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Purpose – To identify the key success factors in a change process and to demonstrate how adherence to the phases of large-scale change contributed to the successful reform of the Irish cancer services and is critical to the sustainability of this large-scale change.

Design – In-depth retrospective analytical case study drawing from face- to-face semi-structured interviews with key stakeholders and players.

Findings – The Irish health care reform had been continually thwarted by local politics. The Irish government confronted this trend by bringing in an outside expert to head the cancer services reform project who, with government support, managed both clinician and public resistance and, based on the evidence of international best practice, led the reform. Sustainable change was achieved by attention to how large-scale change works. The leadership of the project is an important element in overcoming the path dependency that is dogged in most health care reforms.

Value – This chapter provides evidence that the four key phases of large system change: understanding the need for change, framing the change, undertaking the change and sustaining the change, coupled with key success factors in relation to timing, financial viability, political will and leadership, public support, well-managed process, and technical infrastructure and capacity are critical to the implementation and sustainability of large-scale change.

Primary care cancer lead clinicians (PCCLs) act strategically in primary care trusts (PCTs) in England to improve communication and understanding of cancer across primary and secondary care and provide a link between Cancer Networks and primary care. The aim is to evaluate the first three years of the initiative.

A postal questionnaire was sent to all PCT chief executives in all PCTs in England and some were passed on to other PCT managers for completion. The response rate was 61 per cent. PCT directors of public health were the largest group of respondents (29 per cent). Most (74 per cent) PCCLs were GPs and 22 per cent were nurses.

PCCLs were most likely to focus on palliative care and preventive services. Key achievements were identified as raising awareness of cancer, developing relationships and promoting primary care. The personal skills of the PCCLs were important as was support of colleagues at all levels. Lack of time was a major barrier to achievement, as was a lack of understanding of the role from others. Links with the Cancer Networks were being developed. About 85 per cent of managers wanted the role to continue.

The paper illustrates that PCCLs are at the forefront of improving cancer services in primary care. They are particularly important in view of the priority of reducing premature deaths and promotion of healthy lifestyles.

This paper aims to develop a conceptual framework that clarifies the social supportive role of cancer resource center services in the lives of men with cancer and its impact on their perceived quality of life.

Personal reflections.

The authors put forth a conceptual framework which shows that men with cancer may perceive the availability of four types of social support from others present in a cancer resource center. The perceived availability of social support is posited to enhance their perceptions of their quality of life.

The study yields propositions that may be empirically tested by services and health researchers in future studies. In addition, the research findings may not extend to terminally ill male cancer patients.

Given the health benefits associated with social support, health-care professionals, social workers and cancer center directors should encourage their male cancer patients to participate in cancer resource programing and activities.

Cancer resource centers offer male cancer patients opportunities to enhance their quality of life beyond the use of pharmaceutical drugs or professional medical treatment. The health benefits may lower costs associated with medical expenses.

This study contributes to an emerging paradigm in services marketing. It is one of the first papers to focus on the socially supportive role that cancer resource center services may assume in the lives of men with cancer and those surviving the disease.

The purpose of this paper is to provide suggestions regarding how cancer resource center directors, staff and volunteers may encourage men battling cancer, as well as male cancer survivors, to patronize cancer resource centers and to participate in center services.

This paper provides a personal viewpoint based on research and on the author’s managerial experiences with cancer resource center services, including planning services and programming.

This paper offers cancer resource center directors suggestions regarding how they can attract male cancer patients to their organizations and encourage their participation in center services.

No limitations were identified.

This paper provides possible strategies for overcoming barriers to access to cancer resource centers in the male cancer-survivor population.

Given the medical costs associated with cancer care, encouraging men with cancer to actively participate in cancer resource center programming, which profoundly influences their physical, mental, social and spiritual well-being, can yield many societal benefits.

Cancer resource centers desire to be inclusive of all cancer patients, regardless of gender; however, these centers tend to be disproportionally patronized by women with cancer. This viewpoint addresses how this problem may be addressed via service enhancement, service programming and service design to encourage greater usage by men.

Introducing change is a difficult issue facing all health care systems. The use of various clinical governance levers can facilitate change in health care systems. The purpose of this paper is to define clinical governance levers, and to illustrate their use in a large-scale transformation.

The empirical analysis deals with the in-depth study of a specific case, which is the organizational model for Ontario’s cancer sector. The authors used a qualitative research strategy and drew the data from three sources: semi-structured interviews, analysis of documents, and non-participative observations.

From the results, the authors identified three phases and several steps in the reform of cancer services in this province. The authors conclude that a combination of clinical governance levers was used to transform the system. These levers operated at different levels of the system to meet the targeted objectives.

To exercise clinical governance, managers need to acquire new competencies. Mobilizing clinical governance levers requires in-depth understanding of the role and scope of clinical governance levers.

This study provides a better understanding of clinical governance levers. Clinical governance levers are used to implement an organizational environment that is conducive to developing clinical practice, as well as to act directly on practices to improve quality of care.

The National Health Service Breast Screening Programme set up 20 years ago in the UK has to evolve continuously to meet changing needs as a result of fundamental transformations in the age and ethnic profile of the population. This article draws on evidence generated as part of the Healthcare Commission's national study aimed at identifying issues that may contribute to different groups not having equal access to, experience of, or outcomes from services relating to breast screening and breast cancer treatment. Findings indicate that ethnicity has an effect on the awareness of services and of breast cancer. Access to screening and the experience of screening and treatment are influenced by the interaction of ethnicity with age. Younger women from certain black and minority ethnic groups face particular barriers. There can be additional barriers experienced by those from linguistic minorities. Equality of access, experience and outcomes does not mean treating everyone the same way.

The purpose of this paper is to explore the type of personalisation services satisfying the needs of cancer websites’ target users, and the influence of their emotional states on website usage intentions.

Three data collection methods were employed. Survey questionnaires were distributed to online health users. Interviews with representatives of the cancer-affected population further explored emotions as stimuli for online cancer-related activities. Finally, availability of personalisation features was evaluated on existing health websites in Bosnia and Herzegovina and the UK.

A clear preference emerged for personalisation on cancer-related websites. There are specific personalisation features the cancer-affected population desires. Interestingly, certain emotions were found to stimulate visits to health websites.

Fighting cancer implies constant support, including from cancer-related websites. It is thus vital to understand the required personalisation, stemming from target users’ actual needs, including the neglected user characteristics, as are emotions for cancer-affected people. This supports emotion-based personalisation.

The paper focusses on the cancer-affected population, and developing a comprehensive understanding of their personalisation needs in online health services. It further shows which emotions influence intentions to use cancer websites. The three concepts combined have not yet been studied, to the best of the authors’ knowledge.

The purpose of this paper is to investigate the role of masculine identity in generating value destruction and diminished well-being in a preventative health service.

This research used five focus groups with 39 Australian men aged between 50 and 74 years. Men’s participation in the National Bowel Cancer Screening Program informed the sample frame. In total, 12 Jungian male archetypes were used to identify different masculine identities.

Thematic analysis of the data revealed three themes of masculinity that explain why men destroy value by avoiding the use of a preventative health services including: rejection of the service reduces consumer disempowerment and emasculation, active rejection of resources creates positive agency and suppressing negative self-conscious emotions protects the self.

Limitations include the single context of bowel cancer screening. Future research could investigate value destruction in other preventative health contexts such as testicular cancer screening, sexual health screening and drug abuse.

Practical implications include fostering consumer empowerment when accessing services, developing consumer resources to create positive agency and boosting positive self-conscious emotions by promoting positive social norms.

This research is the first known study to explore how value is destroyed in men’s preventative health using the perspective of gender identity. This research also is the first to explore value destruction as an emotion regulation strategy.

Many individuals are concurrently eligible for multiple sources of government-reimbursed health care services (e.g. Department of Veterans Affairs (VA) and Medicare). Unclear is whether combined eligibility translates into increased access to care and/or improved outcomes of care. Alternatively continuity of care may suffer, promoting health inequalities when patients receive health services from multiple unrelated sources of care. The current study examines the impact of dual eligibility for government-reimbursed care on long-term outcomes of care for a population of veterans diagnosed with colorectal cancer and initially treated surgically at Department of Veterans Affairs Medical Centers.

Facilitating user involvement is regarded as a significant factor in advancing the overall quality of health care provision. The wish to develop user involvement is present in White Papers, government reports and policy guidance. The reform of cancer services consequent on the implementation of the Calman Hine Report creates opportunities for meaningful user involvement in cancer care. Draws on research conducted in the Trent Region of the NHS and examines how far user groups have been involved, which groups may be excluded and what remains to be done to elevate user views in planning and evaluation of cancer services. Many commissioners and providers of health care are currently establishing the infrastructure to encourage the development of user involvement. Suggests the experience in relation to cancer can offer a model for others.