Areas Of Service Delivery Research Articles

Safely reopening and operating a primary healthcare facility after closure due to SARS-CoV-2 infection in a healthcare worker – Nairobi, Kenya, 2020

The first COVID-19 case in a healthcare worker in Kenya was reported on March 30, 2020, in Nairobi, leading to a 41-day closure of the health facility where he had worked. We assessed infection prevention and control (IPC) activities and implemented recommendations to re-open and operate the facility. We conducted a risk assessment of the facility in April 2020 using a modified World Health Organization, six-element IPC facility risk assessment tool. IPC recommendations were made, and a follow-up assessment of their implementation was conducted in July 2020. Breaches in IPC measures included poor ventilation in most service delivery areas; lack of physical distancing between patients; inadequate COVID-19 information, education, and communication materials; lack of standard operating procedures on cleaning and disinfecting high-touch areas; insufficient IPC training; inadequate hand hygiene facilities; insufficient personal protective equipment supplies; and an inactive IPC committee. Strengthening IPC measures is critical to prevent healthcare facility closures.

Development of a tool to assess financial advocacy service delivery.

21 Background: In 2023, the Association of Cancer Care Centers (ACCC) Financial Advocacy Network published Financial Advocacy Services Guidelines developed through an expert-led, consensus-driven process (1). The Guidelines provide a framework for equitable delivery of financial advocacy (FA) services to address patients’ financial concerns. The Guidelines cover 3 domains: financial advocacy services and functions, program management functions, and partner engagement functions. ACCC adapted the Guidelines into a Financial Advocacy Services Assessment Tool to help cancer care organizations assess and improve service delivery and to advance research of organization-level FA practices across the U.S. Methods: ACCC convened an expert task force to guide this work. ACCC conducted a scan of implementation science literature and health care organizational assessments to inform the development of a rating system for each of the 43 guidelines. Four service delivery levels were identified, and a score was assigned to each level (Table). The tool was programmed in Qualtrics to provide a total score and average score per guideline for each FA domain and sub-domain. The task force added unscored questions about organizational demographics, barriers, and readiness to enable aggregate research and sub-group analysis. ACCC invited members of the Financial Advocacy Network to participate in a pilot via email invitation and provided opportunities for open-ended feedback. Results: 20 cancer centers participated in the pilot between March-May 2024. 15% were academic institutions and 85% were community-based programs (18% of which are directly affiliated with an academic institution). Respondents reported the tool was easy to use and informative for quality improvement efforts. See Table 1 for total scores for initial pilot. Conclusions: Pilot results reflect that all participating cancer centers are already engaged in some level of FA services. Broader dissemination and analysis is ongoing. The assessment provides centers with a practical resource to assess alignment to guidelines and identify opportunities for quality improvement. Regular review of aggregate results will help ACCC provide benchmarks for areas of service delivery, identify barriers to implementation, and monitor trends in FA staffing. 1. Kajdic Hodzic R, Liang MI, et al. Developing consensus-based oncology financial advocacy services guidelines. JCO Oncol Pract. 2023;19(suppl 11):38. Levels of FA service delivery and pilot total scores. Level Description % of pilot cancer centers Level 1 Not performing financial advocacy services. 0% Level 2 Making progress with financial advocacy services, but it is done informally or inconsistently. 35% Level 3 Performing financial advocacy services consistently in at least one key area of the organization. 60% Level 4 Reliably performing financial advocacy services across all key areas of the organization. 5%

Cascade of care for substance use and mental health disorders for justice-involved populations

IntroductionJustice-involved populations have dramatically higher rates of substance use disorders (SUD) and mental health disorders (MHD) compared to the general population. Despite high rates of SUD and MHD, treatment for this population is often limited and not evidence-based. The cascade of care model estimates drop-offs in the continuum of care from screening to identification of need, referral, care initiation, care engagement, and care completion. Recently, healthcare providers have utilized the cascade of care to improve the continuity of care for people with SUD and MHD in justice settings. The purpose of the current study is to 1) identify typologies that explain the proportion of new intakes that pass through each level of the cascade of care for SUD and MHD, and 2) describe agency-level factors that predict typology assignments and agency ability to assess client flow through the levels of the care cascade. MethodUsing Latent Class Analysis, we classify 791 agencies serving justice-involved individuals into typologies according to utilization of each stage in the mental health and substance cascades of care. Then, we examined county and agency characteristics that affect three stages of the cascade process: identification of need for behavioral health services, referrals to appropriate services, and treatment initiation. We build on previous work by exploring these patterns for both SUD and MHD treatment. ResultsThe study identified four SUD/MHD treatment patterns: Low Access, SUD-Focused, High Need-High Access, and Lower Need-High Access classes. Factors influencing typology alignment include location, specialized staff availability, warm hand-off coordination, Medicaid reimbursement, and performance measure tracking. Thirty-nine percent (39 %) of agencies could not be classified because they were unable to report their rate of care along the cascade measures. ConclusionFocusing on factors influencing typology assignment can help counties in assessing service delivery, identifying barriers, and targeting areas for improvements in policies and practices, potentially facilitating long-term changes and overall improvement in the care of individuals with mental health and substance use disorders. Identification of these factors and typologies can improve mental health treatment and access in counties and agencies with large resource barriers or limited attention to mental health treatment.

A Comparative Study on Local Governments’ Institutional Capacity of Service Delivery in Bhojpur

This study is a comparison of Local Governments' Institutional Capacity Self-Assessment (LISA) scores on service delivery of local governments in Bhojpur district during four fiscal years. The principal objective is to compare and analyze the LISA scores and find out the status on service delivery area of local governments in Bhojpur district. It has focused on comparative analysis of the status of local governments using their self-assessment scores to find out the progress in service delivery of local government institutions. The methodology used in this study is collecting secondary data of self-assessment reports from the website, and compare and analyze the data of all local governments over the four fiscal years. This study has followed descriptive and analytical approach as well as used document review, and website observation as research tools. Data collection has been done from secondary sources of data. The finding of this study reveals that the service delivery status of local governments has been gradually increased in LISA scores over the period. The emphasis on service delivery during the self-assessment has been given most and provided largest weightage and most indicators included. The Bhojpur municipality, where headquarter of the district located has been evaluated less scores than another municipality and the far remote rural municipalities, such as Salpa Silichho and Amchowk rural municipalities.

The Aspire Social Impact Bond: How social impact bond financing can promote positive social and economic outcomes

AbstractFinancing human service delivery through social impact bonds (SIBs) is the subject of some critical commentary in the academic literature, but this tends to be largely theoretical rather than empirically based. This paper presents empirical evidence of how SIB financing can promote positive social and economic outcomes for governments, not‐for‐profit providers, individual service beneficiaries and society more broadly. The paper presents some of the results of an evaluation of the Aspire SIB, which financed an innovative intensive case management program providing housing and wraparound supports over a 3‐year period for people experiencing chronic homelessness. Aspire participants experienced significantly improved outcomes and decreased service needs, delivering downstream cost savings across several areas of government service delivery. This paper describes how the SIB financing mechanism underpinned the success of Aspire by promoting flexible, collaborative, outcome‐focussed and data‐informed responses to a challenging, multi‐faceted social problem.

Assessing User Satisfaction with Facilities in Medium-Cost Strata Residence

Strata residences require more intensive facilities management than landed residences due to the shared common properties between strata owners. However, despite the establishment of the strata building sector, there is still a lack of clarity on what constitutes 'good facility management'. This study aimed to assess resident satisfaction with strata residence facilities. The research design employed a quantitative research method, involving the administration of questionnaires to gather the required data from residents. The findings of the research indicate that enhancing the satisfaction of strata residents is achievable through a comprehensive understanding of their expectations, identification of areas within service delivery requiring improvement, and subsequent implementation of appropriate changes. Management corporations could identify areas of service delivery that needed improvement and make changes to enhance the satisfaction of strata residents.

Examining the Strengths and Challenges of a Smart Reentry Program: Lessons Learned

Although reentry programming has grown, little is known about the process of developing reentry programming that utilizes peer support. Peer support is commonly utilized along side evidence-based practices in other service delivery areas (e.g., mental health), and is increasingly used during reentry, yet little is known about whether this practice is effective at reducing recidivism. This study examines a Smart Reentry program in an urban, Midwestern city. Drawing on 18 interviews with peer guides and family support specialists across two time points, and program participants at one time point, the authors examine the challenges and strengths related to staff training and development, program culture, and participant engagement. Results demonstrate the strengths of a family-centered model of reentry programing, and the challenges of working with the department of correction staff and paraprofessional peer guides within a professional environment. Suggestions are offered for programming utilizing similar models of paraprofessionals.

Expenditure Practices of Provincial and Local Governments: The Case of Nepal

Nepal promulgated a new constitution in 2015, which adopted a federal system of governance to achieve economic equality, prosperity and social justice. The constitution has allocated expenditure responsibilities to each level of government. In such a scenario, this study employs a descriptive approach to analyze the spending practices of Nepal’s provincial and local governments. Secondary sources of data were used to cover the period from 2018/19 to 2021/22. The study found that the average share of recurrent expenditure at the provincial level of Nepal was 42.5% while such share of capital expenditure was 57.5%. At the local level, the average share of recurrent and capital expenditure was 60.5% and 39.5% respectively. Within the capital expenditure of Nepal’s provincial governments, the average share of expenditure items having relatively more contribution to capital formation was 70.6% while that of local governments, such share was 52.9% only. The study also found that Nepal's provincial and local governments spend less on the major subnational service delivery areas. Nepal’s subnational government spending practices highlight the need to spend more on capital formation. Within the capital formation, more spending on the areas having a direct impact on their future growth and prosperity is necessary. The subnational governments must also spend more on major subnational service delivery areas.

South African Government Functionality Assessment through the Eyes of Ordinary Citizens

While there are promises of improving in areas such as creation of jobs, law enforcement, education and other fields by government representatives, it seems as if the targeted beneficiaries or citizens no longer believe in government interventions. They see the government deteriorating in general service delivery and many believe the government functionality in providing safety and better life to all citizens is compromised and in downward trajectory as this is even widely reported by South African media.
 This qualitative study was intended to stipulate different works done by different government departments and agencies and use the beneficiaries accessible for participation to share their views in service delivery as received from specific agencies. In simple terms, this study focusses on understanding how ordinary citizens rate government delivery in general and how this is depicted by the media sources. In majority, the study is based on desk top data with limited observation and some face-to-face interviews. The study revealed that indeed there are levels of dissatisfaction from members of the community, and some believe the functionality of the government of South Africa is questionable. Some even compare the first ten years of the democratic South Africa ending up in 2004 to the rest and argue that things are going to worse situations in South Africa as they feel no longer protected and no longer gearing to the creation of better life. There are citizens who believe South Africa has become kakistocracy state as it seems unable to come with effective plans in many areas of service delivery. On the other hand, this provides media with multiple negative headlines.

Health System Resilience in a PHC Setting in India—A study of Assam and MP

Context: To bolster the ambitious Program of Government of India (GOI), to build a strong and resilient healthcare system plans to establish 1,50,000 Health and Wellness Centres (HWCs) across the country by 2024, the GOI gave a clear to its partners to explore options. Aim: Therefore, LEHS | WISH, initiated a baseline study to assess the service availability and service readiness (SARA) status of 18 Sub-centres (SCs) and Primary Health Centres (PHCs) to be upgraded as HWCs to deliver the twelve package of services as envisaged in HWC guidelines to strengthen the primary healthcare system. Settings and Design: Health system resilience, was assessed against the 10 Areas of Concern, elaborated in National Quality Assurance Standards (NQAS) for all the 12 thematic areas of service delivery of HWCs. Methods and Material: A sequential mixed method of design was adopted, which included both quantitative and qualitative components of assessment. The major focus of the study was quantitative in nature to assess HWC facility level gaps across key areas. Qualitative study with stakeholders including that of the community was undertaken to elicit reasons for such gaps and awareness of the community to respond/ engage with health systems better. Statistical Analysis Used: STATA was used a quantitative analysis tool undertake the analysis. Results: on average, both the last mile healthcare delivery system (PHC and SC) and the community are less than 25% resilient, even for disasters. Conclusion: It is not possible to make the system resilient unless focused effort is made. Therefore, there’s a need to clearly define the essential services and its resource requirement to be made available 24X7 for 365 days without fail, offer regular training to the staff to ensure process resilience, create awareness within the community to engage with the health system optimally, strengthen local governance to assure provision of essential services.

Impact of Hospital Services on Patient Satisfaction: With Reference to a Government Hospital in Sri Lanka

In order to execute continual improvements in hospitals, it is essential to measure the quality of healthcare. Due to the complexity of how services are delivered and how a hospital sets up its various units and work processes, it is a challenging undertaking. Measuring patient satisfaction can help identify areas of service delivery that need improvement. The purpose of this study is to examine the impact of hospital services on patients’ satisfaction. A total of 155 responses were collected through a self-administered questionnaire based on the convenience sampling approach. A government hospital in Sri Lanka was chosen to conduct the research. The questionnaire was designed to study the impact of patient’s perspective on hospital management, tangibles, working environment, technology and hospitality towards the patient’s satisfaction. A conceptual model was derived, and the results were analyzed using Multiple Regression Analysis. Findings revealed that there is a significant impact on aforesaid independent variables on patients’ satisfaction. Based on above findings, the academic and practical implications have been discussed.

A Systematic Review on Products and Services of IBS Software Private Limited

Purpose: The airline industry is one of the important sectors in all aspects of human life. The word ‘Aviation’ means the flying vehicles that come under airplanes, helicopters, and unmanned aircraft such as drones, UAVS, etc. This industry is mainly classified into two types, Airlines and Aviation industry. An Airlines business offers air travelling services for people or cargo, whereas the aviation industry is based on the working of defence systems, manufacturing, and training-based things. The modern airline industry is very important because of its globalized nature, helping to connect all continents, countries, and cultures. The aviation industry is a major backbone of every country's annual economy. Every country's international airports are major hubs for overseas trading around the world. It gives direction to a country's international competitiveness and global investments in tourism, IT, and infrastructure. The largest aircraft manufacturing companies in the airline sector are European player Airbus and US-based Boeing. Many airline companies work in national and international sectors, based on annual revenue the leading companies are American airlines, Delta airlines, Southwest airlines, China southern airlines, Ryanair airlines, KLN royal airlines, Turkish airlines, etc. IBS software is a leading provider of new-generation IT products in the logistics, transportation, and travel industry. The ultimate aim of IBS is to offer their clients maximum efficiency, improve revenue, increase safety, analyse growth and reduce total cost. Their service delivery area included the oil & gas sector, airport management, cruise lines, and tour operators. IBS software is a CMM Level 5 certified airline software development company having offices in America, Europe, Japan, the Middle East, Asia, Australia, and Africa. Objective: IBS Software Pvt Ltd, a SaaS -related aviation software development company located in Techno Park, Trivandrum, Kerala is the subject of the company analysis case study. Design/Methodology/Approach: The pertinent data and specifics for this case study on IBS came from product papers that were released in a variety of peer-reviewed journals, conferences, and business websites. Additional details have been given in white papers. Findings/Result: The study of this paper focuses on the company's products and services, Business strategy with their Partners and Alliances, Recruitment and training strategy of IBS Software, Corporate social responsibility, and analysis based on SWOT. Originality Value: The study provides a brief overview of IBS Software Private Limited products & services, In-depth knowledge about flight and staff application, flight repair solutions, customer convocation, License agencies, employee transit, and payload administrations. Type of Paper: Case Study.

Experiences of ‘virtual’ occupational therapy service delivery in Wales

Introduction: COVID-19 accelerated the implementation of virtual working at pace, which carries the risk of missed opportunities for shared learning across organisations and services. This study therefore investigated the experiences of ‘virtual working’ among occupational therapy (OT) staff and students in Wales. The objectives were to establish the meaning of virtual working for occupational therapists (OTs), identify the perceived advantages and disadvantages of the technologies used to support virtual working and explore the specific contextual factors that impact on service delivery. Method: An online questionnaire was completed by 191 registered and unregistered OT staff and students working in Wales, and 11 semi-structured interviews were conducted in a convergent mixed methods design. Results and Findings: The questionnaire data confirmed that the use of virtual working has increased and impacts all areas of service delivery. The semi-structured interviews identified three themes: the art of OT, keeping doors open and looking forward. Conclusion: Virtual working can improve access to services, but one size does not fit all and its use in person centred care should be carefully considered. Virtual working should not compromise high quality service provision and the risks of virtual working to staff’s mental and physical health needs to be considered.

High-Efficiency Particulate Air Filters for Preventing Wildfire-related Asthma Complications: A Cost-Effectiveness Study.

Rationale: Air pollution caused by wildfire smoke is linked to adverse health outcomes, especially for people living with asthma. Objectives: To evaluate whether government rebates for high-efficiency particulate air (HEPA) filters, which reduce concentrations of smoke particles indoors, are cost effective in managing asthma and preventing exacerbations in British Columbia (BC), Canada. Methods: We used a Markov model to analyze health states for asthma control, exacerbation severity, and death over a retrospective time horizon of 5 years (2018-2022). Concentrations of wildfire smoke-derived particulate matter with an aerodynamic diameter ⩽2.5 μm (PM2.5) from the Canadian Optimized Statistical Smoke Exposure Model and relevant literature informed the model. The base-case analysis assumed continuous use of a HEPA filter. Costs and quality-adjusted life-years (QALYs) resulting from varying rebates were computed for each Health Service Delivery Area (HSDA). Measurements and Main Results: In the base-case analysis, HEPA filter use resulted in increased costs of $83.34 (SE, $1.03) and increased QALYs of 0.0011 (SE, 0.0001) per person. The average incremental cost-effectiveness ratio among BC HSDAs was $74,652/QALY (SE, $3,517), with incremental cost-effectiveness ratios ranging from $40,509 to $89,206 per QALY in HSDAs. Across the province, the intervention was projected to prevent 4,418 exacerbations requiring systemic corticosteroids, 643 emergency department visits, and 425 hospitalizations during the 5-year time horizon. A full rebate was cost effective in 1 of the 16 HSDAs across BC. The probability of cost-effectiveness ranged from 0.1% to 74.8% across HSDAs. A $100 rebate was cost effective in most HSDAs. Conclusions: The cost-effectiveness of HEPA filters in managing wildfire smoke-related asthma issues in BC varies by region. Government rebates up to two-thirds of the filter cost are generally cost effective, with a full rebate being cost effective only in Kootenay Boundary.

84 What works and why for interprofessional collaboration in older people’s care integration: realist evidence synthesis

Abstract Background Interdisciplinary Community Specialist Teams for older people (CSTs) are a novel innovation in Irish health service delivery and require, over time, a shift in cultures of care to allow for the development of interprofessional collaboration. However, there is limited international guidance on how to foster, enhance and sustain meaningful interprofessional collaboration in the context of interdisciplinary team-based care integration for older people. This realist review presents initial programme theories of what works and why in fostering competencies for interprofessional collaboration in CSTs for older persons. Methods Realist reviews are an interpretive theory-driven approach to evidence synthesis which uses multiple sources of evidence including published peer-reviewed studies, policy documents and grey literature. This evidence is combined with stakeholder theories and explanations of how interventions might work. Four stakeholder cohorts were identified: public and patient representatives of older people and family carers, healthcare professionals who are members of CSTs; team leads responsible for the operational management of CSTs, and healthcare managers responsible for national clinical programme design. Results This synthesis resulted in a series of evidence-based Initial Programme Theories (IPT) in the form of statements that explain the Mechanisms (M) and Resources (R), generated within particular Contexts (C) in response to interprofessional collaboration, that are thought to lead enhanced care Outcomes (O). For example: Where CST members have professional experience in different areas of service delivery (C), they bring to the team pre-existing relationships with other HCPs (R), enabling good cross-sectoral communication and trust (M) leading to enhanced continuity of care (O). Conclusion The IPTs generated from this realist synthesis of international literature support workforce education, development and planning. They also provide healthcare leaders with knowledge of the resources and supports required to harness the benefits of interprofessional collaboration and realise the goals of care integration for older people.

Differences in patients accessing inpatient versus outpatient palliative care at time of referral at a cancer centre

Outpatient palliative care clinics are a new and developing area of service delivery that can respond to increasing demand and facilitate earlier contact in the illness trajectory. Work is needed to standardise the criteria for referral to outpatient palliative care services and clarify which patients are likely to benefit the most from this mode of support. This study aimed to describe the demographic, clinical and symptom profile, and survival of patients referred to a newly established hospital-based integrated palliative care program. Comparisons were made between patients initially seen as outpatients versus those seen as inpatients. A retrospective population was identified from routinely collected hospital admitted inpatient and ambulatory databases comprising adult cancer patients receiving a new referral to the service during a 6-month period. Patients were grouped into two cohorts according to the setting of their first palliative care assessment and followed to death or study censor date. During the study period, 473 new referrals were made comprising 229 (48%) patients initially seen as outpatients and 244 (52%) initially seen as inpatients. The outpatient cohort had higher performance status, experienced higher symptom burden, lived longer, had fewer inpatient admissions, and received earlier referral to palliative care resulting in greater palliative care involvement up to their death (all p < .05). Early palliative care can be effectively delivered by an outpatient palliative care service for cancer patients who are experiencing symptom burden but are otherwise functional. These cases lived longer and had fewer subsequent inpatient visits, demonstrating the preliminary effectiveness of this integrated service.

Psychiatry in Qatar.

The first article written about psychiatric services in Qatar was published in BJPsych International in 2006. Since then, the health system in Qatar has undergone significant transformation in the areas of service delivery, research and education. International accreditations are sought in all these fields to emphasise the standard achieved. In this article, we follow up on the mental health services currently available in Qatar, their strengths and the associated challenges.

North East England South Asia Mental health Alliance (NEESAMA): an exemplar of global north and global south collaboration to improve research, training and service delivery in mental healthcare.

Despite the worldwide burden of mental illness and recent interest in global approaches to address this, progress on increasing awareness, lessening stigma, reducing the treatment gap, and improving research and training in mental health has been slow. In 2018, the North East England South Asia Mental health Alliance (NEESAMA) was developed as a collaboration between high-income (global north) and low- to middle-income (global south) countries to address this slow progress. This paper outlines how the joint priority areas for research, training and service delivery were identified across the life course (child and adolescent, adults and older people) between partner organisations spanning Afghanistan, Bangladesh, India, Nepal, Pakistan, Sri Lanka and the UK. It describes the progress to date and proposes a way forward for similar alliances to be forged.

Knowledge Regarding Interpretation of Brain Stem Evoked Response Audiometry (BERA) Report by Speech -Language Pathologists

According to ASHA assessment of hearing loss is part of scope of practice &amp; service delivery area of SLP’s with Brain Stem Evoked Response Audiometry tests being an effective tool. Keeping in view dearth and disparities in the knowledge and professional abilities of SLPs, need of early identification and intervention for hearing impaired population and importance of BERA test and gap in research current study was conceived. Objective: To determine the knowledge regarding interpretation of Brain Stem Evoked Response Audiometry (BERA) report by Speech-Language Pathologists. Methods: This Cross-Sectional study was conducted at Riphah International University, Pakistan from January, 2022 to June, 2022. Study using convenience sampling recruited N=102 speech language pathologists of both genders, aged 25 to 50 years, working in private and public hospitals, special education schools, private clinics, Universities and Rehabilitation Centers of Rawalpindi and Islamabad. A self-developed questionnaire was used for data collection and analysis performed using SPSS Version-20. Results: Knowledge of interpretation of BERA report by Speech and language Therapists/ Pathologist in current study revealed a total mean score of 40.78 ± 7.03, indicating moderate level of knowledge of interpretation of BER. Knowledge of interpretation of BERA is not associated with gender, age and experience, however it revealed significant associated with qualification of SLP. Conclusions: It was concluded from the result of present study that the majority of speech and language Pathologists have moderate level of knowledge regarding interpretation of BERA. Knowledge of interpretation of BERA is associated with qualification of SLP.

Compassion in Autism Services: A Preliminary Framework for Applied Behavior Analysis.

Many have suggested that a compassion-focused approach to applied behavior analysis (ABA) services may improve provider-client therapeutic relationships and has the potential to improve program acceptability and clinical outcomes experienced by our clients. In this article, radical compassion is defined and explored as a foundational approach to the implementation of ABA, with special emphasis on practical applications in the area of service delivery for families living with autism. In this framework for care, compassion is offered as a measurable repertoire and as a philosophical guidepost for future developments in the profession. This article explores preliminary tenets of compassion-focused ABA and their implications for practice. This approach is offered in the hope of moving the field toward a future of improved acceptability and sustainable consumer preference.