Melissa De Regge

Purpose: This study investigates how boundary spanners realise network engagement during the implementation of digital technologies in healthcare operations, focusing on how actors connect diverse stakeholder groups across organisational, functional and professional boundaries. Design/methodology/approach: A multiple case study was conducted in two hospitals implementing comparable digital technologies with contrasting outcomes. Data were collected through archival documents and two rounds of semi-structured interviews. By means of inductive analysis, we identified boundary-spanning roles and their contribution to network engagement across organisational, functional and professional boundaries. Findings: The findings show that boundary-spanning roles operate not in isolation, but as a constellation that jointly activate, embed and legitimise across diverse groups of actors. Through this constellation, actors cross organisational, functional and professional boundaries, thereby supporting the implementation of digital technologies in healthcare operations. Originality/value: This study contributes to healthcare operations literature by moving beyond single-organisation adoption models and introducing a network-based perspective on technology implementation. It advances boundary-spanning theory by conceptualising how boundary-spanning roles enable engagement across multi-actor networks, addressing a gap at the intersection of digital technology, healthcare operations and implementation. Practical principles are provided to guide managers in defining, supporting and leveraging boundary-spanning roles during technology implementation in healthcare operations.

Background/Objectives: Scanxiety, the distress associated with cancer surveillance imaging, is a common concern among cancer survivors. Although most research has focused on the imaging event itself, less is known about how scanxiety unfolds throughout the broader cancer surveillance journey. This study aimed to map the cancer surveillance journey of cancer survivors and identify patient-centred intervention opportunities to reduce scanxiety. Methods: We used a qualitative participatory design involving cancer survivors, travelling companions, and healthcare professionals. Nine co-creation workshops were conducted; in six survivors and companions participated in journey-mapping exercises, while in three, healthcare professionals completed an immersive exercise. All groups subsequently engaged in structured brainstorming workshops to generate intervention opportunities. Data were analysed using abductive thematic analysis. Results: Scanxiety extended beyond the imaging procedure and unfolded throughout the cancer surveillance journey, spanning three phases and seven subphases. Participants identified opportunities to redesign the journey by enhancing existing touchpoints, augmenting the journey with additional touchpoints, and eliminating unnecessary or stress-inducing touchpoints. These opportunities targeted interpersonal, technical, environmental, and administrative dimensions of care. Administrative qualities, particularly timeliness and operational processes, emerged as important contributors to distress. Preferences for support and communication varied, underscoring the need for flexible supportive care during medical surveillance. Conclusions: Scanxiety is a journey-wide experience shaped by both individual and organisational factors. Opportunities to address scan-related distress may include not only psychosocial support, but also improvements in how surveillance care is organised and delivered. The findings provide a patient-centred approach for redesigning cancer surveillance services and identifying intervention opportunities for future evaluation.

Introduction: An aging population and increasing care complexity are placing growing pressure on home healthcare services worldwide. Rising demand, nurse shortages, and high workloads risk reducing patient satisfaction and care quality, potentially leading to poorer outcomes. Accurate assessment of care intensity is essential for efficient resource allocation and optimal nurse–patient alignment. Objective: Beyond improving care delivery, insights in care intensity can also play a key role in supporting nurse-retention strategies. Existing tools, such as the Katz Index and BelRAI, omit several critical determinants. This study examines these gaps and outlines directions for developing a more comprehensive care intensity instrument (CII) for home healthcare. Methods: A narrative review was conducted to examine existing CIIs in home care and to identify missing determinants. Additional insights were obtained through expert consultation and field engagement. Instruments were analyzed to determine which determinants are currently captured in widely used assessment tools. Results: Eight CIIs currently validated or used in Belgian home healthcare were identified. Their coverage of patient-related determinants varied: physical health was consistently assessed, whereas mental and behavioral aspects received less attention, and social or environmental factors appeared in only a few tools. Nursing-related determinants—such as workload, skills, work environment, and demographics—were mostly absent. Conclusions: None of the instruments provided a fully comprehensive assessment integrating both patient and nursing determinants. This narrative review, complemented by expert consultation and field engagement, highlights the need for a CII that integrates patient determinants with nursing determinants to improve the quality, safety, and efficiency of home healthcare.

Operational failures in hospitals, such as communication breakdowns and equipment malfunctions, challenge nurses by disrupting patient care, workflow, and clinical processes. These failures are primarily addressed with short‐term solutions, rather than comprehensive, long‐term strategies. This study investigates the impact of operational failures on patients and examines whether nurses alter their problem‐solving behavior in response to the perceived direct impact on patients. A qualitative, exploratory study was conducted in 23 wards across five Belgian hospitals. Data were collected through in‐depth semi‐structured interviews with 26 nurses and a group discussion with ward managers (n = 6). Findings reveal that barriers such as nurses' limited awareness regarding the broader impact of operational failures on patients, poor communication, and excessive workloads hinder problem‐solving efforts. However, when operational failures result in patient harm, nurses are more likely to take corrective action to prevent recurrence. Enablers to enhance problem‐solving behaviors include using narrative medicine to highlight patient safety risks, improvements to communication frameworks, the streamlining of reporting systems, and the allocation of adequate time and resources to address underlying issues. Furthermore, a proactive approach, grounded in Safety‐II principles, emphasizes nurses' flexibility and adaptability, recognizing their indispensable role in learning from successful outcomes and making real‐time adjustments to strengthen resilience within healthcare systems.

Objective: The objective of this study is to explore how higher education students behave when they are confronted with imposed measures that provide temporal cues, also called organizational temporal structures, and how their behavior evolves with time. Theoretical Framework: The Temporal Cognitive-Affective Processing System (T-CAPS), developed by Shipp and Richardson (2021) is used as the overarching theory to study the phenomenon. The theory describes five possible behavioral responses when individuals are confronted with organizational temporal structures. Method: The study uses a mixed-method design including surveys and interviews during three large COVID-19 waves in Belgium. In total, 1246 students filled in the survey and 30 interviews were carried out. Results and Discussion: The findings suggest that, in general, students mostly complied to the imposed measures. Especially in the beginning of the pandemic, resistance was almost non-existent. However, resistance increased over time, particularly when measures interfered with social life. Our qualitative data provides more insight into the reasoning behind indicated behavioral responses. Convenience appeared to be an important reason for compliance with remote learning and resistance towards the restrictions in social contact increased because of their deteriorating effect on mental health. Research Implications: Our research gives rise to recommendations aimed at governments, educational institutions and people entrusted with educational policy making, as it provides better insight into when and why students comply to new regulations. Originality/Value: This study contributes to the literature by applying the conceptually developed T-CAPS in an empirical setting and as a result validates propositions related to the theory.

Palliative care is becoming an essential component of healthcare, but there is insufficient research on how integration across different levels of care (micro, meso, and macro) is realized in practice. Without such integration, care may become fragmented, leading to suboptimal patient outcomes. While many studies have explored palliative care models, there is a gap in understanding how priorities for integrated care align across these levels within healthcare ecosystems. Specifically, it is unclear whether key actions at each level are shared, coordinated, and supported effectively, making it difficult to implement sustainable, cohesive care strategies. Our study aims to explore the extent to which important goals (i.e., priorities) are shared across the micro, meso, and macro levels of the palliative care ecosystem in Flanders, Belgium. We applied a multimethod study using the analytic hierarchy process method (AHP). This consists of three sequential steps: a broad literature search and interviews with Belgian stakeholders (n = 12) to determine the criteria for the organization of integrated care; focus groups (n = 8) with patients, their relatives and caregivers to establish the completeness and relevance of the criteria; and prioritization of the criteria using a questionnaire among 305 Flemish participants (patients, relatives, caregivers and policy makers). Our findings revealed that integration is imbalanced, with priorities being most emphasized at the micro level (57%), followed by the meso (29%) and macro (14%) level. Functional enablers dominate at the macro (80%) and meso organizational level (67%), while normative enablers are emphasized at the meso professional (67%) and micro level (75%). Effective palliative care requires vertical coordination of these enablers: for instance, transparent communication with patients at the micro level depends on cross-organizational information exchange at the meso level, supported by a unified data system at the macro level. Achieving integrated palliative care requires deliberate alignment of priorities across all levels of the ecosystem. While each level plays a unique role, palliative care is comprehensive and effective only by sharing both functional and normative enablers across micro, meso, and macro level.

Background: The last decade has seen a considerable increase in the number of mobile health (mHealth) apps in everyday life. These mHealth apps have the potential to significantly improve the well-being of chronically ill patients. However, behavioral engagement with mHealth apps remains low. Objective: The aim of this study was to describe the behavioral engagement of chronically ill patients with mHealth apps by investigating (1) how it is affected by social factors (ie, physician recommendation) and app-related factors (ie, app integration) and (2) how it affects patient well-being. This study also considers the moderating effect of attachment to traditional health care and the mobile app experience among patients. Methods: We carried out a scenario-based survey study of chronically ill patients (N=521). A Bayesian structural equation modeling with mediation and moderation analysis was conducted in MPlus. Results: Both physician recommendations for mHealth app use and app integration have positive effects on the behavioral engagement of chronically ill patients with mHealth apps. Higher behavioral engagement positively affects the hedonic well-being (extent of pleasure) and the eudaemonic well-being (extent of self-efficacy) of chronically ill patients. Mobile app experience, however, positively moderates the relationship between app integration and behavioral engagement, whereas patient attachment to traditional care does not moderate the relationship between physician recommendation and behavioral engagement. Taken together, the proportion of variance explained (R²) equals 21% for behavioral engagement and 52.8% and 62.2% for hedonic and eudaemonic well-being, respectively, thereby providing support for the strong influence of app integration and physician recommendation via the mediation of the patients’ behavioral engagement on both patients’ hedonic and eudaemonic well-being. Conclusions: Physician recommendation and app integration enable behavioral engagement and promote well-being among chronically ill patients. It is thus important to take social and app-related factors into consideration during and after the development of mHealth apps.