Objective: To evaluate an early home-supported discharge service for stroke patients. Design: We carried out a prospective, randomised, open-label, blinded-endpoint trial (allocation ratio of 1:1) with patients assigned to either an early home-supported discharge service or usual care. Setting: The study was undertaken in Aveiro, Portugal, between April 2009 and April 2013. Subjects: We included stroke patients aged 25–85 years admitted to the stroke unit with an initial Functional Independence Measure of up to 100, who gave informed consent. Interventions: Patients in the early home-supported discharge group began their rehabilitation intervention in the stroke unit and the early home-supported discharge team worked with them at home for a maximum of one month. Patients in the control group received usual services. Main measures: The primary outcome measure was the Functional Independence Measure at six months after stroke. Results: We randomised 190 patients of whom 34 were lost to follow-up. There were no significant differences (p > 0.5) in the average scores of Functional Independence Measure between the early home-supported discharge (69 ±22; mean ±SD) and the control groups (71 ±17) measured at baseline; and between the early home-supported discharge (107 ±20) and the control groups (107 ±25) measured at six months. The number of individuals with a low Functional Independence Measure score (<60) in the early home-supported discharge group compared with the control group was higher at admission (34/95 vs. 26/95) and lower at follow-up (2/74 vs. 5/78). Conclusions: It was feasible to implement early home-supported discharge procedures in a Southern European setting, but we have not shown convincing differences in disability at six months.

Purpose: The purpose of this paper is to determine the contribution of company functional areas – production, marketing, and human resources – to strategic flexibility configurations. It also seeks to explore the comparative contributions of functional areas to product innovation.Design/methodology/approach: The study uses the fuzzy-set qualitative comparative analysis to develop a better understanding of departmental contributions to strategic flexibility configuration and the effect of strategic flexibility on product innovation by functional areas.Findings: The findings of this study indicate that marketing flexibility has a key role in product innovation.Research limitations/implications: A limited number of cases may be one of the possible reasons for no proven contribution of HR flexibility to product innovation, and may affect results due to poor representation.Practical implications: The required flexibility level is at least the one maintaining the company’s status and certifying competitive advantage.Social implications: A pressure for flexibility leads companies to modify their organizational structure, processes, and resources.Originality/value: The environmental change and uncertainty provide dynamic challenges that increase the need of company flexible reactions

This paper reports on the experiences of working with new digital tools along with the experience of new remote work. We explore the emotional experiences of working from home during the first three months of the COVID-19 pandemic and their implications. There were two groups of respondents participating in the study, those who had experience working remotely before the pandemic [digital natives] and those who started working remotely during the pandemic [digital immigrants]. The results show that emotional experiences while working from home do not differ depending on the profession, age, gender, length of experience and from previous remote work. This suggests that the digital natives had to deal with the same emotions as the digital immigrants. The study found that independent external changes determine the growth of competence in employees, in this particular case, to work remotely. Working in conditions that are difficult for everyone obliges employees to cooperate, even across company boundaries, and increases each other’s competencies. In such situations, the management is required to be emotionally involved and closer to the employee.

Integrated care is increasingly present in the agenda of policy-makers, health professionals and researchers as a way to improve care services in relation to access, quality, user satisfaction and efficiency. These are overarching objectives of most sectoral reforms. However, health care and social care services and systems are more and more dependent on the performance of each other, imposing the logic of network. Demographic, epidemiologic and cultural changes result in pressure to increase efficiency and efficacy of services and organisations in both sectors and that is why integrated care has become so relevant in the last years. We first used concept maps to organise and systematise information that we had gathered through deep literature review in order to set a framework where to base the subsequent work. Then, we interviewed informants at several levels of the health and social care systems and we built a list of major recent reforms addressing integrated care in Portugal. In a third step, we conducted two independent focus groups where those reforms were discussed and evaluated within the context of the concepts and frameworks identified from the literature. Results were confronted and reconciled, giving place to a list of requisites and guidelines that oriented further search for documentation on those reforms. Several important health reforms are in course in primary and hospital care in Portugal, while a so-called third level of care has been introduced with the launch of the National Network of Long-Term Integrated Care (RNCCI - Rede Nacional de Cuidados Continuados Integrados). The social care sector has itself been a subject of alternative models springing from opposite political orientations. All these changes are having repercussions on the way the systems work with each other as they are leading to ongoing and ill-evaluated reformulations on the way they are governed, financed, structured and operated. Care integration is not absent from policy-making and implementation endeavour in Portugal. However, recurrent issues seem to be consistently hampering the efforts regarding the integration of care in the country. It is urgent to assess current situation as experienced by those closely involved and directly affected.