Patterns Of Service Delivery Research Articles

Early integration of outpatient palliative care among adults with advanced cancer in a safety-net health system.

195 Background: Medically underserved adults with cancer present at later disease stages. The American Society of Clinical Oncology recommends all advanced cancer patients receive early intervention by a palliative care (PC) team soon after diagnosis (within 8 weeks) and during active treatment. Few studies have examined early integration of PC in the outpatient setting among advanced cancer patients within a safety-net system. This study examined patterns of outpatient PC service delivery (referrals and visits) for advanced cancer patients seen in the primary safety-net provider of cancer care for under- and uninsured adults in Dallas, TX. Methods: Patients diagnosed with advanced-stage solid tumor and who had at least one outpatient oncology visit January 1, 2018 to July 31, 2023 at the safety-net system were identified via electronic health record. The primary outcome was timeliness of outpatient PC referral (categorical outcome). Among patients with an outpatient PC referral, we used Kruskal-Wallis to test univariate associations across key characteristics, including age, race/ethnicity, cancer site, preferred language, insurance, and diagnosis year. Further, we used multivariate logistic regression to evaluate associations between key characteristics and completed PC visits among those with any outpatient PC referral. Results: Among 1,572 eligible patients (mean age 59, range: 21-94), 44% were female and 76% were non-White. Diagnoses included lung (20%), gastrointestinal (17%), colorectal (14%), breast (9%), prostate (9%), head/neck (9%), pancreatic (8%), and gynecologic (6%) cancers. Over half (n=870, 55%) of patients received an outpatient PC referral during the study period. Of those with a referral, 486 (56%) patients were referred ≤ 8 weeks of diagnosis, 157 (18%) between 9 and 24 weeks, 105 (12%) between 25 and 52 weeks, and 122 (14%) > 52 weeks. Timeliness of referral varied according to race/ethnicity and cancer type (p<.05; Table). Two-thirds of referred patients (n=576) completed a PC visit during the study period. In the adjusted regression model, compared to males, females had higher odds of completing a PC visit – (aOR, 1.40; 95% CI, 1.01-1.94). Conclusions: Just over half of advanced cancer patients received a referral to the outpatient PC team. Nearly half of referred patients had the referral ordered after 8 weeks of diagnosis. Except for gender, there were no other factors associated with PC visit completion. These findings demonstrate a need and potential for interventions targeting PC service delivery to improve care for underserved cancer patients. Time from diagnosis to PC referral.* ≤8 Weeks 9 - 24 Weeks 25 - 52 Weeks > 52 Weeks Cancer type (%) Colorectal 50 16 17 17 Lung 64 17 11 8 Pancreatic 64 19 8 9 Prostate 30 17 12 40 Race/ethnicity, (%) White 66 14 10 9 Black 54 22 12 12 Hispanic 52 17 13 18 Select cancer types shown where significant differences were found. *p<.05.

WP4.19 - The Emergency General Surgeon: what is their current operative role?

Abstract Aims Determine the current operative role of dedicated Emergency General Surgery (EGS) surgeons in the United Kingdom (UK) and the Republic of Ireland (ROI). Methods A live interactive online survey, designed and endorsed by ASGBI, was completed by attendees at two ASGBI conferences in 2023. The study was conducted according to CHERRIES and exempt from REC according to HRA. Consent was obtained from study participants, who were asked which surgeons usually perform the most common EGS operations in their hospital. Results The survey was completed by 156/371 eligible participants, of which 132 responses were analysed once duplicate responses (n=16), and non-UK/ROI respondents (n=8), were excluded. Participants included consultants (34%), surgical trainees (42%), and other doctors (23%), 61% were male and 39% were female, aged between 25 and 69. The general surgeon on-call – or a dedicated EGS surgeon, where such service exists – operates on the majority of EGS pathology through an un-selected take. A surgeon with the relevant sub-specialty interest usually operates on emergency non-traumatic complex upper gastrointestinal or colorectal pathology. These include emergency colonic resections for cancer or inflammatory bowel disease, and operations for gastric volvulus, bariatric complications, and Boerhaaves. Acute cholecystectomy forms a major part of a dedicated EGS surgeon’s practice. Conclusions Dedicated EGS surgeons deliver a wide variety of operations, in addition to the peri-operative management of acute surgical patients. Future curriculum design and NHS workforce planning should reflect this service delivery pattern, should EGS become a recognised specialty interest.

Teledentistry utilization by oral health professionals and policy considerations: A mixed methods case study.

To examine variations in the delivery of teledentistry after the COVID-19 pandemic and to explore oral health professionals' utilization of various teledentistry modes of delivery. In this mixed methods case study, we collected teledentistry claims data from patient electronic health records (n = 78,756) encompassing various types of teledentistry utilization in clinical settings and through community outreach from a Dental Support Organization (DSO) in Oregon from January 2021 to November 2022. We analyzed the patient demographic and claims data using descriptive statistics and logistic regression analyses to identify patterns of teledentistry service delivery. Qualitatively, we conducted virtual interviews (n = 13) through Microsoft Teams with oral health professionals about their experiences with teledentistry utilization. We used inductive and deductive coding to code individual transcripts and identify common themes among provider experiences. Out of the 78,756 electronic health record claims for teledentistry, 75.7% used synchronous audio, 13.4% used synchronous video, and 10.9% used asynchronous teledentistry methods. We observed a 8.6% increase in synchronous audio teledentistry utilization at the end of the study period, compared with a 4.2% increase in synchronous video and a 4.4% decrease in asynchronous teledentistry. Oral health professionals interviewed reported choosing the type of teledentistry delivery based on patient and provider access to the virtual teledentistry platform. Oral health professionals' knowledge of and experiences with teledentistry need to be considered when developing policy and best practices for the use of teledentistry for patient care.

Examination of Patient Safety and Experience in Ghanaian Healthcare Facilities

Objective: This paper analyzes Ghana’s healthcare quality challenges utilizing the Donabedian model covering structures, processes and outcomes to inform comprehensive systems improvement recommendations. Methods: A mixed methods approach compiles empirical findings from multiple clinical studies across Ghana assessing healthcare infrastructure, service delivery patterns, and resultant patient consequences. Qualitative case reports provide context while quantitative metrics spotlight nationwide deficiencies. An adapted Donabedian framework incorporated expanded quality domains for rigorous evaluation. Results: Significant infrastructure limitations, disjointed processes and alarming patient outcomes signify major quality gaps tied to wider health financing shortfalls. Specific issues include resource distribution inequities, medical supply unreliability, poor referral systems, limited staff accountability and infection control breaches—culminating in high preventable complications. Conclusions: Interdependencies exist between financing, tools, clinical workflows and patient experiences whereby strengthening isolated aspects risks continued quality issues without addressing root causes holistically. Sustainable reforms necessitate coordinated investments in infrastructure, oversight, coordination and worker training. Recommendations: A 10-step roadmap details structural upgrades, delivery protocols and monitoring mechanisms health authorities must institute in tandem to raise care standards for patient welfare and trust. Scientific Significance: This paper advances use of mixed, multi-level modeling to diagnose complex health sector challenges in resource-limited contexts. Practical Relevance: The blueprint formulated provides an evidence-based guide for policymakers to sequentially address identified healthcare deficiencies through coordinated quality assurance initiatives.

Examination of Patient Safety and Experience in Ghanaian Healthcare Facilities

Objective: This paper analyzes Ghana’s healthcare quality challenges utilizing the Donabedian model covering structures, processes and outcomes to inform comprehensive systems improvement recommendations. Methods: A mixed methods approach compiles empirical findings from multiple clinical studies across Ghana assessing healthcare infrastructure, service delivery patterns, and resultant patient consequences. Qualitative case reports provide context while quantitative metrics spotlight nationwide deficiencies. An adapted Donabedian framework incorporated expanded quality domains for rigorous evaluation. Results: Significant infrastructure limitations, disjointed processes and alarming patient outcomes signify major quality gaps tied to wider health financing shortfalls. Specific issues include resource distribution inequities, medical supply unreliability, poor referral systems, limited staff accountability and infection control breaches—culminating in high preventable complications. Conclusions: Interdependencies exist between financing, tools, clinical workflows and patient experiences whereby strengthening isolated aspects risks continued quality issues without addressing root causes holistically. Sustainable reforms necessitate coordinated investments in infrastructure, oversight, coordination and worker training. Recommendations: A 10-step roadmap details structural upgrades, delivery protocols and monitoring mechanisms health authorities must institute in tandem to raise care standards for patient welfare and trust. Scientific Significance: This paper advances use of mixed, multi-level modeling to diagnose complex health sector challenges in resource-limited contexts. Practical Relevance: The blueprint formulated provides an evidence-based guide for policymakers to sequentially address identified healthcare deficiencies through coordinated quality assurance initiatives.

Bureaucratic Reform through Public Policy Implementing Quality Dimensions in Integrated Licensing Services

The bureaucratic reform of the licensing service sector in Gorontalo City was followed up by Regional Regulation Number 14 of 2006 concerning the establishment of a one-stop integrated service unit. However, the integrated service unit has not been able to provide quality services as expected. Therefore, this research is very important to provide corrections and improvements to publicly accessible licensing services. The scope of the study on the two services has reviewed the procedures carried out in the two selected services from the beginning until the licensing documents were issued. The research method used is a qualitative descriptive method through an in-depth and comprehensive study of the series of licensing services. The results showed that 1) there are differences in the application of public service dimensions in environmental permit services and building permits. 2) several factors determine the success of licensing services, namely internal factors and external factors. Internal factors include general management patterns of the organization and the provision of supporting facilities, as well as human resource development. External factors include service patterns, service provision procedures, and service distribution patterns, as well as service delivery patterns. This research provides positive benefits in the efforts of local governments to innovate public licensing services. The practical implications of the research results encourage the organization of regional equipment to meet the facility standards needed to provide quality public services.

Examining service delivery patterns before and after implementation of a direct-to-patient telehealth service providing medication abortion in Australia.

In August 2016, MSI Australia (MSIA) brought to scale a direct-to-patient telehealth medication abortion service. We used MSIA's patient management systems from January 2015 to December 2018 to assess changes in the proportion of abortion patients obtaining care after 13 weeks' gestation, proportion of abortion patients obtaining medication abortion versus procedural abortion and proportion of abortion patients from regional and remote versus metropolitan areas. The proportions of abortion patients obtaining care before 13 weeks' gestational duration and those from regional and remote residents did not change between the pre- and post-periods. We observed an increase in medication abortion use that was greater among those in regional and remote areas than those in metropolitan areas.

Pediatric collaborative care outcomes in a regional model

BackgroundDespite the movement toward hospital-based medical centers acquiring pediatric primary care offices, many primary care pediatricians still work in small, independent practices. To expand mental healthcare access, service delivery models must consider primary care practice needs and regionally available resources.ObjectiveThis report describes the implementation and evaluation of the Mood, Anxiety, ADHD Collaborative Care (MAACC) program over a 4 years period. MAACC. MAACC engaged 97 pediatric primary care clinicians across 39 practices in mental health training and supported the treatment of referred patients through a collaborative care model. To support psychosocial treatment needs, we built a child community therapy referral network of 213 licensed psychotherapy providers.MethodsData were collected on service delivery patterns (e.g., referrals, treatment use, and attrition) and patient outcomes. Measures included parent and children and adolescents PROMIS anxiety and depression short forms and the Parent NICHQ Vanderbilt.ResultsSix hundred ninety-six children and adolescents aged 6–18 were evaluated and provided treatment recommendations. Anxiety disorders were the most common diagnosis (45.4%), followed by ADHD (30.7%) and mood disorder (17%). For children and adolescents with an anxiety or mood disorder, significant improvement was observed from baseline to any initial follow-up and from baseline to 6, 12-, and 18 weeks on children and adolescents and parent measures of anxiety and depression. For children and adolescents with ADHD, significant improvement was observed from baseline to any initial follow-up measure and at 6 and 18 weeks on parent-reported inattentive symptoms. Significant differences in treatment outcomes were identified for children and adolescents with anxiety receiving psychotherapy alone and medication management and psychotherapy.ConclusionMAACC utilization and patient outcomes suggest that real-world collaborative care can effectively provide high-quality care while cultivating increased primary care treatment capacity and building on existing community resources.

Care Delivery in Community Health Centers Before, During, and After the COVID-19 Pandemic (2019-2022).

Health centers provide primary and behavioral health care to the nation's safety net population. Many health centers served on the frontlines of the COVID-19 pandemic, which brought major changes to health center care delivery. To elucidate primary care and behavioral health service delivery patterns in health centers before and during the COVID-19 public health emergency (PHE). We compared annual and monthly patients from 2019 to 2022 for new and established patients by visit type (primary care, behavioral health) and encounter visits by modality (in-person, telehealth) across 218 health centers in 13 states. There were 1581,744 unique patients in the sample, most from health disparate populations. Review of primary care data over 4 years show that health centers served fewer pediatric patients over time, while retaining the capacity to provide to patients 65+. Monthly data on encounters highlights that the initial shift in March/April 2020 to telehealth was not sustained and that in-person visits rose steadily after November/December 2020 to return as the predominant care delivery mode. With regards to behavioral health, health centers continued to provide care to established patients throughout the PHE, while serving fewer new patients over time. In contrast to primary care, after initial uptake of telehealth in March/April 2020, telehealth encounters remained the predominant care delivery mode through 2022. Four years of data demonstrate how COVID-19 impacted delivery of primary care and behavioral health care for patients, highlighting gaps in pediatric care delivery and trends in telehealth over time.

Leadership and Team Work Competencies for Librarians and Effective Service Delivery Patterns in the Selected Academic Libraries

Leadership and Team Work Competencies for Librarians and Effective Service Delivery Patterns in the Selected Academic Libraries

Knowledge, Concerns, and Psychological Distress Among Caregivers of Patients Seeking Emergency Medical Care for Non-COVID-19-Related Illness During the COVID-19 Pandemic: A Cross-Sectional Study.

Introduction During the active phase of the COVID-19 pandemic, the global healthcare system failed to meet the increased demand for healthcare resources,infrastructures, and facilities. The brunt of the healthcare crisis was faced not only by COVID-19 victims; a large majority of non-COVID patientswere deprived of routine and emergency care. Factors that possibly affected resource utilization, healthcare-seeking behavior, service delivery patterns, and national health systems' priority during the pandemic were the knowledge and attitudinal concerns related to the COVID-19 disease and its control measures. Here, we evaluated the knowledge, concern, and psychological distress among the caregiversof the patients attending the emergency department at a tertiary healthcare center inIndia.​ Methodology We conducted a survey-based study using a pre-validated questionnaire on the caregivers of the patients visiting the emergency department (ED) from June to September 2020 (during the first wave of the COVID-19 pandemic). The demographic details and responses of the participants were documented in the semi-structured proforma. A pre-validated COVID-19 Peritraumatic Distress Index (CPDI) questionnaire was used to assess psychological stress. Results Out of 1014 participantsinterviewed, the majority weremale attendants (72%), aged 18-45 (82%), and seeking medical attention for patients with chronic illnesses (76%). Acute onset emergencies like stroke, myocardial infarction, trauma, etc. were the ED presentation in only one-fifth of patients. COVID-19-related knowledge wasadequate for questions related to age groups at risk for the viral infection (97% agreed that all age groups were at risk), mode of transmission (75-90% were aware of the commonmodes of transmission), and >65% knew the common symptoms of COVID-19 infection. However, only 38.5% knew about frequent handwashingas a protective measure. More than half of the participants considered the COVID-19vaccine as the sole ray of hope and disregarded the effectiveness of alternative medicines such as Ayurvedic/homeopathic/allopathic medicines as preventive options. One-third were first-time visitors to the hospital, while two-thirds of all participants were afraid to visit any hospital during the COVID-19 pandemic. The majority (84%) faced difficulty in accessing the index tertiary care center due to transport, socioeconomic support, or lockdown-related restrictions. In comparison, 60% reported some form of discrimination at almost all levels of healthcare settings due to COVID-19-related priority changes. Nearly half (48%) of all enrolled caregivers reported experiencing mild-to-moderate distress (CPDI score=28-51), and 15.7% felt severe distress (CPDI score >51) while seeking treatment for the non-COVID-19 illness of their patient. Age and socioeconomic status were significantly associated with COVID-19-related psychological distress levels (p<0.001 in logistic regression), while gender, education, and residence showed no significant associations. Conclusion Most of the patient caregivers visiting the emergency department during the COVID-19 pandemic had an adequate understanding of risk factors and preventive measures. The major barriers to accessing healthcare facilities were transport, financial issues, and lockdown-related restrictions. Almost two-thirds of the caregivers revealed mild-to-moderate to severe psychological distress due to the pandemic and lockdown-related concerns.

Handling of the Covid-19 Pandemic and Its Effects on Bariatric Surgical Practice: Analysis of GENEVA Study Database

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic led to a worldwide suspension of bariatric and metabolic surgery (BMS) services. The current study analyses data on patterns of service delivery, recovery of practices, and protective measures taken during the COVID-19 pandemic by bariatric teams.Materials and MethodsThe current study is a subset analysis of the GENEVA study which was an international cohort study between 01/05/2020 and 31/10/2020. Data were specifically analysed regarding the timing of BMS suspension, patterns of service recovery, and precautionary measures deployed.ResultsA total of 527 surgeons from 439 hospitals in 64 countries submitted data regarding their practices and handling of the pandemic. Smaller hospitals (with less than 200 beds) were able to restart BMS programmes more rapidly (time to BMS restart 60.8 ± 38.9 days) than larger institutions (over 2000 beds) (81.3 ± 30.5 days) (p = 0.032). There was a significant difference in the time interval between cessation/reduction and restart of bariatric services between government-funded practices (97.1 ± 76.2 days), combination practices (84.4 ± 47.9 days), and private practices (58.5 ± 38.3 days) (p < 0.001).Precautionary measures adopted included patient segregation, utilisation of personal protective equipment, and preoperative testing. Following service recovery, 40% of the surgeons operated with a reduced capacity. Twenty-two percent gave priority to long waiters, 15.4% gave priority to uncontrolled diabetics, and 7.6% prioritised patients requiring organ transplantation.ConclusionThis study provides global, real-world data regarding the recovery of BMS services following the COVID-19 pandemic.Graphical abstract

Health care patterns and policies in 18 European countries during the first wave of the COVID-19 pandemic: an observational study.

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has developed into an unprecedented global challenge. Differences between countries in testing strategies, hospitalization protocols as well as ensuring and managing ICU capacities can illustrate initial responses to a major health system shock, and steer future preparedness activities.MethodsPublicly available daily data for 18 European countries were retrieved manually from official sources and documented in an Excel table (March–July 2020). The ratio of tests to cases, the share of hospitalizations out of all cases and the share of ICU admissions out of all hospitalizations were computed using 7-day rolling averages per 100 000 population. Information on country policies was collected from the COVID-19 Health System Response Monitor of the European Observatory on Health Systems and Policies. Information on health care capacities, expenditure and utilization was extracted from the Eurostat health database.ResultsThere was substantial variation across countries for all studied variables. In all countries, the ratio of tests to cases increased over time, albeit to varying degrees, while the shares of hospitalizations and ICU admissions stabilized, reflecting the evolution of testing strategies and the adaptation of COVID-19 health care delivery pathways, respectively. Health care patterns for COVID-19 at the outset of the pandemic did not necessarily follow the usual health service delivery pattern of each health system.ConclusionsThis study enables a general understanding of how the early evolution of the pandemic influenced and was influenced by country responses and clearly demonstrates the immense potential for cross-country learning.

Outpatient use patterns and experiences among diabetic and hypertensive patients in fragile settings: a cross-sectional study from Lebanon

ObjectivesAssess and describe the health service use and delivery patterns for non-communicable disease (NCD) services in two contrasting fragility contexts and by other principal equity-related characteristics including gender, nationality and...

Added Value of Electronic Immunization Registries in Low- and Middle-Income Countries: Observational Case Study in Tanzania

BackgroundThere is growing interest and investment in electronic immunization registries (EIRs) in low- and middle-income countries. EIRs provide ready access to patient- and aggregate-level service delivery data that can be used to improve patient care, identify spatiotemporal trends in vaccination coverage and dropout, inform resource allocation and program operations, and target quality improvement measures. The Government of Tanzania introduced the Tanzania Immunization Registry (TImR) in 2017, and the system has since been rolled out in 3736 facilities in 15 regions.ObjectiveThe aims of this study are to conceptualize the additional ways in which EIRs can add value to immunization programs (beyond measuring vaccine coverage) and assess the potential value-add using EIR data from Tanzania as a case study.MethodsThis study comprised 2 sequential phases. First, a comprehensive list of ways EIRs can potentially add value to immunization programs was developed through stakeholder interviews. Second, the added value was evaluated using descriptive and regression analyses of TImR data for a prioritized subset of program needs.ResultsThe analysis areas prioritized through stakeholder interviews were population movement, missed opportunities for vaccination (MOVs), continuum of care, and continuous quality improvement. The included TImR data comprised 958,870 visits for 559,542 patients from 2359 health facilities. Our analyses revealed that few patients sought care outside their assigned facility (44,733/810,568, 5.52% of applicable visits); however, this varied by region; facility urbanicity, type, ownership, patient volume, and duration of TImR system use; density of facilities in the immediate area; and patient age. Analyses further showed that MOVs were highest among children aged <12 months (215,576/831,018, 25.94% of visits included an MOV and were applicable visits); however, there were few significant differences based on other individual or facility characteristics. Nearly half (133,337/294,464, 45.28%) of the children aged 12 to 35 months were fully vaccinated or had received all doses except measles-containing vaccine–1 of the 14-dose under-12-month schedule (ie, through measles-containing vaccine–1), and facility and patient characteristics associated with dropout varied by vaccine. The continuous quality improvement analysis showed that most quality issues (eg, MOVs) were concentrated in <10% of facilities, indicating the potential for EIRs to target quality improvement efforts.ConclusionsEIRs have the potential to add value to immunization stakeholders at all levels of the health system. Individual-level electronic data can enable new analyses to understand service delivery or care-seeking patterns, potential risk factors for underimmunization, and where challenges occur. However, to achieve this potential, country programs need to leverage and strengthen the capacity to collect, analyze, interpret, and act on the data. As EIRs are introduced and scaled in low- and middle-income countries, implementers and researchers should continue to share real-world examples and build an evidence base for how EIRs can add value to immunization programs, particularly for innovative uses.

“The Impact of Health Informatics on Public Health Emergency Response During the COVID-19 Pandemic in Developing Countries – Systematic Review”

<strong>Introduction: </strong>The world grapples with the unprecedented challenges of the Covid-19 pandemic with devastating economic and social impacts. The healthcare systems across developed and developing countries are laid a huge responsibility with immense pressure to combat this contemporary global crisis. With modern technological improvements health informatics (HI) plays a vital role in the public health emergency response (PHER). However, there is little empirical evidence to show the impact of HI in developing countries during this pandemic. <strong> </strong> <strong>Objective: </strong>To determine how HI impacted the PHER during Covid-19 pandemic in developing countries. <strong> </strong> <strong>Methodology: </strong>This study deployed a systemic review of published quality academic journals that emphasize and evaluate the HI role and impact during PHER in developing countries. <strong> </strong> <strong>Results: </strong>The synthesized evidence in developed countries found that the technological advances in telemedicine, e-health and mobile devices have proven to possess huge potentials in controlling the pandemic spread with enormous rapid transformations of service delivery patterns, with high patient satisfaction. HI impact on developing countries reported a high positivity towards PHER during Covid-19 pandemic. The adoption rates were low in developing countries with the key determinants; digital technology, efficient health governance, partnership, collaboration in national &amp; international, infrastructure, stakeholder skills and acceptance. The empirical research findings clearly showed the fundamental need to establish suitable HI initiative framework in developing countries in align with the countries national policies with medium to long-term plans and collaborative international partnerships. The level of maturity of HI needed to be deployed within health systems at pace and scale ready enough to save the world in most needed.

Identifying and Prioritizing Dimensions and Indicators of Customer Lifetime Value for Supplemental Health Insurance Industry

Objectives: This study aimed to identify and prioritize the dimensions and indicators of measuring customer lifetime value (CLV) for the supplemental health insurance industry. Methods: In this exploratory qualitative study, first, the initial dimensions and indicators of CLV were extracted through a scoping review. Next, 20 key informants, including academics and insurance industry experts, were selected by purposive sampling and then interviewed to identify and extract other dimensions and indicators of CLV for the supplemental health insurance industry. The data were collected using an in-depth and semi-structured interview and analyzed using the fuzzy analytic hierarchy process (AHP). Results: Out of 232 retrieved articles, 13 studies were eligible to include in this scoping review. After reviewing this study, seven general factors, including customer profitability, service cost, customer retention rate, revenue, discount rate, and time and price paid by the customer, were identified as effective factors in CLV. Moreover, 61 comments were identified after interviewing experts (at the first stage of the interview). Then, after three stages of semi-structured interviews, 17 comments were removed, and 44 comments were approved. Finally, three dimensions, including profitability, customer loyalty, and value co-creation, and 13 indicators, including customer satisfaction, trust, repurchase intention, customer trust, brand performance to repurchase, financial purchasing pattern, service delivery pattern, information search, information sharing, co-production, feedback, helping, and tolerance, were extracted. After conducting the fuzzy AHP, profitability (0.652), customer loyalty (0.226), and customer value co-creation (0.122) were the most important dimensions for CLV, respectively. Additionally, purchase pattern (0.274), financial procedures (0.261), and service delivery pattern (0.117) had the highest priority among the indicators, respectively. Conclusions: According to the results, although customer profitability was the most important dimension to measure CLV, CLV is a combinatorial concept. Therefore, the dimensions of customer loyalty and customer value co-creation should be taken into consideration as effective dimensions in predicting and measuring the concept.

Artificial intelligent towards hotels’ competitive advantage. An exploratory study from the UAE

PurposeHotel industry is witnessing a radical change as a result of technology interaction such as artificial intelligence (AI) in service tasks. As a result of this transformation, the pattern of service delivery based on human interaction has been changed to digital interaction. This brought opportunities to the hotels industry and consolidate its competitive advantage. However, the understanding gap still existed in both practical implementation and literature, especially in developing countries. Therefore, this paper aims to explore how hotels use AI to carry out services tasks.Design/methodology/approachThe authors adopted the qualitative research method through Semi interviews. The sample was purposively selected from five 5-star hotels in the UAE, meanwhile, the managers were the targeted respondents.FindingsThrough content analysis, the authors find that the UAE hotels use AI in managing trip planning, reception service and room services. The authors also find that there are four key drivers that improve the performance of AI, which include AI infrastructure flexibility, strategic alignment, management and skills. Finally, the authors found four indicators of the impact of AI on hotels, which are quality, cost and market share and customers satisfaction.Originality/valueThis study is one of few studies that explored the use of AI in the hotels industry and discussed how AI influence several aspects of hotels performance and helped them to attain their competitive advantage. This study is also one of few studies and the first study in UAE to explore the key drivers of AI performance in UAE hotels.

E-Lebbami: An Innovation of Information Technology in Services at DPMPTSP of Makassar City

The take and give phenomenon between the community and the government is a consequence of a convoluted, inefficient and ineffective pattern of service delivery. Therefore, in addition to improving government management, the government apparatus also needs to be continually improved through public service innovation. This study aims to describe the process of developing public service innovations carried out by Investment Office and One Stop Integrated Services (DPMPTSP) and identify the factors that influence public service innovation implemented by DPMPTSP Kota Makassar. The research method used is descriptive qualitative. The researcher will explain the research problem in detail, namely the innovation process and the factors that influence it. The collection of data obtained through direct observation of the object of research and in-depth interviews (in-depth interviews) with resource persons. Data processing using the model of Miles and Huberman (1992). namely: data reduction, data presentation, and drawing conclusions /verification. Based on the results of the study, it can be concluded that the innovation development process carried out by DPMPTSP Kota Makassar can be categorized as a radical innovation because it makes fundamental changes in public services or the introduction of completely new ways in the organizational and service process. This can be reflected in the birth of the E-Lebbami application, where the licensing service application utilizes the development of information technology. However, there are factors that become obstacles in this innovation process, namely the dependence on certain figures in providing innovation ideas.

Prison mental health in-reach teams in Aotearoa New Zealand: A national survey

The STAIR in-reach model of care for prisoners with serious mental illness focuses on screening, triage, assessment, interventions and reintegration by using the principles of assertive community treatment. An evidence base exists for the efficacy for its use in Aotearoa New Zealand. However, little is known about its adoption throughout the country. This national survey of managers of in-reach teams to all prisons (N = 19) aimed to determine the pattern of in-reach service delivery. It compared STAIR in-reach teams with other teams regarding service structure, staffing, interventions, reintegration strategies and training needs. This study signals gains made by adopting the STAIR model (multi-disciplinary team service delivery, ‘through the wire’ support and use of technologies to assist discharge planning) and potential areas of improvement (further use of psychosocial interventions and training needs). To assist national adoption of STAIR, a review is required to consider the cultural responsivity, gender-responsivity and recovery-orientated characteristics of the model.