Innovative Service Delivery Research Articles

Global research challenges and opportunities for mental health and substance-use disorders.

The research agenda for global mental health and substance-use disorders has been largely driven by the exigencies of high health burdens and associated unmet needs in low- and middle-income countries. Implementation research focused on context-driven adaptation and innovation in service delivery has begun to yield promising results that are improving the quality of, and access to, care in low-resource settings. Importantly, these efforts have also resulted in the development and augmentation of local, in-country research capacities. Given the complex interplay between mental health and substance-use disorders, medical conditions, and biological and social vulnerabilities, a revitalized research agenda must encompass both local variation and global commonalities in the impact of adversities, multi-morbidities and their consequences across the life course. We recommend priorities for research – as well as guiding principles for context-driven, intersectoral, integrative approaches – that will advance knowledge and answer the most pressing local and global mental health questions and needs, while also promoting a health equity agenda and extending the quality, reach and impact of scientific enquiry.

Governing drug use through partnerships: Towards a genealogy of government/non-government relations in drug policy

Drug policy in Australia is underpinned by the idea of partnerships wherein the non-government sector is one important partner in both delivering services and contributing to policy and decision-making processes. This article presents a genealogy of the concept of government/non-government ‘partnerships’, tracing its emergence and development within drug policy discourse in Australia. We find that the rise of neo-liberal policies since the 1980s has been a key factor facilitating the emergence of government/non-government ‘partnerships’ rhetoric in drug policy. Since the 1980s, the role of non-government organisations (NGOs) in drug policy has been articulated in relation to ‘community’ responsibilisation in contrast to the welfarist reliance on expert intervention. We link the rise of this rhetoric with the neo-liberal turn to governing through community and the individualisation of social problems. Furthermore, although we find that governments on the whole have encouraged the service delivery and policy work of NGOs at least in policy rhetoric, the actions of the state have at times limited the ability of NGOs to perform advocacy work and contribute to policy. Constraints on NGO drug policy work could potentially compromise the responsiveness of drug policy systems by limiting opportunities for innovative policy-making and service delivery.

Barriers to Cervical Screening Among Sex Workers in Vancouver.

We longitudinally examined the social, structural, and geographic correlates of cervical screening among sex workers in Metropolitan Vancouver, British Columbia, to determine the roles that physical and social geography play in routine reproductive health care access. Analysis drew on (2010-2013) data from an open prospective cohort of sex workers (An Evaluation of Sex Workers' Health Access). We used multivariable logistic regression with generalized estimating equations (GEE) to model correlates of regular cervical screening. At baseline, 236 (38.6%) of 611 sex workers in our sample had received cervical screening, and 63 (10.3%) were HIV-seropositive. In multivariable GEE analysis, HIV-seropositivity (adjusted odds ratio [AOR] = 1.65; 95% confidence interval [CI] = 1.06, 2.58) and accessing outreach services (AOR = 1.35; 95% CI = 1.09, 1.66) were correlated with regular cervical screening. Experiencing barriers to health care access (e.g., poor treatment by health care staff, limited hours of operation, and language barriers) reduced odds of regular Papanicolaou testing (AOR = 0.81; 95% CI = 0.65, 1.00). Sex workers in Metropolitan Vancouver had suboptimal levels of cervical screening. Innovative mobile outreach service delivery models offering cervical screening as one component of sex worker-targeted comprehensive sexual and reproductive health services may hold promise.

Prescribing by mental health nurses in acute general hospitals

This article will consider the role of mental health nurses (MHNs) working in a mental health liaison team (MHLT) as non-medical prescribers (NMPs) for inpatients in acute hospitals. The author has spent 10 years working as a mental health liaison nurse in acute hospitals, qualified as an NMP in 2014, and has seen how NMPs working in MHLTs can enhance care given to patients. MHLTs support and advise colleagues caring for patients with mental health problems in the acute general hospital environment, and ensure appropriate diagnosis and subsequent treatment. Consideration is given to the recent delivery of innovative services, such as rapid assessment interface and discharge (RAID), and how these services could be further strengthened by MHN NMPs, along with possible barriers and facilitators to the MHN NMP role in the acute hospital. The author believes NMP roles within MHLTs are essential to patients experiencing mental health problems in acute hospitals; these roles facilitate quick access to assessment, diagnosis and prescribing.

New Service Delivery Alternatives from the Automation of Knowledge with Virtual Assistants

Companies have been deploying for the last 45 years Technology Based Self-Service systems (TBSS) such as ATMs as a means of replacing human centered interaction with technology in the process of service creation with their customers. Since the year 2010 companies have begun introducing more sophisticated information and communication technologies like Virtual Assistants (VAs) that allow people to interact verbally with cars, navigation devices, smart phones, PCs, tablets etc. (e.g. SIRI, Sher.pa). The companies working in the VA industry are starting to develop these systems for the wearable devices industry. Soon we will be able to interact with a VA in the form of Google Glass or Apple iWatches. Furthermore these companies are starting to test new service delivery alternatives. TBSS research is not able to keep pace with technological developments, therefore the generalisability of extant knowledge to these new technologies remains un-answered. Responding to the above observations, the aim of this study is explorative as it seeks to formulate problems, clarify concepts in order to create hypotheses and a conceptual model in a forthcoming paper. This study involved a thorough review of extant literature, exploratory face-to-face and telephone interviews with experts from different disciplines. Insights obtained from the study suggest the following points: (1) in the future there will be space in the marketplace for the three types of service deliveries identified in the literature: (a) humans, (b) TBSS and (c) intelligent machines such as VAs. (2) Despite the introduction of these new intelligent systems, customers will continue performing the service or parts of the service by themselves with the use of TBSS systems. (3) Users will not be able to absorb all the technological developments at the same speed as the innovations are coming out into the marketplace. (4) Finally intelligent machines such as VAs will foster new innovative service delivery alternatives in which the firm will act together with external parties through informal arrangements or formal alliances with a collaborative mindset. These insights make the following important contributions to the subject matter.

Tele-audiology: Expanding Access to Hearing Care and Enhancing Patient Connectivity.

Tele-audiology within the Department of Veterans Affairs has expanded significantly in response to growing Veteran hearing needs and issues, namely maldistribution of provider resources and continued lags in timely access to care. Although tele-audiology originated from successive telemedicine programs dating back to the early 1960s, the innovation that is currently being developed broadens tele-audiology and hearing care practice to virtual care modalities such as clinical video telehealth, store-and-forward telehealth, home telehealth, mobile health applications, secure messaging, and electronic consults. The purpose of this article is to address current and emerging tele-audiology initiatives in context of a connected health care practice model. It includes information on initiatives within the Department of Veterans Affairs, provides an overview of current and potential modalities for improving patient hearing care, and identifies the challenges that exist in implementing and sustaining these services. Information is intended to stimulate creative thinking about future innovative service delivery models. Significant challenges exist in the evolution of innovative tele-audiology services. Despite barriers, these initiatives have the potential to match existing capacity with emerging patient demands in a mutually beneficial partnership and can be successfully integrated into diverse health care and private sector organizations.

Coproduction of healthcare service

Efforts to ensure effective participation of patients in healthcare are called by many names—patient centredness, patient engagement, patient experience. Improvement initiatives in this domain often resemble the efforts of manufacturers...

The influence of political factors in policymakers' perceptions on the implementation of Web 2.0 technologies for citizen participation and knowledge sharing in public sector delivery

Public administration is being pressured for innovation, driving service delivery towards a more personalized, outcome-driven, participative, efficient and collaborative model. In this regard, Web 2.0 technologies are potential powerful tools for supporting public engagement, intended to improve public services and to establish relationships between government and citizens based on information sharing and dialogue. This paper seeks to analyse the influence that political variables could have in the perception of policymakers regarding the use of Web 2.0 technologies for user participation, for knowledge sharing, and for technological innovation in public service delivery. Findings indicate that policymakers are prone to using Web 2.0 tech- nologies to improve internal productivity of local governments and the engagement of citizens in the process of public services' delivery, but with the aim of making suggestions through consultations. In addition, political factors such as ideology, political competition or political stability could influence the perception of policymakers regarding the use of Web 2.0 technologies for citizen participation and knowledge sharing in public sector delivery.

Interlinking Service Delivery Innovation And Service Quality: A Conceptual Framework

The purpose of writing this paper is to present the relationship between service delivery innovation and service quality in service organizations and to establish a research conceptual framework about this relationship. There are few studies that illustrate the relationship between service delivery innovation and its impact on service quality. This paper theoretically examines the antecedents and consequences of service delivery innovation and its influence on service quality. Authors suggest that customer service is an important mediator between service delivery innovation and service quality which affects the service quality of a firm. The recommended framework and its relationships with service quality present practical guidance for service managers to observe their service delivery in an effort to improve service quality by delivering superior customer service for their customers in a distinctive manner that leads to enhances firms competitiveness.

Implementation of a pilot telehealth programme in community palliative care: A qualitative study of clinicians’ perspectives

Background: Telehealth technologies are an emerging resource opening up the possibility of greater support if they have utility for patients, carers and clinicians. They may also help to meet health systems’ imperatives for improved service delivery within current budgets. Clinicians’ experiences and attitudes play a key role in the implementation of any innovation in service delivery. Aim: To explore clinicians’ perspectives on and experiences of the utilisation of a pilot telehealth model and its integration into a specialist community palliative care programme. Design: Focus groups and interviews generated data that were analysed through the lens of a realistic evaluation theoretical framework. Setting/participants: The study was conducted in a metropolitan specialist palliative care service in South Australia. Participants (n = 10) were clinicians involved in the delivery of community specialist palliative care and the piloting of a telehealth programme. Results: Service providers consider telehealth resources as a means to augment current service provision in a complementary way rather than as a replacement for face-to-face assessments. Introducing this technology, however, challenged the team to critically explore aspects of current service provision. The introduction of technologies also has the potential to alter the dynamic of relationships between patients and families and community palliative care clinicians. Conclusion: Implementation of a pilot telehealth programme in a specialist palliative community team needs to involve clinical staff in service redesign from the outset. Reliable IT infrastructure and technical support is critical for telehealth models to be effective and will aid uptake.

Systematically Identified Failure Is the Route to a Successful Health System.

Although we have a systematic approach to innovation and evaluation (and scale-up) for treatments, medical technologies and diagnostic tests in healthcare, we have no equivalent for service delivery innovations. Service delivery innovation is common but frequently goes unevaluated, leading to less systematic decisions about which innovations are scaled up and which ones are not. The absence of a formal evaluation system for service delivery innovation means that there is no objective standard for evaluating an innovation's success or failure, and thus no way to decide whether it should be scaled up, adapted and retested, or not scaled up at all. This results in "bad failure" - the scale-up of innovations that are untested, and the failure to scale-up other innovations that might have been effective but no one measured their effectiveness in a systematic way.

The Technology-Enabled Patient Advocate: A Valuable Emerging Healthcare Partner.

The U.S. healthcare system is changing and is becoming more patient-centered and technology-supported, with greater emphasis on population health outcomes and team-based care. The roles of healthcare providers are changing, and new healthcare roles are developing such as that of the patient advocate. This article reviews the history of this type of role, the changes that have taken place over time, the technological innovations in service delivery that further enable the role, and how the role could increasingly be developed in the future. Logical future extensions of the current typical patient advocate are the appearance of a virtual or avatar-driven care navigator, using telemedicine and related information technologies, as healthcare provision moves increasingly in a hybrid direction, with care being given both in-person and online.

Putting users at the heart of care: engaging the “cared-for” in integrated innovation

Putting users at the heart of care: engaging the “cared-for” in integrated innovation

Customer-centered knowledge management: challenges and implications for knowledge-based innovation in the public transport sector

Purpose – This study aims to explore the role of knowledge management practices in supporting current and emerging passengers’ and customer needs, aiming to create value. Specifically, the research examines the importance of customer-centred knowledge management in the delivery of innovative services and practices in the public transport sector, promoting the role of interactions between mobility stakeholders and travellers. Design/methodology/approach – A theoretical framework is developed and supported by the background literature on customer-centric knowledge management approaches, business model innovation, as well as on inter-organisational and network co-operations. Findings – Results show that the development of sustainable innovation and technologies in the transport sector requires knowledge management practices, which enable the access to knowledge about users’ needs, the mapping and evaluation of innovative knowledge, the promotion of knowledge-based innovation through collective approaches, as well as the acquisition and integration of new knowledge. Research limitations/implications – The conceptual framework developed in the paper remains limited to a theoretical understanding. Further research should empirically examine knowledge issues related to the intangible character and intellectual capital intensiveness of innovation in the transport sector. Practical implications – Researchers, public transport companies and public transport authorities are expected to benefit from this research, by developing mechanisms for customer-centred knowledge management, which is found to lead to innovative services and practices in the public transport sector. Another practical implication regards the adoption of knowledge management practices, leading to technological innovations in public transport, and advancing the level of sustainability in transport systems. Originality/value – The originality of this study lies in the development of a customer-focussed knowledge management framework, which provides a novel perspective of value creation in an attempt to engage researchers and practitioners from the transport industry in the conceptualisation and development of innovative solutions.

Community-based wellness and prevention programs: the role of medicare.

Community-based wellness and prevention programs: the role of medicare.

Aboriginal Mental Healthcare in Canada: The role of alternative service delivery in transforming the provision of mental health services

With growing complexity surrounding the issue of mental health, there is increased pressure for healthcare providers to engage in Alternative Service Delivery (ASD) and collaborative service delivery. Moreover, Aboriginal mental health has historically been an area of high concern and controversy, due to the high incidence of mental illness within this population. The unique social and cultural contexts that impact the type of healthcare services provided, and how these services are organized and delivered, require special consideration to be made when designing ASD models for Aboriginal mental healthcare. This paper seeks to identify current ASD initiatives being undertaken in Canada, while exploring the need for innovative and collaborative service delivery initiatives related to Aboriginal mental health, identifying current gaps and potential barriers to service delivery.

To Technovate or Not to Technovate? Examining the Inter-Relationship of Consumer Technology, Museum Service Quality, Museum Value, and Repurchase Intent

Increased reliance on technology has driven museums to consider the technology required to provide a creative cost effective experience. Technovation is a process of developing and innovating services using technology. This research will contribute to a better technology investment decision-making for museum managers and advance understanding of consumer value, co-creation, technology use and museums. Structural equation modelling was conducted on a survey administered to 412 museum visitors to test technology efficacy, technology acceptance, service quality, museum value and repeat intent in museums. Results indicate the significant relationships of technology self-efficacy, technology acceptance, service quality, museum value to repurchase intention. Consumers supported the role of technology and suggested that technology innovation in museum service delivery is essential. The research suggests that to ensure value co-creation, technology management must guide and support the visitor with the interaction. This is the first known paper testing this system of relationships in the museum context.

Towards a framework for enhancing procurement and supply chain management practice in the NHS: lessons for managers and clinicians from a synthesis of the theoretical and empirical literature

BackgroundThis review provides intelligence to NHS managers and clinicians involved in commissioning and procurement of non-pay goods and services. It does this in the light of ongoing pressure for the NHS to save money through a combination of cost cutting, productivity improvements and innovation in service delivery, and in the context of new commissioning structures developing as a result of the Health and Social Care Act 2012 (Great Britain.Health and Social Care Act 2012. Chapter 7. London: The Stationery Office; 2012).ObjectivesWe explore the main strands of the literature about procurement and supply chain management (P&SCM); consider the extent to which existing evidence on the experiences of NHS managers and clinicians involved in commissioning and procurement matches these theories; assess how the empirical evidence about different P&SCM practices and techniques in different countries and sectors might contribute to better commissioning and procurement; and map and evaluate different approaches to improving P&SCM practice.Review methodWe use a realist review method, which emphasises the contingent nature of evidence and addresses questions about what works in which settings, for whom, in what circumstances and why. Adopting realist review principles, the research questions and emerging findings were sense-checked and refined with an advisory group of 16 people. An initial key term search was conducted in October 2013 across relevant electronic bibliographic databases. To ensure quality, the bulk of the search focused on peer-reviewed journals, though this criterion was relaxed where appropriate to capture NHS-related evidence. After a number of stages of sifting, quality checking and updating, 879 texts were identified for full review.ResultsFour literatures were identified: organisational buying behaviour; economics of contracting; networks and interorganisational relationships; and integrated supply chain management (SCM). Theories were clustered by their primary explanatory focus on a particular phase in the P&SCM process. Evidence on NHS commissioning and procurement practice was found in terms of each of these phases, although there were also knowledge gaps relating to decision-making roles, processes and criteria at work in commissioning organisations; the impact of power on collaborative interorganisational relationships over time; and the scope to apply integrated SCM thinking and techniques to supply chains delivering physical goods to the NHS. Evidence on P&SCM practices and techniques beyond the NHS was found to be highly fragmented and at times contradictory but, overall, demonstrated that matching management practice appropriately with context is crucial.ConclusionsWe found that the P&SCM process involves multiple contexts, phases and actors. There are also a wide variety of practices that can be used in each phase of the P&SCM process. Thinking about how practice might be improved in the NHS requires an approach that enables the simplification of the complex interplay of factors in the P&SCM process. Portfolio-based approaches, which provide a contingent approach to considering these factors, are recommended. Future work should focus on conflicting preferences in NHS commissioning and procurement and the role of power and politics in conflict resolution; the impact of power on the scope for collaboration in health-care networks; and the scope to apply integrated SCM practices in NHS procurement organisations.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Citizen Engagement and Public Services in the Arab World: The Potential of Social Media

Citizen Engagement and Public Services in the Arab World: The Potential of Social Media

Comparison communities in a cluster randomised trial innovate in response to ‘being controlled’

We conducted qualitative interviews among primary health care teams and community agencies in eight communities in Victoria, Australia which had (1) agreed to be part of a universal primary care and community development intervention to reduce post natal depression and promote maternal health; and (2) were randomised to the comparison arm. The purpose was to document their experience with and interpretation of the trial. Although ‘control’ in a controlled trial refers to the control of confounding of the trial result by factors other than allocation to the intervention, participants interpreted ‘control’ to mean restrictions on what they were allowed to do during the trial period. They had agreed not to use the Edinburgh Post Natal Depression Scale or the SF 36 in clinical practice and not to implement any of the elements of the intervention. We found that no elements of the intervention were implemented. However, the extension of the trial from three to five years made the trial agreement a strain. The imposition of trial conditions also encouraged a degree of lateral thinking and innovation in service delivery (quality improvement). This may have potentially contributed to the null trial results. The observations invite interrogation of intervention theory and consequent rethinking of the way contamination in a cluster trial is defined.