Stakeholder collaboration in long-term care of older people in Lithuania

Demographic situation, changes in the role of women in society and growing demand for long-term care (LTC) of older people have challenged the ability to meet the growing LTC needs in most developed countries. In countries where responsibility for LTC is still largely laid on families, it is, however, even more critical and calls for improvements in formal LTC systems. More intensive stakeholder collaboration in LTC policy development, organising and delivery are of primary importance in improving LTC systems. Such collaboration, however, is not always successful; thus, it is critical to understand what makes it effective and efficient. In this paper, we specifically look into multistakeholder collaboration in LTC in Lithuania, one of the fastest ageing countries in the EU, with the demand for LTC services growing fast and exceeding the supply despite rising business and NGO engagement. To determine facilitators of such collaboration, we build on the data obtained through eight focus group discussions with all key stakeholder representatives (LTC policymakers, organisers and service providers [public, private and NGOs], 54 participants in total). Our findings indicate that in addition to national and organisational level facilitators studied in prior research, there are important individual level factors, such as meaningfulness at work, concern and care for others, possibility for personal growth and development, satisfaction with supervision, a sense of belonging and role clarity. On the other hand, our results show that collaboration is constrained by a shortage of human resources, increased workload caused by growing LTC demand, bureaucratic requirements, legal restrictions, lack of awareness of LTC service availability among elder persons, and prevailing social norms and attitudes to institutionalised care. Interestingly, a lack of financial resources is not perceived as a major constraint.     

Methods for Early Assessment of the Societal Value of Health Technologies: A Scoping Review and Proposal for Classification

ObjectivesEarly assessments of health technologies help to better align and integrate their development and assessment. Such assessments can take many forms and serve different purposes, hampering users in their selection of the most appropriate method for a specific goal. The aim of this scoping review was to structure the large set of methods according to their specific goal.MethodsA scoping review was conducted using PubMed and reference lists of retrieved articles, to identify review studies with a methodological focus. From the included reviews, all individual methods were listed. Based on additional literature and examples, we extracted the specific goal of each method. All goals were clustered to derive a set of subclasses and methods were grouped into these subclasses.ResultsOf the 404 screened, 5 reviews were included, and 1 was added when searching reference lists. The reviews described 56 methods, of which 43 (77%) were included and classified as methods to (1) explore the nature and magnitude of the problem, (2) estimate the nature and magnitude of the expected (societal) value, (3) identify conditions for the potential value to materialize, and (4) help develop and design the type of research that is needed.ConclusionsThe wide range of methods for exploring the societal value of health technologies at an early stage of development can be subdivided into a limited number of classes, distinguishing methods according to their specific objective. This facilitates selection of appropriate methods, depending on the specific needs and aims.     

利益相关者视角下的远程医疗发展策略研究

远程医疗是一个多维的、复杂的系统,它涉及众多不同利益主体,包括政府、各级卫生行政部门、医院、医生、患者和软硬件企业等。结合远程医疗的特点,依据利益相关者理论,首先将远程医疗利益相关者进行分类,然后分析他们的利益诉求,最后提出促进远程医疗发展的有效策略。     

县级公立医院补偿机制改革利益相关者的行为分析

以利益相关者理论为基础,通过对县级公立医院补偿机制改革利益相关者的行为分析,从目标函数、动力机制、约束机制和道德风险的角度构建利益相关者的一般均衡模型。模型表明,政策的价值取向以及政府的投入、监管等方面的责任是县级公立医院补偿机制帕累托改进的关键因素。     

我国医疗机构分类管理政策实施进展评估

文章介绍了医疗机构分类管理政策的背景、目标及主要内容,并对政策的执行情况进行了评估。同时,在分析了社会各界对政策不同反应的基础上,借鉴国外相关改革及我国教育部门改革的经验,提出了进一步落实分类管理政策的建议。     

基于利益相关者理论的医生激励机制构建

利益相关者分析作为一种新的理论,已经广泛应用于西方国家的企业管理与卫生政策改革研究与实践中,并取得了初步成效。在介绍该理论的基础上,针对我国现行医生激励机制的局限性,从利益相关者分析这一新的视角,探讨医生激励机制构建的新思路。     

Engaging Stakeholders in Review and Recommendations for Models of Outcome Monitoring for Substance Abuse Treatment

We present an example of a collaborative process designed to review models of outcome monitoring for substance abuse services, with a view to assessing the feasibility of different approaches in Ontario, Canada. A conceptual framework that describes the parameters of an outcome monitoring system and four models of outcome monitoring were identified. Consultations were held with stakeholders (managers, directors, researchers, clinicians, and governmental representatives) about the types of information they would like to obtain from an outcome monitoring system. Our process is useful as a model for collaborative research with respect to performance measurement. The study's implications and limitations are noted.     

Trustworthiness of information about blood donation and transfusion in relation to knowledge and perceptions of risk: an analysis of UK stakeholder groups

Summary. There is evidence that the public perceive blood transfusion as risky, and there is a growing literature exploring factors associated with perceived transfusion risk. One contributory factor might be the types of information different key stakeholders (e.g. general practitioners, anaesthetists, health/life style journalists and blood donors) rely on for information. This article addresses four unanswered questions about transfusion/donation risk, namely (1) do different stakeholder groups perceive different sources of information as more or less trustworthy, (2) to what extent is the perceived trustworthiness related to levels of knowledge and perceived risk, (3) is optimistic bias observed across the stakeholder groups, and (4) is knowledge related to levels of perceived risk across the stakeholder groups? A questionnaire survey was used to assess the trustworthiness of sources of information, perceived risk and knowledge. Four stakeholder groups were examined, namely (1) blood donors (n = 250), (2) general practitioners (n = 88), (3) anaesthetists (n = 143) and (4) medical journalists (n = 20). The results showed that (1) judgements of trustworthiness vary as a function of stakeholder groups, and (2) it is what people think they know rather than what they actually know that is related to judgements of trustworthiness and perceptions of risk. Judgements of trustworthiness are generally unrelated to perceptions of risk, and all stakeholder groups show optimistic bias. The implications of these findings for risk communication, specifically relating to transfusion medicine, are discussed.