Search

Two research questions lie at the heart of this paper: what are the needs of terminally ill patients and their families and what can tourism providers do to better meet these needs? We offer both theoretical and managerial contributions to these questions, drawing insights from our extensive empirical research into terminal illness, positioned here as a profound form of unsettled times. We mine the stories collected from in excess of 200 patients and their families diagnosed with a terminal illness through to bereavement. Domestic tourism, visiting friends and relatives and respite care all dominate this space. We propose a hierarchy of service needs categorised as: emotional; informational; environmental; restorative; and aftercare, offering also a temporal understanding of which services are needed, and at which point in time. Future opportunities to test the validity of this hierarchy in other health-tourism contexts to aid tourism business planning and practice are outlined.

Successive interventions designed to curb the spread of COVID-19 have all served to exacerbate the demands placed upon informal carers, a population indispensable to health care systems. The need for breaks from caring has never been so pronounced. This paper adopts, and extends, the theory of hierarchical leisure constraints to better understand barriers to tourism respite participation. Lived experiences are collected via story-telling techniques (n = 157) from carers taking trips of one night or more away during times of palliative and end-of-life care. Three cross-cutting constraints are emergent in the data

This article introduces the trajectory touchpoint technique (TTT), a service design methodology that harnesses customer experiences for enriched understanding of value throughout multilevel service components to ultimately increase innovativeness. We detail the design and development of the TTT using design science research, a goal-oriented methodology that produces robust and practical solutions to organizational problems. We demonstrate the TTT’s practical utility through collaborations with different organizations (n = 9) and diverse service users (n = 240). We show how the TTT is an easy to use methodology that enhances understanding of value creation and illustrate its benefits with concrete examples of innovations to service encounters, the service system, and the value constellation. We reveal how a service design methodology can be the bridge between the theoretical standpoint of S-D logic’s perspective on value cocreation and the practical tools and techniques required to operationalize it.

Leisure has suffered a neglect in the palliative care literature, with clinically driven narratives often overlooking the pivotal role leisure plays within this landscape. A problem inherent in muc...

PurposeThe paper aims to explore and analyze how multinational companies (MNCs) in Bangladesh define corporate social responsibility (CSR) and how CSR is used by these companies as a strategic tool to improve business and social performances.Design/methodology/approachThe authors choose a qualitative case study approach for this study, using multiple semi-structured interviews with 15 CSR managers and secondary data from websites and annual reports. Both primary and secondary data were collected from ten leading MNCs that operate in Bangladesh.FindingsThe findings indicate that most of the MNCs in Bangladesh are moving toward strategic CSR and away from the conventional altruistic (philanthropic) CSR. It also appears that stakeholder prioritization and one-way communication are key for managing stakeholders.Research limitations/implicationsThe most unavoidable limitation of this research lies in sample selection. A total of ten companies were selected because of lack of accessibility to additional MNCs. To overcome this limitation and increase the credibility of findings, the authors triangulate interview and secondary data from annual reports and websites.Practical implicationsThe findings indicate that MNCs are increasingly recognizing the importance of using their core competencies to generate social benefits. The idea of adopting strategic CSR is predominantly steered by business benefits, which also provide the necessary resources for social and environmental activitiesSocial implicationsThe findings suggest that the shift from philanthropy to strategic postures leads to creating and fostering social benefits such as developing an entrepreneurial spirit and empowering women.Originality/valueMNCs operating in Bangladesh are gradually departing from philanthropy and moving toward strategic CSR by aligning business strategies with CSR. Transition from philanthropy to strategic CSR also reflects on MNCs’ CSR definitions, which include various dimensions such as social, stakeholders and sustainability, except philanthropy. In Bangladesh, where CSR was previously viewed as philanthropic activity, the findings make important contributions to the extant literature, particularly international CSR strategic literature, and can be useful for future research in other developing countries.

Drawing upon transformative service research and social tourism literature, this paper explores the relationship between respite care and childhood illness. It focuses specifically upon the short break opportunities attached to respite care offered in children's hospices in the United Kingdom. Pathographies (illness narratives), shared by patients, siblings and family (n = 23), provide unique insights into ways in which each participate in respite care. Participation prompts inclusivity and normality. It offers a break from illness, and contributes to uplifting feelings of optimism, escapism and new beginnings. Conclusions drawn argue the need for healthcare policy to move beyond ‘Dying Well’ narratives into ones which celebrate ‘Living Well with Dying’. Tourism participation has much to offer such a progressive healthcare policy.

Background Eighty per cent of people in the UK state they would prefer to die at home. A ‘good death’ is a key objective of palliative care and a comfortable death improves wellbeing among the bereaved. This study was designed to take a deep-dive into the service experiences of a new Hospice@Home service, with the overall aim of ascertaining the human stories behind Hospice@Home helping people to achieve their preferred place of death. Methods We collected 45 narratives from bereaved caregivers whose family member had received Hospice@Home in the weeks prior to their death. We used the Trajectory Touchpoint Technique (TTT), a rich pictures methodology that enables the collection of deep and rich data. The TTT encourages people to talk about their whole Hospice@Home journey in 5 stages: pre-arrival, arrival, clinical care and support, comfort, discharge and aftercare. Narratives were recorded and transcribed verbatim before being subjected to thematic analysis. Results We found multiple problems. A lack of awareness and understanding of hospice help among both families and some referring clinicians delays access. Even when offered, resistance comes from a reluctance to allow ‘strangers’ into their homes, a hesitancy to hand over the care of their loved ones, and/or a disinclination to use the service due to not feeling entitled. These barriers persist despite many families being in crisis. Certainly, we found Hospice@Home positively impacts quality of life and quality of death for patients. However, families were unable to equate their experiences with a positive impact on their own quality of life, resulting in many re-thinking their own place of death preferences. Conclusions There are major gaps in care provision, particularly notable in the wider healthcare system, including GPs, Pharmacies, access to equipment, and private care providers.

Background Advance Care Planning (ACP) enables people to make plans regarding their future healthcare and has been shown to positively impact on the quality of patient care. There are multiple barriers to engaging in the process of advance care planning. These include a lack of understanding of what ACP entails and patient, relative and healthcare professionals’ anxieties in discussing potentially distressing issues. The Trajectory Touchpoint Technique (TTT) was applied to ACP discussions in order to create a visual aid to help circumvent these barriers, allowing deep and detailed discussions of potentially distressing topics. Methods A literature review was performed to identify topics that patients may have wanted to talk about. These were ratified through a human centred design process (Design Thinking) with members of the public. ACP discussions were performed using the visual aid on an in-patient specialist palliative care unit. Qualitative enquiry was used in the form of patient, relative and clinician interviews following ACP discussions to evaluate the feasibility and benefits of using the visual aid. Results Data was collected over a 4 week period in a single acute in-patient palliative care unit. Patients (n=4), relatives (n=2), and clinicians (n=3) participated in the study. Thematic analysis of interview transcripts showed the visual aid enabled patients to begin the conversation by talking about the ACP related issues they felt comfortable with and that were most important to them. Relatives found the visual aid helped to identify what issues can be discussed. Clinicians found the visual aid helped focus the ACP discussions. Conclusions We have demonstrated that the visual aid was useful in facilitating ACP discussions with this cohort of patients, relatives and clinicians. Further, we suggest these findings warrant trials across primary and secondary care for patients in end-of-life to further develop this approach to ACP facilitation.

Conceptualizations of luxury usually derive from individuals who are agentic and empowered. Building upon the consumer-centered experiential movement, this paper deviates from researching the typical, listening instead to consumer narratives associated with luxury in contexts where agency is transitioning. We revisit notions of sacred and profane within the liminal space of palliative and end-of-life care. Adopting purposeful sampling, and agency enhancing storytelling, pathographies in particular, consumption experiences are narrated by patients, families, and bereaved users (n = 140) of multiple hospices (n = 5) in the UK. Findings shift the evolving consumer centric conceptualization of luxury into conceptions of liminal space, place (hospices as cathedrals), and people (community). A psychosocial narrative emerges which conceptualizes experiences as lived, personalized, integrated, familiar, transformational, hedonic, eudaimonic, and (dis)connected. Our discussion extends notions of the sacred and profane into the mundane and illustrates the ways in which those navigating a liminal space encounter unexpected yet astonishing luxury experiences.

Corporate social responsibility (CSR) has the potential to yield economic and social value in the Middle East (ME), especially given the current high environmental flux in the region. Although much scholarly has been paid to CSR issues, a key question remains about how to operate responsibly in the ME, particularly since institutional environments and stakeholders’ needs vary across ME states. The purpose of this paper is to provide a systematic review of the current state of CSR in the ME. We identify thirty-eight articles that are most pertinent to CSR in the ME and examine the main theoretical frameworks, methodologies, trajectories for further conceptual development, gaps where new research pathways need to be created and also future research questions. From the systematic review, we reveal how attention on CSR in the ME is slowly gaining traction. A snapshot of the gaps identified include the collaboration between business and NGOs, the impact of stakeholders and institutions on CSR, the impact of political and economic crisis on CSR and the influence of individualistic characteristics shaping managers’ CSR behaviour. In addition to such gaps, we present an agenda for future research.

Background There is a struggle to meet the demands of adequate, let alone high-quality, palliative care, with one in four UK families unable to access the expert palliative care they need. This research uncovered difficulties experienced in accessing palliative care along with insights into why others have not accessed these services at all. Methods This research is part of a larger ongoing study into palliative care. Data collection began in 2015. To date we have collected almost 2 million words of data from in-depth interviews with palliative care patients and their families (n=223) and healthcare professionals including GPS, Community Nurses and Hospital Staff (n=22). We also surveyed (n=100) non-users. Results We find that many of the long-recognised barriers, such as patient and family misconceptions (‘the Death House’) and lack of knowledge (‘I didn’t know what a palliative care nurse was’; ‘I thought it was just for cancer patients) are just as prevalent as they have always been. There is an acute lack of awareness of wider palliative care offerings (e.g. non-pain physical, psychological, spiritual). Many people believe hospice care is solely for patients with cancer, or just for inpatients, or is private and has to be paid for. Confusion and lack of confidence among healthcare providers are also widespread, particularly when dealing with non-cancer patients. We also found poor integration of healthcare services in the wider ecosystem, often confounded by technological barriers and a lack of effective collaboration between service providers. Conclusions Palliative and hospice care needs to be rebranded and better communicated to the wider public. Better training is needed to educate and equip healthcare professionals with the knowledge and confidence they desperately need. Champions are needed to improve collaboration and integration among healthcare professionals and their systems.

Background We present the trajectory touchpoint technique (TTT), a new methodology to appreciate all user experiences of palliative care. Better understanding of user needs means providers can become more patient-centered. However, no available tools capture experience of all aspects of palliative care. Consequently we developed the new methodology, allowing a deep dive into the palliative care journeys of patients and their families. Methods Using concepts from the social sciences, we blended service blueprinting, customer journeys, touchpoints, servicescapes, experienced based co-design, and rich pictures methodology; producing a technique that systematically captures palliative care user experiences from seven major dimensions. The technique incorporates all aspects of palliative care that are important to the user, integrating emotional, physical, sensorial, and social elements of their experience. We have tested and refined the TTT in a collaboration with hospices and palliative care providers (n=8), successfully capturing the voices (n=223) of palliative care patients and their families. Results The TTT overcomes many data collection difficulties typical to palliative care. The TTT is easy to understand and use, yet costs a fraction of alternative techniques while allowing for a broader perspective into patient-centeredness, incorporating both the clinical encounter and macro-level organizational structures and processes. Importantly, results demonstrate the TTT’s ability to uncover areas for improvement that alternative methodologies have failed to identify, despite many of our collaborating organizations already being rated as ‘outstanding’. Conclusions Data collection methods that reveal actionable results which lead to meaningful changes are crucial to implementing improvements to palliative care. Our TTT responds to this need. Based on our results, our collaborating organizations have already begun to make improvements to the ways in which palliative care services are designed, delivered, communicated, co-created, and connected to the wider health care ecosystem.

Mass protests, demonstrations, and armed conflict which are now known as the “Arab Spring” revolution have swept across countries such as Iraq, Egypt, and Libya. These disruptive events are occurrences which change over time (Giesler and Thompson’s 2016) and uncover rich service encounters within a complex service ecosystem (Blocker and Barrios 2015). To date, transformative service research (TSR) has attended to our understanding of service ecosystems. However, we argue that institutions (i.e., the norms, rules, meanings, symbols, and practices which connected actors share) and how service ecosystems evolve in disruptive events also warrant attention. Through 67 semi-structured interviews, this paper closely examines the role of consumption practices in challenging institutional boundaries during periods of disruptive conflict in Egypt, Libya, and Iraq.

This paper builds on Belk's notions of the extended, social, family and dialogic selves in an attempt to explore the transformation of the self during the Arab Spring phenomena. From the perspective of the respondents in Egypt\ud and Libya, this paper provides a reading of how images of self are related to artifacts of consumption, rituals, and\ud symbols and how consumer values are navigated through this difficult landscape. The paper uses a three phase\ud history, happening, and hopes narratives to show that the self in a liminal period of flux is referent to history and\ud hopes and proposes a notion of a transitional self that incorporates this observation of reference to past and future. In particular, the findings suggest that consumption, especially Western consumption can be transcendental during a liminal period of flux and that such revelatory incidents offer an opportunity to access the candid thoughts of consumers.

In this paper, we analyse the impact of social media technology on the Arab spring, and how individuals and communities used Schemata of Interpretation and Human Factor (cause, justification and emotions) to support the uprising throughout the Middle East. Social Media enabled activists from different regions to use technologies to share ideas and tactics, to inspire and engage protesters aspirations and to resonate from rural areas to gather at centrally located points push the momentum. Using social media the activists were able to distribute key messages for collective action and contribute to awareness and discussion from different political factions to create social anarchy, chaos, cultural imagery and symbolisms. By creating social anarchy activists can forge mutual friendship by individuals within the group through sharing belief and culture. The Causes & Technologies framework being presented here looks at the human factor and identifies key traits and themes that are necessary for Actors within the society to form necessary uprisings.