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The Patient-Centered Medical Home (PCMH) has become a dominant model of primary care re-design. This transformation presents a challenge to many care delivery organizations. The purpose of this paper is to describe attributes shaping successful and unsuccessful practice transformation within four medical practice groups.

As part of a larger study of 25 practices transitioning into a PCMH, the current study focused on diabetes care and identified high- and low-improvement medical practices in terms of quantitative patient measures of glycosylated hemoglobin and qualitative assessments of practice performance. A subset of the top two high-improvement and bottom two low-improvement practices were identified as comparison groups. Semi-structured interviews were conducted with diverse personnel at these practices to investigate their experiences with practice transformation and data were analyzed using analytic induction.

Results show a variety of key attributes facilitating more successful PCMH transformation, such as empanelment, shared goals and regular meetings, and a clear understanding of PCMH transformation purposes, goals, and benefits, providing care/case management services, and facilitating patient reminders. Several barriers also exist to successful transformation, such as low levels of resources to handle financial expense, lack of understanding PCMH transformation purposes, goals, and benefits, inadequate training and management of technology, and low team cohesion.

Few studies qualitatively compare and contrast high and low performing practices to illuminate the experience of practice transformation. These findings highlight the experience of organizational members and their challenges in practice transformation while providing quality diabetes care.

The aim of this paper is to gain knowledge in podcast mining as an additional source for Web-based horizon scanning (HS). The paper presents theoretical insights on the potential of podcast mining by exploring topics, which may be relevant in the future, and by reflecting the results against a background of HS approaches. The study provides a preliminary overview by presenting an exemplary list of podcast shows for further research.

The paper uses an exploratory quantitative content analysis, which was conducted on the basis of 30 topics deemed to be relevant in the future and which were identified in the field of applied science. Based on these topics, podcasts and episodes were identified which address future-oriented topics and were discussed in terms of range of content.

The findings indicate that future-oriented topics are addressed in podcasts. However, differences in dynamics and range of content of the podcasts concerned highlight the necessity of identifying a list of suitable podcasts according to the specific scanning focus and the dynamics of each future-oriented topics.

While a growing number of podcast studies have already noted the importance of podcasts as a key medium, for example, educational processes and media sciences, no detailed explanation of podcast mining as a tool for the purposes of HS has been published. The review therefore makes an original contribution to this field, highlighting areas where future research is needed.

In the context of organizational change, identifying, and organizing the various roles of change agents remains a challenge for practitioners and scholars alike. This chapter examines how different agents can enable an effective change process. Empirical evidence from three hospitals illustrates the process of transformation and its underlying arrangements to identify agents and their roles. The findings underline the importance of designing a coherent system of agents, determining where they come from, their role during the process, and how this may change throughout the change process. Managerial choices in the cases are discussed, leading to implications for theory and practice.

What is our unit of analysis and by implication what are the boundaries of our cases? This is a question we grapple with at the start of every new project. We observe that case studies are often referred to in an unreflective manner and are often conflated with geographical location. Neat units of analysis and clearly bounded cases usually do not reflect the messiness encountered during qualitative fieldwork. Others have puzzled over these questions. We briefly discuss work to problematise the use of households as units of analysis in the context of apartheid South Africa and then consider work of other anthropologists engaged in multi-site ethnography. We have found the notion of ‘following’ chains, paths and threads across sites to be particularly insightful.

We present two examples from our work studying commissioning in the English National Health Service (NHS) to illustrate our struggles with case studies. The first is a study of Practice-based Commissioning groups and the second is a study of the early workings of Clinical Commissioning Groups. In both instances we show how ideas of what constituted our unit of analysis and the boundaries of our cases became less clear as our research progressed. We also discuss pressures we experienced to add more case studies to our projects. These examples illustrate the primacy for us of understanding interactions between place, local history and rapidly developing policy initiatives. Understanding cases in this way can be challenging in a context where research funders hold different views of what constitutes a case.

A workstation‐based system for materials planning is intended to complement a host‐based materials‐planning system, thereby leading to a multi‐level system that combines fully detailed planning procedures with “aggregate” decision support capabilities. Planning objects as well as planning procedures are formulated within the relational database frame‐work. By that means, at execution time the database management system guarantees processing efficiency as well as consistency control. After a short characterisation of the state‐of‐the‐art of database utilisation in conventional materials planning, a set of requirements which have to be met by the proposed approach is formulated. Based on this, the suitability of the relational database model as a framework for multi‐stage materials planning is discussed. In particular, the integration of abstraction hierarchies is emphasised and hierarchical planning procedures adopted from artificial intelligence are integrated into the concept. Some examples adopted from a prototype show that, at least for simple planning problems, it is possible to achieve end‐user support at any level of detail when using a relational database system for materials planning.

When introducing new health technologies, decision makers must integrate research evidence with local operational management information to guide decisions about whether and under what conditions the technology will be used. Multi‐criteria decision analysis can support the adoption or prioritization of health interventions by using criteria to explicitly articulate the health organization's needs, limitations, and values in addition to evaluating evidence for safety and effectiveness. This paper seeks to describe the development of a framework to create agreed‐upon criteria and decision tools to enhance a pre‐existing local health technology assessment (HTA) decision support program.

The authors compiled a list of published criteria from the literature, consulted with experts to refine the criteria list, and used a modified Delphi process with a group of key stakeholders to review, modify, and validate each criterion. In a workshop setting, the criteria were used to create decision tools.

A set of user‐validated criteria for new health technology evaluation and adoption was developed and integrated into the local HTA decision support program. Technology evaluation and decision guideline tools were created using these criteria to ensure that the decision process is systematic, consistent, and transparent.

This framework can be used by others to develop decision‐making criteria and tools to enhance similar technology adoption programs.

The development of clear, user‐validated criteria for evaluating new technologies adds a critical element to improve decision‐making on technology adoption, and the decision tools ensure consistency, transparency, and real‐world relevance.

This paper considers the role and process of the formation and development of a social network in the furtherance of rural small business. The paper's contribution is in enhancing our knowledge about the social aspects of rural networking. The study uses a qualitative approach of data collection involving participant observation and interviews to build a full picture of the networking activities of two competing olive oil producers based in a small village in Greece. The data were analysed by comparative analysis to show that for both cases networking is primarily a social activity. Networking practices involved becoming embedded in the community, building a reputation for usefulness and establishing trust. It was noted that the entrepreneurs both focused on linking activities by using their position within the rural network to establish useful further external linkages.

The authors surveyed city administrators in the six-county Chicago region to test an innovation management capacity process model. Innovation management capacity is conceptualized as the function of council-staff functionality, managerial leadership capacity, and staff team management. The empirical results from 220 city administrators in 53 cities support the hypothesis that the number of municipal innovations is positively correlated with innovation management capacity, controlling for structural, socioeconomic, and demographic variables. However, this study does not find a statistical relationship between innovation effectiveness and innovation management capacity. The authors posit two possible explanations for these results and propose an alternative innovation management capacity process model for testing in future research.

Purpose – The chapter aims to understand what kind of policy approach has been more successful in facilitating the involvement of patients and the public in the design and provision of health-care services at the local level and the explanatory factors justifying the implementation outcome.Methodology – By applying Richard Matland's ambiguity/conflict policy implementation model, the chapter analyses the impact of a number of policies introduced after 1997 in the English National Health Service that targeted final users and the local population in decision-making processes.Findings – The evidence shows that policies emphasising the importance of context-specific contingencies can be more effectively implemented when room for interpretation and discretion in selecting the appropriate means for involvement is given. In this way, the overall aims/purposes of health policies can be locally reshaped by allowing the adoption of flexible strategies within the implementation process.Practical implications – A strong leadership at the top of public sector organisations and, in particular, from the board of directors is needed to steer and facilitate a consensus oriented outcome in organisational decision-making processes that aim to incorporate the views and opinions of patients and the public.Social implications – Local initiatives in increasing participation, for specific purposes, are bound to be more successful than a general initiative, expecting comparatively uniform implementation.