Supply-driven System Research Articles

Task shifting for musculoskeletal disorders in Norwegian primary care: a qualitative interview study of general practitioners and specialist musculoskeletal physiotherapists

Objective To explore the views of general practitioners and physiotherapists on the current model of care for patients with musculoskeletal disorders in Norwegian primary care, and if the English First Contact Practitioner model, where patients have access to multiple professional groups with musculoskeletal health expertise, could inform service development. Design, setting, and subjects We analysed interviews with five GPs and 11 physiotherapists and used Lipsky’s theories about street-level bureaucracy and Foucault’s theories of mechanisms of power and institutional structures to explore task shifting and cooperation between different professions. Results and interpretation The empirical material reflected a multi-faceted discourse about skill-mix in primary care, where financial factors, perceptions about competence, and task preferences moderated attitudes to task shifting. Competition and cooperation coexist between the professions, and the seemingly gradual blurring between historical hegemony and new models of care creates both alliances and rivalries. Examples of deviations from the Choosing Wisely principles and evidence-based practice indicate that both general practitioners and physiotherapists balance the roles of patient advocate, gatekeeper, and homo economicus, in a context where task shifting is challenged by established practice. It appears that the management of patients with musculoskeletal disorders is fragmented and to some extent reflects a supply-driven system.

Understanding Organisational Risks and Opportunities Associated with Implementing Australia’s National Disability Insurance Scheme from the Nonprofit Service Provider Perspective—Findings from Quantitative Research

In this paper, we provide useful lessons from a quantitative analysis across several nonprofit organisations undergoing generational change due to the implementation of the Australian government’s National Disability Insurance Scheme (NDIS). This paper contributes to the field in demonstrating the usefulness of the approach in revealing how change has to occur at both the micro and macro levels of the organisations involved, affecting both followers and transforming leadership, whilst simultaneously reinforcing the need to address the strategic and operational risks inherent in such transformational change. It represents a follow-up to an earlier published longitudinal qualitative research and provides further evidence on the key findings associated with the development of the NDIS Implementation Framework. The current paper considers the importance of the risk and opportunity conundrum associated with the implementation of the NDIS among Australian nonprofit service providers. This paper recognises that, as entities operating ostensibly outside the purely commercial realms of service design and delivery, nonprofit service providers are potentially handicapped by an historic lack of relevant and necessary market-based skills. The risks necessitate an accelerated programme of skill development and skill acquisition to enable the full range of opportunities to be realised. The change management processes, identified using the conceptual framework of readiness → implementation commitment → sustainability, as discussed in this paper, highlight the potential financial consequences which have substantial impacts on such nonprofit service providers. Organisations in these settings are challenged by ongoing financial sustainability issues where very small financial margins, resulting directly from the generational business model shift from a supply-driven system to a demand-driven system, may prove the difference between organisational survival and failure.

Dance-communicated distances support nectar foraging as a supply-driven system.

Much like human consumers, honeybees adjust their behaviours based on resources' supply and demand. For both, interactions occur in fluctuating conditions. Honeybees weigh the cost of flight against the benefit of nectar and pollen, which are nutritionally distinct resources that serve different purposes: bees collect nectar continuously to build large honey stores for overwintering, but they collect pollen intermittently to build modest stores for brood production periods. Therefore, nectar foraging can be considered a supply-driven process, whereas pollen foraging is demand-driven. Here we compared the foraging distances, communicated by waggle dances and serving as a proxy for cost, for nectar and pollen in three ecologically distinct landscapes in Virginia. We found that honeybees foraged for nectar at distances 14% further than for pollen across all three sites (n = 6224 dances, p < 0.001). Specific temporal dynamics reveal that monthly nectar foraging occurs at greater distances compared with pollen foraging 85% of the time. Our results strongly suggest that honeybee foraging cost dynamics are consistent with nectar supply-driven and pollen demand-driven processes.

Determining the target groups of Hungarian short food supply chains based on consumer attitude and socio-demographic factors

Consistent with the trend witnessed in other European countries, in recent years there has been an increasing demand among Hungarian consumers for products purchased directly from farmers. However, no research has been published on the determination of clusters of consumers of short food supply chain (SFSC) products in Hungary. This study describes which groups of consumers are more likely to purchase such products, and their reasons for doing so. In the summer of 2013, 1,015 randomly-sampled adults were asked to complete questionnaires during face-to-face, on-street meetings with trained staff. The survey explored their willingness to support direct sales and production of local foods, their perceptions of product reliability, and their attitudes toward global supply-driven systems. As it was not possible to identify a clear structure of factors determining opinions, perceptions and attitudes directly from the results of the questionnaires, principal component analysis was performed, and K-mean cluster analysis was used to partition the respondents into five clusters. These were labelled 'Favouring imports and large farms, 'Favouring small farms', 'Informed and empowered consumers group in favour of local farms', 'Universally positive' and 'Unconcerneď. This method was effective in identifying groups of potential target consumers. The level of support for local foods rises with increasing age, and is higher among women, the more highly educated, those that are economically active or retired, and those that consider themselves as having an average income. The results can be used to promote the demand for SFSC products in Hungary through more effective targeting of marketing activities by farmers involved in direct selling, and their organisations.

Determining the target groups of Hungarian short food supply chains based on consumer attitude and socio-demographic factors

Consistent with the trend witnessed in other European countries, in recent years there has been an increasing demand among Hungarian consumers for products purchased directly from farmers. However, no research has been published on the determination of clusters of consumers of short food supply chain (SFSC) products in Hungary. This study describes which groups of consumers are more likely to purchase such products, and their reasons for doing so. In the summer of 2013, 1,015 randomly-sampled adults were asked to complete questionnaires during face-to-face, on-street meetings with trained staff. The survey explored their willingness to support direct sales and production of local foods, their perceptions of product reliability, and their attitudes toward global supply-driven systems. As it was not possible to identify a clear structure of factors determining opinions, perceptions and attitudes directly from the results of the questionnaires, principal component analysis was performed, and K-mean cluster analysis was used to partition the respondents into five clusters. These were labelled 'Favouring imports and large farms, 'Favouring small farms', 'Informed and empowered consumers group in favour of local farms', 'Universally positive' and 'Unconcerneď. This method was effective in identifying groups of potential target consumers. The level of support for local foods rises with increasing age, and is higher among women, the more highly educated, those that are economically active or retired, and those that consider themselves as having an average income. The results can be used to promote the demand for SFSC products in Hungary through more effective targeting of marketing activities by farmers involved in direct selling, and their organisations.

The accountable healthcare leader: Can a supply chain mindset lead the way to value-based healthcare?

Healthcare is undergoing unprecedented change as it transitions to a system that rewards the value, rather than the volume, of care delivered. The rules are changing, with new payment methodologies that levy stiff financial penalties on healthcare providers that fail to deliver quality care, along with incentives to improve efficiencies, care coordination and patient satisfaction. As the system changes, so, too, must the strategies and skill sets of those charged with leading their organisations through this disruptive conversion. The newly released final rule on Comprehensive Care for Joint Replacement Model provides insight into the changing nature of healthcare reform under bundled payment programmes and can be used to assess the kinds of leadership strategies and skills that will be needed to succeed in a value-based healthcare market. Hospital leaders will be measured on their ability to improve collaboration and coordination across internal functions and with outside partners whose financial and clinical performance will have a real impact on hospital reimbursement. This level of coordination will require investments in underlying technology and care coordination to link financial expenditures and process improvements with outcomes data. To achieve these fundamental objectives, healthcare executives can learn from essential traits of leaders in iconic firms outside of healthcare, from Tesla to Netflix, the application of design thinking and open innovation, and a supply chain mindset that organises care around the demand – the patient – in contrast to a more traditional supply-driven system that is focused primarily on hospitals and physicians.

Shifting From Volume to Value: Opportunities and Challenges for the Field of Orthopaedic Surgery.

Shifting From Volume to Value: Opportunities and Challenges for the Field of Orthopaedic Surgery.

A value-based, no-cost-to-patient health model in the developing world: Critical appraisal of a unique patient-centric neurosurgery unit.

Background:It is well-accepted that the current healthcare scenario worldwide is due for a radical change, given that it is fraught with mounting costs and varying quality. Various modifications in health policies have been instituted toward this end. An alternative model, the low-cost, value-based health model, focuses on maximizing value for patients by moving away from a physician-centered, supply-driven system to a patient-centered system.Methods:The authors discuss the successful inception, functioning, sustainability, and replicability of a novel health model in neurosurgery built and sustained by inspired humanitarianism and that provides all treatment at no cost to the patients irrespective of their socioeconomic strata, color or creed.Results:The Sri Sathya Sai Institute of Higher Medical Sciences (SSSIHMS) at Whitefield, Bengaluru, India, a private charitable hospital established in 2001, functions on the ideals of providing free state-of-the-art healthcare to all in a compassionate and holistic manner. With modern equipment and respectable outcome benchmarks, its neurosurgery unit has operated on around 18,000 patients since its inception, and as such, has contributed INR 5310 million (USD 88.5 million) to society from an economic standpoint.Conclusions:The inception and sustainability of the SSSIHMS model are based on self-perpetuating philanthropy, a cost-conscious culture and the dissemination of human values. Replicated worldwide, at least in the developing nations, this unique healthcare model may well change the face of healthcare economics.

Is there a business case for quality in The Netherlands?: A critical analysis of the recent reforms of the health care system

Major reforms of the health insurance system and reimbursement systems for care providers are currently taking place in The Netherlands. These market-oriented health care reforms will transform the current central supply-driven system to a system of managed competition both among health care insurers and care providers. The reforms are not systematically linked to the discussions about quality of care and together with consumers who might be more interested in lower premiums; they offer almost no incentive for health care insurers and providers to steer on quality. Dutch policy makers should, therefore, be more explicit whether competition should take place on quality or price, and if the former is the case, additional incentives as part of the system reforms, are needed to create a business case for quality.