How Do Health Systems Address Patient Flow When Services Are Misaligned With Population Needs? A Qualitative Study

Background: Patient flow through health services is increasingly recognized as a system issue, yet the flow literature has focused overwhelmingly on localized interventions, with limited examination of system-level causes or remedies. Research suggests that intractable flow problems may reflect a basic misalignment between service offerings and population needs, requiring fundamental system redesign. However, little is known about health systems’ approaches to population–capacity misalignment, and guidance for system redesign remains underdeveloped. Methods: This qualitative study, part of a broader investigation of patient flow in urban Western Canada, explored health-system strategies to address or prevent population–capacity misalignment. We conducted in-depth interviews with a purposive sample of managers in 10 jurisdictions across 4 provinces (N = 300), spanning all healthcare sectors and levels of management. We used the constant comparative method to develop an understanding of relevant strategies and derive principles for system design. Results: All regions showed evidence of pervasive population–capacity misalignment. The most superficial level of response – mutual accommodation (case-by-case problem solving) – was most prevalent; capacity (re)allocation occurred less frequently; population redefinition most rarely. Participants’ insights yielded a general principle: Define populations on the basis of clusters of co-occurring need. However, defining such clusters demands a difficult balance between narrowness/rigidity and breadth/flexibility. Deeper analysis suggested a further principle: Populations that can be divided into homogeneous subgroups experiencing similar needs (eg, surgical patients) are best served by narrow/ rigid models; heterogeneous populations featuring diverse constellations of need (eg, frail older adults) require broad/ flexible models. Conclusion: To remedy population–capacity misalignment, health system planners should determine whether clusters of population need are separable vs. fused, select an appropriate service model for each population, allocate sufficient capacity, and only then promote mutual accommodation to address exceptions. Overreliance on case-by-case solutions to systemic problems ensures the persistence of population–capacity misalignment.

Type and Feasibility of Agribusiness of Kub Chicken Household Scale

The aims of this assessment are to determine the type of KUB chicken agribusiness and feasibility of its business in household scale. The assessment was carried out from November to December 2020 using a survey method. Data were collected by using structured questionnaires to 133 KUB chicken farmers in East Java. Data were analyzed descriptively, using tabulation methods for understanding farming conditions and R/C ratio analysis for knowing economic feasibility. The results showed that there were many types of businesses run by KUB chicken farmers in East Java, namely day old chicks (DOC) production 29%, meat production 29 %, consumption egg production 19%, and others are hatching eggs and pullet productions. Farming population capacity was more than 100 (30.5%), 50-100 chickens (35.9%) and less than 50 chickens (33.6%). The highest business feasibility was in the type of breeding business for DOC production with an R/C ratio of 2.12, and the lowest was in egg production and meat production with R/C ratio of 1.16. It can be concluded that the main type of business that has a high value of business feasibility in the household scale KUB chicken farm in East Java is the nursery to produce DOC.

The Importance of Being British

From the 1880s onwards the Colonial Conferences and empire chamber of commerce movements promoted ‘British World’ trade connections and schemes for imperial preference in particular. Much of the appeal of schemes for promoting preferential trade within the empire rested on widespread beliefs about the vast future population capacity of the Dominions. However, Joseph Chamberlain’s subsequent tariff reform campaign proved highly divisive, and efforts to promote British World collaboration more broadly sharpened divisions between ‘British’ and Indian and colonial business elites. The development of British World trade networks led to the establishment of competing trade organizations, particularly amongst ethnic Indian and Chinese communities, which began to challenge the economic subordination of their communities within the imperial trade system.