BackgroundThe aim of this study was to describe barriers and facilitators for shared decision making (SDM) as experienced by older patients with multiple chronic conditions (MCCs), informal caregivers and health professionals.MethodsA structured literature search was conducted with 5 databases. Two reviewers independently assessed studies for eligibility and performed a quality assessment. The results from the included studies were summarized using a predefined taxonomy.ResultsOur search yielded 3838 articles. Twenty-eight studies, listing 149 perceived barriers and 67 perceived facilitators for SDM, were included. Due to poor health and cognitive and/or physical impairments, older patients with MCCs participate less in SDM. Poor interpersonal skills of health professionals are perceived as hampering SDM, as do organizational barriers, such as pressure for time and high turnover of patients. However, among older patients with MCCs, SDM could be facilitated when patients share information about personal values, priorities and preferences, as well as information about quality of life and functional status. Informal caregivers may facilitate SDM by assisting patients with decision support, although informal caregivers can also complicate the SDM process, for example, when they have different views on treatment or the patient’s capability to be involved. Coordination of care when multiple health professionals are involved is perceived as important.ConclusionsAlthough poor health is perceived as a barrier to participate in SDM, the personal experience of living with MCCs is considered valuable input in SDM. An explicit invitation to participate in SDM is important to older adults. Health professionals need a supporting organizational context and good communication skills to devise an individualized approach for patient care.
MULTIFILE
Big data analytics received much attention in the last decade and is viewed as one of the next most important strategic resources for organizations. Yet, the role of employees' data literacy seems to be neglected in current literature. The aim of this study is twofold: (1) it develops data literacy as an organization competency by identifying its dimensions and measurement, and (2) it examines the relationship between data literacy and governmental performance (internal and external). Using data from a survey of 120 Dutch governmental agencies, the proposed model was tested using PLS-SEM. The results empirically support the suggested theoretical framework and corresponding measurement instrument. The results partially support the relationship of data literacy with performance as a significant effect of data literacy on internal performance. However, counter-intuitively, this significant effect is not found in relation to external performance.
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We aim to understand the interaction between shifting organizational field logics and field actors’ responses to reconcile logic plurality and maintain legitimacy through business model innovation. Drawing on a multimethod, longitudinal field study in the fashion industry, we traced how de novo and incumbent firms integrate circular logics in business models (for sustainability) and uncover how productive tensions in field logics lead to experimental spaces for business model innovation. Our findings showed a shift in the discourse on circular logic that diverted attention and resources from materials innovation (e.g. recycling) to business model innovation (e.g. circular business models). By juxtaposing the degree of field logic tension and the degree of business model innovation, we derive four types of business model hybridization responses that actors engaged in to maintain legitimacy – constrained, limited, integrated, and expanded. Our study generates new insights on business models for sustainability as vehicles for organizational field change.
