Service Delivery Organizations Research Articles

Improving health service delivery organisational performance in health systems: a taxonomy of strategy areas and conceptual framework for strategy selection

Health systems strengthening (HSS) is a priority for global health funders, policy-makers and practitioners. Although many HSS efforts have focused on policy levers such as financing approaches, payment schemes or regulatory reforms, less attention has been directed to targeting the organisations that deliver health services such as hospitals, health centres and clinics. Evidence suggests that the impact of organisation-level interventions varies by context; however, we lack a general framework for integrating organisational context into performance improvement strategies for health service delivery organisations. Drawing on open systems theories from organisational behaviour and management as well as a review of 181 empirical studies of health service delivery organisations in low- and middle-income countries, we propose a taxonomy of seven strategy areas for improving organisational performance as well as a multistage conceptual framework for selecting among them. We propose that the choice of strategy for improving health service delivery organisational performance should be informed by: (i) the root cause of the organisation's performance gap; (ii) the environmental conditions facing the organisation; and (iii) the implementation capability of the organisation. We also highlight conditions under which different strategy areas may be expected to be optimally effective. The approaches presented in this paper offer a way for health system decision-makers and researchers to systematically assess and incorporate organisational context in the process of developing strategies to improve the performance of health service delivery organisations and, ultimately, of health systems.

Developing Interdisciplinary Centers in Aging: Learning From the RAND/Hartford Building Interdisciplinary Geriatric Health Care Research Centers Initiative

The rising number of older patients with complex, often chronic conditions presents challenges in service delivery and social organization. Addressing the complexity of multiple interacting chronic conditions and devoting time for extensive interaction with elderly patients requires an interdisciplinary team. The "Building Interdisciplinary Geriatric Health Care Research Centers" initiative was designed to establish geriatric research centers that would bring together interdisciplinary teams of health professionals who would integrate concepts, methods, and practices across disciplines. The directors of the centers planned and conducted activities (e.g., seminars, Wikis, and mentoring) to develop infrastructure, to conduct collaborative research projects, and to support junior faculty career development. The activities in these areas led to a number of grant submissions and awards, to manuscript acceptances and conference presentations, and to career advances for junior faculty members. Overall, the centers' directors found that building interdisciplinary research capabilities takes time, attention, and support. External grant funding helped to create centers that, through infrastructure and activities, brought together individuals from a wide range of disciplines who had common interests and then helped these individuals collaborate to develop new projects or build on existing efforts. Through their infrastructure, collaborative research, and career development activities, the centers changed the approach to interdisciplinary research.

Institutional features of inter-municipal cooperation: Cooperative arrangements and their national contexts

Inter-municipal co-operation is a widespread phenomenon throughout Europe. But in spite of its wide spread, inter-municipal co-operation has not been subject to systematic comparative research. This article presents some of the findings of a joint research project concerning inter-municipal co-operation in a series of European countries. A comparative analysis shows that inter-municipal co-operation comes in all shapes and sizes. Nevertheless it is possible to distinguish four basic types of co-operation: quasi-regional governments, planning forums, service delivery organizations and service delivery agreements. Research shows that the national institutional context to a large extent explains the presence or absence of the different types in a country.

Organizational Interests and Public Needs: Decentralization and Service Delivery in Viet Nam

Decentralization has emerged as a popular strategy for reforming public services. But the outcomes of decentralization are often at odds with those envisaged, particularly as it concerns the functions of service-delivery organizations (SDOs). Among the most important aspects of decentralization is the changes it engenders in the goals, interests, and operations of service-delivery organizations. This essay examines developments in the delivery of education and health services in Viet Nam and explores ways in which service delivery, which is increasingly decentralized, can be better aligned with Viet Nam’s current and prospective needs. Broadly, four claims are advanced. First, Viet Nam’s government has demonstrated an impressive commitment to the promotion of education and health services that distinguishes it from governments in many other countries. Second, however, in light of recent developments, as well as Viet Nam’s stated development goals and international experience, Viet Nam’s government and SDOs stand to benefit from an aggressive reworking of arrangements for the governance of SDOs. Third, for normative as well as practical reasons to be detailed below, SDOs in Viet Nam are best regarded by all as client-facing organizations with obligations to rights-bearing citizens. Finally, however, any claims regarding SDOs in Viet Nam must be informed by a nuanced understanding of local institutions and what it means to be involved in the delivery and use of education and health services in Viet Nam.

Police‐based victim services: Australian and international models

PurposeThe purpose of this paper is to provide an outline of the strengths and weaknesses of selected models of police‐based victim services. It aims to provide an overview of the current predominant models of police‐based victim support in the USA, Canada, UK and Australia. It also aims to advance a typology of police‐based victim services as a useful analytic tool for understanding the varying models.Design/methodology/approachThe research was based on extensive documentary analysis supplemented by semi‐structured interviews with 17 practitioners in the USA, Canada and Australia. Sites were selected for interview based on documentary research which indicated that they had developed police‐based victim services in their organization that were either particularly representative or innovative.FindingsPolice‐based victim services can be categorized into three broad models: unit services, dedicated liaison officer services, and referral services. Each model has strengths and weaknesses in terms of service delivery and police organization. Unit services may be optimum in delivering services but are also resource‐intensive and may be beyond the financial scope of some police organizations. They also potentially risk sequestering victim services within police organizations and reinforcing a view that dealing with victims of crime is not “real policing”. Dedicated officer services require significant institutional input to achieve their goals, while referral models necessitate workable mechanisms for inter‐agency cooperation. Thus police organizations need a clear perception of their victim services delivery role and how this might best be achieved.Originality/valueThe academic literature on police‐based victim services remains scant. This paper makes a valuable contribution to the literature by providing a useful typology for the analysis of police‐based victim services and the assessment of their strengths and weaknesses. The typology will prove useful for future empirical case‐studies of individual police‐based victim services.

Regulation, Organization and Incentives: The Political Economy of Potable Water Services in Honduras

This case study of urban water and sanitation in Honduras focuses on the perplexing phenomenon of low level equilibrium (LLE). It first seeks to characterize LLE in terms of sector performance and to show how it is propitiated by flawed arrangements for sectoral governance, organization of service delivery and regulation. It then turns to the question of why it is so difficult to escape from LLE. To this end, it analyzes the failure of recent reform efforts, using political economy techniques.

The impact of opening hours on the equity of individual space–time accessibility

While many studies have concentrated on the effects of the spatial distribution of services on individual accessibility, only little is known about the ways in which equity of individual accessibility is affected by the temporal organisation of service delivery. This paper seeks to deepen our understanding about the relationship between accessibility, equity and the opening hours of public service facilities on the basis of space–time accessibility measures. Three approaches based on different equity principles are presented to schedule the opening hours of public service facilities: a utilitarian, an egalitarian and a distributive approach. A case study of public libraries in Ghent (Belgium) demonstrates the relevance of these approaches for amending the opening hours of public services to control the equity of accessibility levels across individuals.

Where next for neighbourhood regeneration in England?

There has been a ‘triple whammy’ for neighbourhood regeneration in England in 2010. Key agencies and infrastructure have been abolished or cut back since the election of a new government; the previous administration’s area-based initiatives are ending; and property-led developments have slowed markedly during the recession. However, while policy stands at a crossroads, the underlying drivers for regeneration remain as pertinent as ever, regardless of wider fiscal and economic circumstances. Within this context, the article considers the form which neighbourhood regeneration might take during the next decade, exploring how evolving policy developments (e.g. localism, ‘Big Society’, Local Enterprise Partnerships) could impact on practice. Analysis suggests that neighbourhood regeneration will exist in a very different world to that which practitioners are familiar with, characterized by resource constraints, organizational change, uncertainty and upheaval. However, there are opportunities: a more powerful position for voluntary and community sector organizations with the greatest capacity; new forms of collaboration between neighbourhood regeneration organizations; and the development of new relationships between commissioners and service delivery organizations.

Girls Incorporated of Alameda County at 50: A Voice for Girls (1958–2008)

Girls Incorporated of Alameda County is nonprofit human service organization that has delivered education, counseling, and advocacy services to girls aged 6 to 18 for 50 years. The organization began as a small, local girls club and has grown into a large multi-faceted service delivery organization attached to a national governing body. The history of Girls Incorporated of Alameda County introduces struggles in relation to external and internal factors that altered the way that the agency financed and managed and exemplifies the important role of nonprofit leadership. The organization's many accomplishments have also presented multiple challenges, particularly related to the changing roles of women in American society.

Managing ward managers for roles in HRM in the NHS: overworked and under‐resourced

Drawing on case study research in seven NHS Trusts, this article considers the role and management of ward managers and paramedic supervisors, focusing on their human resource management (HRM) responsibilities. In the National Health Service (NHS), these front‐line managers are critical to the delivery of effective HRM and thereby strongly influence organisational performance and service delivery. However, despite the mounting literature on leadership and performance in health care, little is known about this body of managers who have been generally neglected by academics and practitioners. This article seeks to address these shortcomings by considering the content and practice of these junior managers' role, their work experiences and factors that influence their ability to deliver effective HRM. The findings reveal that the roles of these managers have been enhanced and extended to include an extensive portfolio of HR duties but is subject to considerable constraint. The multiplicity of roles these managers are required to perform has magnified issues of role conflict and ambiguity, heavy workloads and stress. Fundamentally, however, these managers lacked support from senior managers and the HR function.

패션 명품 브랜드 판매원의 역량과 서비스 지향성이 조직몰입과 서비스 제공수준에 미치는 영향

This study examines the effects of competency and service orientation of imported fashion luxury brands salespersons on the organizational commitment and service delivery level. Questionnaire data from 162 salespersons of imported fashion luxury brands were analyzed. The results were summarized as follows. First, self-management ability, professional executive ability, and the friendly attitude of six competency factors had significant effects on organizational commitment. Second, professional executive ability, self-management ability, and friendly attitude of the six competency factors had significant effects on service delivery level. Third, all factors of service orientation had significant influences on organizational commitment. Finally, special treatment/awareness of needs and instant response/communicative skill of three service orientation factors had significant influences on the service delivery level.

Task Matters: A Structural-Instrumental Analysis of the Autonomy of Hong Kong Government Bodies

What might account for the varying degrees of autonomy granted to public agencies? One broad range of answers is provided by a structural-instrumental perspective on organizations, which assumes that the assignment of autonomy is a response to structural features of organizing on the one hand and to task considerations on the other. Taking the case of Hong Kong, data from a survey of chief executives of 111 government agencies on perceptions of autonomy are analyzed to explore a series of propositions concerning the relationships between structure, task, and perceived autonomy. The method of ordinary least square regression is used to analyze the data. Overall, the findings show that variables describing key features of structure and task do help to explain degrees of autonomy. However, two propositions drawn from rational choice theory concerning task-related variables are not confirmed: public service delivery organizations are under tighter, not looser control, whereas regulatory agencies show no tendency toward autonomy. Interpretation of the findings points to significant features of Hong Kong’s constitutional and political history which highlight the importance of contextualization.

A Glimpse Within: An Exploratory Study of Child Welfare Agencies’ Practices With LGBTQ Youth

This article presents findings from a national survey of agency members of the Child Welfare League of America (CWLA) with respect to organizational culture and service delivery for lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth. Sixty-seven study participants provided quantitative and qualitative data via an Internet questionnaire. Overall, agencies fall short of fully subscribing to recommendations made by the CWLA. They could improve their support for providing an inclusive environment, creating supportive policies, and selecting childcare providers regardless of sexual orientation/gender identity. In addition, agencies varied with respect to the relative emphasis that services geared specifically for LGBTQ should occur. Although some progress has been made, much work remains for child welfare agencies to fully address the needs of LGBTQ youth.

The IBM services connection

Self-service technologies are relied upon by service delivery organizations that make use of their low cost and ubiquity to deliver componentized self-service to worldwide clients. A rolebased portal can be a key technology component for any servicedelivery organization seeking to provide an advanced self-service capability. Portals that have access to information on the client's organization, its contracted services, and the service components provided can be used to manage the parameters of service delivery. Providing the client's management dashboard through self-service portals establishes a foundation that allows a service organization to present its services value chain in terms and subprocesses that are relevant to its clients. Exposing services processes to clients requires a governance layer that ensures consumers of multiple services can manage their service delivery in ways that make the client more efficient. Supporting technologies such as single sign on, reporting, model-driven tooling, and real-time linkages to services entitlement complete the core technology set that fulfills the end-to-end self-service architecture. In this paper, we provide an overview of the unique self-service requirements for service delivery, followed by an overview of the technologies required to meet those requirements. We also review innovations that enable the creation of the IBM Services Connection, a worldwide deployed service support portal.

Crowdsourcing and service delivery

Today, service delivery organizations operate in a highly dynamic, complex, competitive, and globally distributed environment. There is constant pressure to reduce costs and improve performance and quality. Success demands the ability to continuously learn and adapt. Standardization is recognized as essential to reducing variation and, therefore, costs, as well as managing quality. Public frameworks and standards, such as ITIL® (Information Technology Infrastructure Library), provide best-practice guidance and a common vocabulary for managing IT (information technology) services. In this paper, we explore the role that social networking and can play in socializing and developing best practices for a service delivery organization. We draw on our experience developing and deploying a social networking application, called Cyano, which is being used by approximately 13,000 IT professionals to capture and maintain day-to-day activities, processes, and artifacts used for problem and change management of several hundred outsourced infrastructures. Cyano is a new breed of social networking enterprise applications, in which crowdsourcing is leveraged to enrich and maintain IT processes and social networks are not created by explicit membership, but rather are implicitly discovered by the type of activities and infrastructure elements that various users support. In this paper, we focus on 1) the architecture of Cyano for supporting social tagging and linkage across different layers of management applications, 2) process customization and governance, and 3) an automated recommendation system that has been well received by thousands of IT professionals. We also highlight research challenges in this space.

The IBM Services Connection: Service delivery through self-service portal technologies

Self-service technologies are relied upon by service delivery organizations that make use of their low cost and ubiquity to deliver componentized self-service to worldwide clients. A rolebased portal can be a key technology component for any servicedelivery organization seeking to provide an advanced self-service capability. Portals that have access to information on the client's organization, its contracted services, and the service components provided can be used to manage the parameters of service delivery. Providing the client's management dashboard through self-service portals establishes a foundation that allows a service organization to present its services value chain in terms and subprocesses that are relevant to its clients. Exposing services processes to clients requires a governance layer that ensures consumers of multiple services can manage their service delivery in ways that make the client more efficient. Supporting technologies such as “single sign on,” reporting, model-driven tooling, and real-time linkages to services entitlement complete the core technology set that fulfills the end-to-end self-service architecture. In this paper, we provide an overview of the unique self-service requirements for service delivery, followed by an overview of the technologies required to meet those requirements. We also review innovations that enable the creation of the IBM Services Connection, a worldwide deployed service support portal.

Perspectives on Leadership in Organizations Providing Services to People With Disabilities: An Exploratory Study

As leaders from the Baby Boomer generation prepare for retirement over the next decade, emerging leaders must be identified and supported in anticipation of a major organizational transition. Authentic leadership is a construct that informs the development of values-driven leaders who will bring organizations into the future, just as the previous generation of leaders oversaw the movement of services away from state institutions and into networks of community-based service delivery organizations. The purpose of this exploratory study was to examine executive and emerging leaders' opinions about the unique leadership values, skills, and challenges in organizations that serve individuals with intellectual and developmental disabilities. Themes of defining, developing, and sustaining leaders emerged from the data and are explored through an authentic leadership framework.

Shared Services Transformation: Conceptualization and Valuation from the Perspective of Real Options

ABSTRACTIn today's volatile global economy, where many organizations face severe pressure to downsize, the “shared services” model, in which a firm merges common functions performed by multiple units into a single service delivery organization, provides an innovative approach to make business more efficient and effective. To successfully implement shared services, firms need to strategically decide whether and how to pursue various service transformation alternatives such as simplification, standardization, consolidation, insourcing, or outsourcing. In this study, we develop the notion of real options into a unique theoretical lens for conceptualizing service organizations and their transformation in an uncertain business environment. Specifically, we view service organization as a set of strategic options that give the firm preferential access to future transformation opportunities. We create a taxonomy of these options, and introduce a decision methodology for valuing alternative shared services transformation approaches. We illustrate this methodology by applying it in a real business case to justify a global firm's decision regarding the transformation of its finance organization.

Disseminating evidence-based treatments for PTSD in organizational settings: A high priority focus area

Dissemination of evidence-based treatments for PTSD has become an important focus of activity in the aftermath of recent terrorist attacks (e.g., London underground and U.S. 9/11 attacks), natural disasters (e.g., Indian Ocean tsunami and Hurricane Katrina), and wars (e.g., in Iraq and Afghanistan). This has become a high priority need for all mental health training and service delivery organizations. Researchers and educators have begun to examine clinician and client perceptions and preferences regarding PTSD treatment processes, and health care systems are organizing more comprehensive efforts at training and system change. As this evolution of services moves forward, effective dissemination should be a major focus of health policy research for the next decade or more.This review critically evaluates the PTSD-related research and emerging theory related to four major sets of variables that affect dissemination: (1) Practitioner factors, (2) Training methods, (3) The practice innovation(s) being disseminated; and (4) Organization or system factors. We evaluate findings from recent studies in light of emerging models of dissemination, and in the final section of the paper, we consider five broad topics with particular implications for dissemination of PTSD-specific treatments. They are: (1) The content of dissemination (i.e., which treatment protocols or intervention methods should be prioritized); (2) Strict adherence versus flexibility in the use of treatment manuals and the role of fidelity assessment; (3) The need for collaboration with user audiences; (4) The potential role of web-based technologies in increasing the effectiveness and efficiency of dissemination; and (5) Development of dissemination infrastructures within organizations.

Alcohol & Drug Abuse: What Is "Women-Focused" Treatment for Substance Use Disorders?

Alcohol & Drug Abuse: What Is "Women-Focused" Treatment for Substance Use Disorders?