IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v206y2018icp100-109.html
   My bibliography  Save this article

A realist evaluation of value-based care delivery in home care: The influence of actors, autonomy and accountability

Author

Listed:
  • Dainty, Katie N.
  • Golden, Brian R.
  • Hannam, Rosemary
  • Webster, Fiona
  • Browne, Gina
  • Mittmann, Nicole
  • Stern, Anita
  • Zwarenstein, Merrick

Abstract

The increasing demand for home care is occurring in tandem with the need for governments to contain health care costs, maximize appropriate resource utilization and respond to patient preferences for where they receive care. We describe the evaluation of the Integrated Client Care Project (ICCP), a government funded project designed to improve value for outcomes for patients referred to community wound care services in Ontario, Canada. We applied a realist evaluation methodology in order to unpack the influences of contextual and mechanistic choices on the intended outcomes of the ICCP implementation. We collected data through ethnographic methods including 36 months of field observation, 46 key informant interviews and contemporaneous document analysis. The findings presented here highlight how theoretical mechanisms were negatively impacted by strong contextual patterns and weak implementation which led to underwhelming outcomes. Autonomy of the participant organizations, lack of power within the implementation team to drive change, opacity of the goals of the program, and disregard for the impact of complex historical relations within the home care sector compounded to undermine the intended outcome.

Suggested Citation

  • Dainty, Katie N. & Golden, Brian R. & Hannam, Rosemary & Webster, Fiona & Browne, Gina & Mittmann, Nicole & Stern, Anita & Zwarenstein, Merrick, 2018. "A realist evaluation of value-based care delivery in home care: The influence of actors, autonomy and accountability," Social Science & Medicine, Elsevier, vol. 206(C), pages 100-109.
  • Handle: RePEc:eee:socmed:v:206:y:2018:i:c:p:100-109
    DOI: 10.1016/j.socscimed.2018.04.006
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953618301655
    Download Restriction: Full text for ScienceDirect subscribers only

    File URL: https://libkey.io/10.1016/j.socscimed.2018.04.006?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Macfarlane, Fraser & Barton-Sweeney, Cathy & Woodard, Fran & Greenhalgh, Trisha, 2013. "Achieving and sustaining profound institutional change in healthcare: Case study using neo-institutional theory," Social Science & Medicine, Elsevier, vol. 80(C), pages 10-18.
    2. Randall, Glen E. & Williams, A. Paul, 2006. "Exploring limits to market-based reform: Managed competition and rehabilitation home care services in Ontario," Social Science & Medicine, Elsevier, vol. 62(7), pages 1594-1604, April.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Renmans, Dimitri & Castellano Pleguezuelo, Virginia, 2023. "Methods in realist evaluation: A mapping review," Evaluation and Program Planning, Elsevier, vol. 97(C).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Mæhle, Per Magnus & Smeland, Sigbjørn, 2021. "Implementing cancer patient pathways in Scandinavia how structuring might affect the acceptance of a politically imposed reform," Health Policy, Elsevier, vol. 125(10), pages 1340-1350.
    2. Mohammad Ta'Amnha, 2020. "Institutionalizing the Employer Brand in Entrepreneurial Enterprises," International Journal of Economics and Financial Issues, Econjournals, vol. 10(6), pages 183-193.
    3. Sheard, Laura & Marsh, Claire & O'Hara, Jane & Armitage, Gerry & Wright, John & Lawton, Rebecca, 2017. "The Patient Feedback Response Framework – Understanding why UK hospital staff find it difficult to make improvements based on patient feedback: A qualitative study," Social Science & Medicine, Elsevier, vol. 178(C), pages 19-27.
    4. Denicolai, Stefano & Previtali, Pietro, 2023. "Innovation strategy and digital transformation execution in healthcare: The role of the general manager," Technovation, Elsevier, vol. 121(C).
    5. Ning Liu & Zhuo Chen & Guoxian Bao, 2021. "Unpacking the red packets: institution and informal payments in healthcare in China," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(8), pages 1183-1194, November.
    6. Maura Campra & Paolo Esposito & Valerio Brescia, 2023. "Corporate social responsibility and technological perspectives in healthcare: An exploratory analysis of the evolution of the anti‐corruption system through multiple case studies," Corporate Social Responsibility and Environmental Management, John Wiley & Sons, vol. 30(6), pages 2816-2829, November.
    7. Skinner, Mark W. & Rosenberg, Mark W., 2006. "Managing competition in the countryside: Non-profit and for-profit perceptions of long-term care in rural Ontario," Social Science & Medicine, Elsevier, vol. 63(11), pages 2864-2876, December.
    8. Amadeo Fuenmayor & Rafael Granell & María Angeles Tortosa, 2016. "Quasi-markets Targets and the Evaluation of Nursing-home Funding in the Valencian Region," Hacienda Pública Española / Review of Public Economics, IEF, vol. 216(1), pages 13-38, March.
    9. Per Magnus Mæhle & Senada Hajdarevic & Erna Håland & Rikke Aarhus & Sigbjørn Smeland & Bjørn Erik Mørk, 2021. "Exploring the triggering process of a cancer care reform in three Scandinavian countries," International Journal of Health Planning and Management, Wiley Blackwell, vol. 36(6), pages 2231-2247, November.
    10. Petsoulas, Christina & Allen, Pauline & Hughes, David & Vincent-Jones, Peter & Roberts, Jennifer, 2011. "The use of standard contracts in the English National Health Service: A case study analysis," Social Science & Medicine, Elsevier, vol. 73(2), pages 185-192, July.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:206:y:2018:i:c:p:100-109. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.