professionals in occupational health services in Catalonia with respect to carrying out their functions, as prescribed by law. Delphi study in three rounds. The selection of participants was carried out sepa - rately for in-house versus outsourced occupational health services. The first round included two open-ended questions: What difficulties do you encounter when performing your duties in your occupational health service? And, what are your needs in terms of being able to per - form your duties in your occupational health service? In the second and third rounds, partic - ipants ranked the categories identified in the first round according to their importance and relevance. We calculated an inter-rater agreement index (ICC) and an "index of concern (IP)". Among in-house occupational health services, the most highly ranked difficulties were case management of workers with limitations and the low quality of medical sur - veillance systems. Among outsourced occupational health services, the most notable dif - ficulties were the lack of communication with other organizations and the prioritization of economic and profitability criteria associated with the high work volume. For both types of services, there was a clear need to establish communication channels with other institu - tions or organizations such as primary care, mutual insurance companies, public medical evaluation units and public occupational health units. The different type of occupational health services reflects important differ - ences in the types of difficulties encountered, but not in needs, where there are more points in common.

Utility of telemedicine to extend neonatal intensive care support in the community

Moderately ill preterm infants residing in medically underserved areas are frequently transferred to tertiary care NICUs that are mostly located in urban areas, resulting in mother-infant separation, high transportation costs, and the emotional costs of limited infant visitation. In 2012, The American Academy of Pediatrics revised neonatal care guidelines, adding in-house neonatal services to the scope of Level II NICUs. Limited availability of neonatologists in medically underserved areas has prompted innovative solutions like telemedicine to meet this requirement. Telemedicine consultations for pediatric transports have demonstrated improved patient outcomes compared with phone consultation, but evidence regarding telemedicine use for neonatal transport is mostly limited to simulation settings. Also, there are limited data on telemedicine use as a primary means to provide intensive care to neonates in Level I/II NICUs. Recently, two groups demonstrated the feasibility and safety of synchronous telemedicine to guide care for premature infants at lower level NICUs. This approach prevented unnecessary transfer and appeared to provide the same quality of care that the baby would have received at the tertiary care facility. As current evidence regarding the use of telemedicine to extend intensive care is based on single-center experiences, additional research and evaluation of the effectiveness of telemedicine for this application is required. This chapter describes the use of telemedicine to support physicians at lower level nurseries and the transport team with management of critical neonates, utility as primary means to provide care at lower level NICUs, barriers for implementation, and future opportunities to enhance telemedicine's impact in NICU settings.

Next Generation Sequencing Based Non-invasive Prenatal Testing (NIPT): First Report From Saudi Arabia.

Background: Non-invasive prenatal testing (NIPT) for aneuploidy in pregnant women screening has been recently established in Saudi Arabia. We aim from this study to report our experience in the implementation of this new technology in clinical practice and to assess factors influencing cell-free fetal (cffDNA) fraction and successful NIPT reporting.Methods: In total, 200 pregnant women were subjected to the NIPT test using standard methods. Next-generation sequencing (NGS) was used to analyze cffDNA in maternal plasma.Results: Out of the 200 NIPT cases, the average age of pregnant women was 35 ± 6 years (range: 21–48 years). The average cffDNA fraction of reported cases was 13.72% (range: 3–31%). Out of these 200 cases, 187 (93.5%) were at low risk, while 13 (6.5%) cases revealed high risk for aneuploidy. Among these chromosomal abnormalities, 7 (3.5%) cases of Down’s syndrome, 5 (2.5%) Edwards’ Syndrome, and only 1 case of (0.5%) Patau’s syndrome was observed. Out of the 13 high-risk cases, 2 (15.3%) were found in women below the age of 30.Conclusion: This is the first study reporting the successful implementation of an in-house NIPT screening service in Saudi Arabia. Our data showed high accuracy and sensitivity to detect high-risk cases indicating the usefulness of such a technique as an alternative to invasive testing and (hopefully) will change the common screening practice for pregnant women in Saudi Arabia.

The Value and Institutional Impact of an In-System Laboratory Testing During the COVID-19 Pandemic

In-system clinical laboratories have proven themselves to be a fundamentally important resource to their institutions during the COVID-19 pandemic of the past year. The ability to provide SARS-CoV-2 molecular testing to our hospital system allowed us to offer the best possible care to our patients, and to support neighboring hospitals and nursing homes. In-house testing led to significant revenue enhancement to the laboratory and institution, and attracted new patients to the system. Timely testing of inpatients allowed the majority who did not have COVID-19 infection to be removed from respiratory and contact isolation, conserving valuable personal protective equipment and staff resources at a time that both were in short supply. As 2020 evolved and our institution restarted delivery of routine care, the availability of in-system laboratory testing to deliver both accurate and timely results was absolutely critical. In this article, we attempt to demonstrate the value and impact of an in-system laboratory during the COVID-19 pandemic. A strong in-house laboratory service was absolutely critical to institutional operational and financial success during 2020, and will ensure resiliency in the future as well.

What Determines In-house Service Activities within Manufacturing Firms?: Micro Evidence from Korea

What Determines In-house Service Activities within Manufacturing Firms?: Micro Evidence from Korea

Making Sound Decisions: Institutional Responses to the Crisis in Audio Preservation

Some archives have been quick to respond to the crisis in audio preservation brought on by the combined forces of obsolescence and degradation inherent in legacy audio formats and their playback equipment. These archives have undertaken digitization projects for particular collections or, in a few cases, have digitized the bulk of their audio holdings for preservation. Based on an examination of the literature on audio preservation, however, the responses of some institutions—particularly small and midsized institutions—have been stymied by roadblocks related to cost and expertise. Given the limited time available for archives to migrate audio content, this uneven response threatens to leave an incomplete audio legacy, weighted toward grant-worthy collections with few copyright restrictions at larger, better-resourced institutions. After a review of relevant literature, this article suggests interventions institutions of all sizes can undertake to respond to the crisis in audio preservation including stringent selection and reappraisal projects, strategies for tiered audio digitization using a combination of in-house and vendor-based services, and suggestions for increasing access to high-quality digitization for worthy audio materials.

Improving the effectiveness of tobacco use cessation (TUC)

This paper includes an update of a Cochrane systematic review on tobacco use cessation (TUC) in dental settings as well as narrative reviews of possible approaches to TUC and a more detailed discussion of referral for specialist TUC services. On the basis of these reviews we conclude that interventions for tobacco users in the dental setting increase the odds of quitting tobacco. However, the evidence is derived largely from patients using smokeless tobacco. Pharmacotherapy (such as nicotine replacements, bupropion and varenicline) is recommended for TUC in medical settings but has received little assessment in dental applications, although such evidence to date is promising. Whether the dental setting or referral to specialist TUC services is the most effective strategy to help people to quit tobacco use is unclear. An effective specialist service providing best available TUC care alone may not be the answer. Clearly, such services should be both accessible and convenient for tobacco users. Closer integration of specialist services with referrers would also be advantageous in order to guide and support oral health professionals make their referral and to maximise follow-up of referred tobacco users. Future research direction may consider investigating the most effective components of TUC in the dental settings and community-based trials should be a priority. Pharmacotherapy, particularly nicotine replacement therapy, should be more widely examined in dental settings. We also recommend that various models of referral to external and competent in-house TUC specialist services should be examined with both experimental and qualitative approaches. In addition to overall success of TUC, important research questions include facilitators and barriers to TUC in dental settings, preferences for specialist referral, and experiences of tobacco users attempting to quit, with dental professionals or specialist services, respectively.

Cost-Effectiveness of In-House Versus Contracted-Out Vision Rehabilitation Services in England

Context: Vision rehabilitation (VR) services in England promote users’ health and wellbeing, and support all aspects of daily living through two dominant models: in-house and contracted-out VR services. The two models differ in terms of service delivery, but they share a common aim to enhance service users’ quality of life and reduce utilisation of social and health care services. Objective: This study investigated the cost-effectiveness of in-house versus contracted-out VR services. Methods: The analysis was performed from a social care perspective and a social and health care perspective. The analyses used data from a six-month follow-up observational study of VR users. Regression analysis was used to estimate differential outcomes and costs, taking user and local authority characteristics into account. Findings: At a cost-effectiveness threshold of £13,000 and £30,000 per QALY, in-house VR services have a high probability (greater than 90% vs. contracted-out VR services) of being cost-effective from a social care perspective. In-house VR services have a lower probability (lower than 25% vs. contracted-out VR services) of being cost-effective from a social and health care perspective. Limitations: Observational studies are prone to selection bias compared to randomised controlled trials due to confounding. We employed econometric techniques that control for several user and LA characteristics to reduce potential bias. Implications: Contracted-out VR services may be better value for money compared to in-house VR services in the context of integrated social and health care due to substantial healthcare resource savings.

Modeling the e-waste mitigation strategies using grey-theory and DEMATEL framework

E-waste problem is putting pressure on environmental agencies, government, original equipment manufacturers of developing nations like India to adopt, develop and innovate environment friendly e-waste mitigation strategies, with the objective to manage and control the ever growing threat of e-waste to the environment, society and human health. Moreover, increasing producer responsibility, informal recycling practices and disposal issues have given attention to adopt mitigation strategies for successful implementation of e-waste management system. This study acknowledges the critical strategies to recover resources along with processing and treatment of toxic and hazardous component of e-waste mitigation and management which is immediate and existing challenge for India. A combined framework based on Grey concept and DEMATEL technique has been proposed in this work to determine the interdependence among the e-waste mitigation strategies (MS) by cause/effect analysis. This study has revealed that ‘top management initiation and commitment towards return management’ is the most imperative and driving strategy in the e-waste management and control. It also influences the other existing strategies. This work has also highlighted that e-waste mitigation can be effective if it concentrates on effective implementation of e-waste policy, directives and regulations such as extended producer responsibility (EPR), advance recycling fee (ARF) etc., technological and green innovations in recycling network and strategic alliance among supply chain partners and e-waste recyclers (in-house and outsource service provider) in Indian scenario in the management of e-waste issues. The cause–effect relationships are helpful to the managers, Government agencies and policy makers to learn crucial causal strategies that require imperative emphasis in dealing with e-waste issues in India. Sensitivity analysis was also conducted to test the robustness of the proposed framework.

Parents View On In-Home Occupational Therapy Service

Home is a significant environment for any child with or without special needs and one of the important environments where occupational therapy is aimed to bring improvement if necessary in terms of quality of life. The current descriptive qualitative study was designed to find out parental perceptions about occupational therapies provided in their own environments with their children with special needs. The participants of the study were five parents whose children with different special needs were getting private in-house occupational therapy services provided by the researcher at the moment of the study. The data for this study was collected through semi-structured interviews. Interviews were designed to understand how parents perceive in-house Occupational Therapy Services. The findings of the study suggest significant improvements in the quality of life of their children with special needs, thus no one could specifically differ occupational therapy interventions in-home and in other professional settings. It is obvious because of the lack of settings in Armenia with Occupational Therapies and lack of information about the profession in general. Future research is recommended to be conducted between two different groups with Occupational Therapies in-home and other settings, with a larger group and more specific issues. Findings revealed that in-home services are convenient in many different aspects for parents of children with special needs and it should be considered for future practices.

Costs of in-house genomic profiling and implications for economic evaluation: a case example of non-small cell lung cancer (NSCLC)

Objectives Genomic profiling in oncology is vital for determining eligible patients for mutation-specific targeted therapies. Use of commercial genomic testing has the potential to improve patient outcomes. Economic evaluations of in-house genomic profiling typically only include material costs while external commercial services include many other factors. Using non-small cell lung cancer (NSCLC) as an example, this study sought to characterize the unique challenges of costing testing services and their impact on results of economic evaluations. Methods Structured interviews with Canadian oncologists, pathologists, and laboratory directors were conducted to identify material and non-material costs associated with genomic-testing laboratories to allow estimation of a more complete cost of in-house testing, with NSCLC cost-per-test calculated using annual operational costs and NSCLC-specific testing volume. A health and budget impact model of in-house versus external commercial profiling services was used to compare the impact of non-material costs on results. Results In-house testing costs, limited to materials, was $133/single-gene test and $1,400/panel. For a laboratory running 1,300 in-house tests/year, total annual non-material costs included equipment maintenance ($6,842), labor ($502,313; technicians, administrative, and medical staff), shipping/reporting and software updates ($146,050), for an additional $519/test. The combined cost of $652/single-gene and $1,919/panel was compared to a cost of $6,194 for a commercial external test. Based on current Canadian testing patterns and anticipated utilization of external testing, inclusion of in-house non-material costs reduced the estimated 3-year budget impact by 12%. Conclusion When conducting economic evaluation to assess the value of introducing external tests, it is critical that non-material costs of standard testing strategies be measured and incorporated.

Service outsourcing decisions – a process framework

PurposeThe purpose of this paper is to compare service outsourcing decisions between public and private organizations and against a theoretical decision-making framework to both understand differences across the sectors and to provide an outsourcing framework more suitable specifically for outsourcing (and for the public sector).Design/methodology/approachMultiple case studies, i.e. a study of phenomena (here outsourcing process) at various sites is used as an approach.FindingsFindings indicate that public sector organizations are trailing behind private sector organizations in how the decision-making process is conducted and resourced. The authors suggest regular evaluation of service functions internally as a starting point for the outsourcing service decision-making process. Additionally, the market analysis should be done prior to cost analysis and benchmarking as the availability of suppliers more qualified than the internal process defines the make or buy decision.Research limitations/implicationsThe newly developed framework based on empirical evidence includes the following phases: regular evaluation of service functions, market analysis, cost analysis and benchmarking and evaluating relevant service activities. Applying the framework improves the efficient delivery of outsourced public services and brings public sector outsourcing closer to the professionalism currently present in the private sector.Originality/valueChoosing between in-house and outsourced service delivery is a fundamental decision in both private and public sector organizations. Previous outsourcing research has mostly focused on the private sector, with limited focus on the public sector’s outsourcing processes, yet understanding of the service outsourcing process is important in ensuring organizational competitiveness and cost efficiency.