⌛ Literature Review On Distributed Leadership

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Literature Review On Distributed Leadership

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Distributed Leadership In A Nutshell

Rural patients that traveled further for cervical cancer treatment were no more likely to experience delayed diagnosis until an advanced stage, reduced overall survival, greater progression risk, nor longer treatment [ 45 ]. Primary care clinicians also may function as specialists due to necessity in underserved settings, such as for rural dwelling children with special health needs [ 40 ] and rural dwelling veterans with HIV [ 41 ].

However, primary care clinicians are already resource constrained with long appointment wait times reported through the US [ 98 ], and they unlikely possess the training necessary to manage all specialty care needs locally [ 1 , 8 ]. Due to long travel distances, several remote primary care facilities offer integrated behavioral healthcare [ 70 ] or telemedicine services such as ophthalmologic eye screening [ 30 ] or telerheumatology [ 57 ].

Unfortunately, further insurance and policy changes are warranted as regulatory implications and reimbursement limitations still persist throughout much of the US [ 99 , ]. Third, several new themes that impact access were identified that may be important to integrate into conceptual frameworks for improving our understanding of care access. Government and insurance policies may facilitate or restrict access through training resource allocation [ 86 ], financial incentives [ 87 ], insurance policy [ 61 , 64 ], reimbursement [ 64 , 72 ], legislation [ 66 , 72 , 87 , 88 ], malpractice [ 64 , 89 ], and increased government oversight [ 89 ].

Health organization and operations influence may include organizational culture or leadership [ 72 ], process and performance initiatives [ 90 , 91 ], specialist recruitment strategies [ 91 , 92 ], strategic geographic location [ 33 ], insurance acceptance [ 33 ], and decisions regarding offered specialty services [ 93 ]. Patient perceived stigma with a medical condition or service [ 55 , 66 , 71 , 75 , 93 ] and clinician directed patient discrimination [ 64 ] also were identified barriers. Finally, primary care and specialty clinicians themselves were found to influence access [ 40 ].

Although our findings generally support those of Levesque et al. In particular, the four new identified themes government and insurance policy, health organization and operations influence, stigma, primary care and specialist influence may occur beyond the system-supply and patient-demand dimensions in the manner portrayed by the social ecological hierarchical model [ 21 ] shown in Fig. This adapted conceptual framework may help to further inform future research to address care access barriers. This study has several limitations. The systematic review was limited to articles in five electronic databases published within the past five-and-a-half-years since Levesque et al. Since only peer reviewed journal publications were considered, important findings in grey literature or conference proceedings may have been missed.

Our interest in urban and rural specialty care access may have biased us towards disproportionately identifying geographic barriers. Additionally, since the geographic focus of each article was determined by its respective author s , this may have resulted in some definition inconsistencies. While insurance is one variable that affects healthcare access, our search strategy did not include specific coverage differences; thus we were unable to identify differences between Medicaid enrollees and those with private insurance. Although a prior conceptual framework was used to organize our findings, results did not always fit clearly into one or more of its dimensions; distinguishing between system-centric supply and patient-centric demand variables also was challenging in some cases e.

Access to specialty care is an important and ubiquitous problem, with insufficient capacity or time delays having direct implications on health outcomes, mortality, and morbidity. As shown in the literature, causes are broad and complex, with both similarities and differences between urban and rural facilitators and barriers. Results of this systematic literature review can help researchers, policy makers, and practitioners effectively focus on important issues and needs. Since many of these interconnected issues and dynamics occur across several domains, breakthrough improvements will necessitate multi-disciplinary research that address them holistically as a system rather than individually in isolation.

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Senate and House of Representatives. Healthcare Research and Quality Act of ; Google Scholar. The dermatology work force: a focus on urban versus rural wait times. Where we live: health care in rural vs urban America. Healthy People Office of Disease Prevention and Health Promotion. Published Accessed 29 June Aday LA, Andersen R. A framework for the study of access to medical care. Health Serv Res. Penchansky R, Thomas JW. The concept of access: definition and relationship to consumer satisfaction. Med Care. Rural definitions for health policy and research.

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JAMA Psychiatry. Community pharmacies as access points for addiction treatment. Res Soc Adm Pharm. Assessing differences in the availability of opioid addiction therapy options: rural versus urban and American Indian reservation versus nonreservation. J Rural Health. Factors associated with high-risk rural women giving birth in non-NICU hospital settings.

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Structural barriers to comprehensive, coordinated HIV care: geographic accessibility in the US south. AIDS Care. Optimizing telehealth strategies for subspecialty care: recommendations from rural pediatricians. Telemed eHealth. An optimization framework for measuring spatial access over healthcare networks. Guerrero EG, Kao D. Subst Abuse Treat Prev Policy. Disparities in access to emergency general surgery care in the United States.

Surg United States. The associations between race and geographic area and quality-of-care indicators in patients approaching ESRD. Clin J Am Soc Nephrol. Improving access to stroke care in the rural setting: the journey to acute stroke ready designation. J Emerg Nurs. Telemental health evaluations enhance access and efficiency in a critical access hospital emergency department. Telemed e-Health. Womens Health Issues. Study areas — Problems identified Strategic approaches 26 Purpose of the organization long-term objectives, action programs, and resource allocation.

Strategic creation and organizational structures 52 Analysis of the organizational environment action and competitiveness plans and authority hierarchy responsibilities and objectives. Strategy formulation 32 Detection of the strategic GAP scope of organizational objectives. Strategic evaluation 37 Measurement of impact strategic planning. Table 1. Table 2. Table 3. Empirical evidence: strategic regulations to indicate better strategic solutions.

Adjustment or adequacy organizational: alternatives organizational design, human resources policy, management style, and organizational culture for adjustment and strategic adaptation. Table 4. Classification of investigations—strategic approaches area. Structures Advantages Disadvantages Linear: companies which dedicate to produce one or few products in a specific market, generally the owner and the manager is the same person Allows to gather several experts in a team; helps to mitigate conflicts between areas; increases motivation and commitment; it is oriented towards final results; identification of responsibilities of each boss; and it is fast and dynamic, low cost, close relationship with subordinates.

Rigid and inflexible; lack of flexibility to adapt to the growth of the company; indispensable hierarchy levels and difficult to replace if it is necessary; and little specialization of staff due to the fact that they are derived to several duties. Matrix: grouping of materials and human resources available in projects, creating teams with members of various areas looking for a common objective. The employees within the matrix have two bosses; a boss of function and the boss of the project Allows to gather various experts in a team; helps to mitigate conflicts between areas; increases motivation and commitment; improves flexibility and communication, coordination and communication; identification of responsibilities of each boss; allows more efficiency in the use of resources.

Not all the companies can apply it; it requires a lot of balance, capital, coordination, and processing of information; conflict of authority; possibility of disunity between the command; stress among their members; high bureaucratic and operation costs; requires an effective manager in human relations; and scarce definition of priorities and use of resources. By departmentalization: works through the departments with different functions. Circular: the authority levels are concentric integrated by a central square around which are the subordinates. In each one of these circles, are placed the immediate bosses and are linked to the lines that represent the channels of authority and responsibilities.

Points very well the importance of the hierarchic levels; eliminate or decrease the idea of the level of status; and allow more number of positions by level. Sometimes the organization chart can be confusing and difficult to read; difficulty adding levels where there is only one official and force the levels too much. Hybrid: this structure gathers some of the important characteristics of the previous structures. Combines the characteristics of diverse approaches adapting them to the strategic specific needs and using the advantages of the different structures.

This type of structuring is mainly used when companies grow and have several products and markets. Facilitates adaptability and effectiveness inside the divisions of products and efficiency in the functional departments; good alignment between product and corporative objectives; and effective coordination of divisions, department and zones. Accumulation of corporative personnel to supervise divisions; generation of indirect administrative costs; loss of approach in the market and conflicts between the corporative personnel and the divisional. Monofunctional: the authority concentrates in one person or group of persons who make decisions. Low maintenance cost; clear accounting; management; head of production; and supervision.

Need of a good manager; little planning; little control and without operative levels. Hierarchic: also known as functional departmentalization, represents the structural organization. Well-defined chain of command; defined patterns of advance; staff specialization; general manager; manager assistant; submanagers; heads; and supervisors. Few flexibility; communication barriers; and organizational disunity. Approach of the senior managers in key decisions and training of low level managers.

High level of bad decision making by the managers and little control of senior managers. Not pyramidal: are based on matrices that start vertically from the authority and the horizontal line of responsibility on a specific project; in the intersection of the lines, it gives a contribution or support of a functional character. Delegation of responsibilities to the employees; improves their motivation; decision making by the people with greater knowledge of the area; and supports the senior manager to the middle managers and the operatives. The structural incompatibility with the traditional form; unprepared employees slow down the development of the company; and ignorance of the senior manager about the operative part.

Table 5. Environments Phases of the strategic analysis Entry Analysis Exit Qualification of alternatives Evaluation and decision Politician and decision making [ 67 , ] [ 69 , 90 ] [ 76 , 87 , , ] [ 85 , 88 ] [ 68 , 70 , 81 , 84 , 86 , ] Market and technology [ , ] [ 61 , 79 ] [ 66 , 96 , ] [ 63 , , ] [ 65 , 89 , 95 , 99 , , , ] Cognitive and normative environment [ 62 , 80 ] [ , , , ] [ 74 , , ] [ 59 , 78 , 92 , ] [ 64 , 72 , 73 , 75 , 77 , 97 ] Note: entry: summarizes the initial data and poses the strategic position of the company and products. Analysis: integrates external and internal factors and poses the strategic alternatives.

Exit: consolidates the strategies considering their technical feasibility. Qualification of alternatives: meet the condition of feasibility and desirability. Evaluation and decision: choose strategies that generate value to the company. Table 6. Classification of investigations - strategic creation and organizational structures area. Figure 1. Intensive: improvements in the competitive position in relation to existing products market penetration, product development and market development. Diversification: they represent a growth in economic activity by participating in new or similar businesses concentric diversification, horizontal diversification, and conglomerates diversification.

Integration: reduce threats and seize opportunities from external environments; increase negotiation power with suppliers, distributors, and competitors vertical, horizontal integration and contractual coordination. Table 7. Classification of investigations—strategy formulation area. Deviation of service agreement [ , , — ] Claims solved of the total claims Incorporation and client retention Market Internal processes Time of the process cycle [ , , , , — ] Unit cost per activity Production levels Failure costs Reprocessing costs, waste quality costs Benefits derived of the continuous improvement Efficiency in the use of assets Innovation and learning Skills gap staff [ , , , , , , — ] Development of skills Retention of key personnel Application of technologies and added value Cycle of decision making Availability and use of strategic information Progress in system of strategic information Personnel satisfaction Organizational climate.

Table 8. Main BSC indicators and classification of investigations — strategic evaluation area. Phases Products Strategic concept Mission, vision, and challenges Opportunities Topics of strategic orientation Value chain Model of perspectives BSC Plan of the project Objectives, policies, and strategic measures Strategic objectives Preliminary cause-effect model Measures strategic indicators and responsible Strategic vectors and value generators Policies, goals, and initiatives Detailed strategic objectives Cause-effect model with vectors and levers Measures strategic indicators and responsible Goals by indicator Strategic initiatives Communication and implantation Divulgation Managerial agenda of BSC Action plan for noncompleted details Plan of alignment of initiatives and strategic objectives Plan of organizational deployment.

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