An organizational design perspective on the monthly self-scheduling process in nursing homes: A multiple case study.

AIMS: To describe the monthly self-scheduling process in nursing homes (NH), to determine how specific organizational design characteristics (including interpersonal relationships and leadership style) influence this process, and to examine the effect on individual, team, and organization-related outcomes. DESIGN: A multiple case study using an organizational design perspective as the overarching theoretical and explanatory framework. METHODS: Data collection was performed in four Belgian NH during Spring 2019 using semi-structured interviews (n = 39), documents, and observations. Open, axial, and selective coding was used for the data reduction process, and a within-case and cross-case analysis was performed. The COREQ checklist was used for reporting the findings. RESULTS: One group (two NH) used self-scheduling because it corresponds with their decentralized organizational design. Together with a motivating head nurse and additional resources during the core phase of the process, this led to positive outcomes. In contrast, another group used self-scheduling under the assumption that it would solve the mismatch between their organizational design and other organizational problems, which resulted in less positive work attitudes. CONCLUSION: Self-scheduling should match the organizational structure and culture. Additional resources and an adaptive leadership style can help mobilize and support employees. Future research may use quantitative methods to confirm positive outcomes. IMPACT: This study contributes to the rare literature on self-scheduling in NHs by focusing on the monthly self-scheduling process and by including an organizational design perspective. NH management can become informed of different self-scheduling methodologies and the impact of specific organizational characteristics on this process. Head nurses can become aware that they need to adapt their leadership style to obtain improved outcomes. PATIENT OR PUBLIC CONTRIBUTION: Three members of the study team met with several caregivers during field visits to conduct interviews and to observe the monthly self-scheduling process.

Systematic review: What is the impact of self-scheduling on the patient, nurse and organization?

AIM: To systematically review and evaluate the literature on the impact of self-scheduling on patient, nurse and organization-related outcomes. DESIGN: A systematic review. DATA SOURCES: PubMed, Embase, Web of Science, Cinahl, Scopus, Google Scholar, ERIC and Cochrane Library were screened until October 2019 (week 40) for peer-reviewed, empirical articles, written in English, Dutch or French. REVIEW METHODS: Two reviewers screened title and abstract using predetermined eligibility criteria and one reviewer screened the full texts of relevant hits. Quality was assessed with the Mixed Methods Appraisal Tool. RESULTS: Studies (N = 23) were retained and classified into explanatory and descriptive studies. The articles reported on a range of outcomes: patient- and nurse-reported quality of care, job satisfaction, satisfaction with scheduling, work/life balance, planning involvement, interaction with colleagues, health and well-being, psychosocial factors, professional development, nurse manager's scheduling time, general working conditions, turnover, temporary employment agency use and absenteeism, recruitment and retention. CONCLUSION: The evidence base is limited. Several studies confirmed the positive impact of self-scheduling on the nurse and the organization. However, other studies found negative outcomes or no change. These outcomes should be interpreted in the light of contextual factors and the implementation process, which was often not without difficulties. Future research should use a multimethod longitudinal design, bear in mind the possibilities of quantitative research (e.g. for studying psychosocial factors) and employ a theoretical framework. IMPACT: This review informs about the inconsistent evidence on the association between self-scheduling and patient, nurse and organization-related outcomes and includes enablers and barriers to a successful implementation. These outcomes are influenced by the implementation process and the sustainability of the self-scheduling system, which are still major challenges for healthcare management. This demonstrates the urgent need for further research.

Throughput efficiency and service quality after process redesign at a cancer day care unit: Two sides of the coin?

This study was designed to focus on the patient perspective in a reorganisation of care processes at a cancer day care unit (CDU). The effects of dose banding and of taking blood samples one day (or more) before the day care treatment (on Day -1) are investigated in terms of throughput efficiency and perceived service quality. Data were collected by mapping patient processes in detail and surveying patients in two CDUs at a university hospital (n = 308). A univariate model was used to investigate the effect of these factors on patient throughput time, and perceived service quality was examined with multiple linear regression. Taking blood samples on Day -1 decreases patient throughput time and increases the perceived service quality by improving the patient's perception of technical expertise and the outcome. This has a globally positive effect on patients' perceived service quality. Dose banding affected neither patient throughput time nor perceived service quality. Taking the pretreatment blood sample on Day -1 can be considered an important process design characteristic, as it increases both efficiency and service quality.

Problem-solving behaviour of nurses in a lean environment.

AIM: To investigate how the extensiveness of a lean implementation-that is, the extent to which lean as a new practice is adopted across nursing departments-relates to second-order problem solving behaviour of nurses. BACKGROUND: Lean implementation is expected to stimulate nurses' second-order problem-solving behaviour. METHOD: We used a vignette-based survey to look for differences in second-order problem-solving behaviour in early-adopter and late-adopter departments at two hospitals with differing degrees of extensiveness of lean implementation. RESULTS: At the hospital with an extensive lean implementation, nurses at the early-adopter department showed 71 second-order problem-solving responses from 50 problem scenarios, as compared with 39 responses from 37 scenarios in the late-adopter department. At the hospital with a less extensive lean implementation, these numbers were 16 from 23 compared with 18 from 19. CONCLUSIONS: The nurses in the hospital with an extensive lean implementation show more second-order problem-solving behaviour than those in the hospital with a stand-alone approach in a single department. IMPLICATIONS FOR NURSING MANAGEMENT: Extensive lean implementation where management clearly shows its belief in lean is a more favourable environment for changing the problem-solving behaviour of nurses.

Varying viewpoints of Belgian stakeholders on models of interhospital collaboration.

BACKGROUND: Hospitals are increasingly parts of larger care collaborations, rather than individual entities. Organizing and operating these collaborations is challenging; a significant number do not succeed, as it is difficult to align the goals of the partners. However, little research has focused on stakeholders' views regarding hospital collaboration models or on whether these views are aligned with those of hospital management. This study explores Belgian hospital stakeholders' views on the factors affecting hospital collaborations and their perspectives on different models for Belgian interhospital collaboration. METHODS: Qualitative focus group study on the viewpoints, barriers, and facilitators associated with hospital collaboration models (health system, network, joint venture). RESULTS: A total of 55 hospital stakeholders (hospital managers, chairs of medical councils, chair of hospital boards and special interest groups) participated in seven focus group sessions. Collaboration in health care is challenging, as the goals of the different stakeholder groups are partly parallel but also sometimes conflicting. Hospital managers and special interest groups favored health systems as the most integrated form. Hospital board members also opted for this model, but believed a coordinated network to be the most pragmatic and feasible model at the moment. Members of physicians' organizations preferred the joint venture, as it creates more flexibility for physicians. Successful collaboration requires trust and commitment. Legislation must provide a supporting framework and governance models. CONCLUSIONS: Involvement of all stakeholder groups in the process of decision-making within the collaboration is perceived as a necessity, which confirms the importance of the stakeholders' theory. The health system is the collaboration structure best suited to enhancing task distribution and improving patient quality. However, the existence of networks and joint ventures is considered necessary in the process of transformation towards more solid hospital collaborations such as health systems.

Fulfillment of administrative and professional obligations of hospitals and mission motivation of physicians.

BACKGROUND: To be successful, hospitals must increasingly collaborate with their medical staff. One strategic tool that plays an important role is the mission statement of hospitals. The goal of this research was to study the relationship between the fulfillment of administrative and professional obligations of hospitals on physicians' motivation to contribute to the mission of the hospital. Furthermore the mediating role of the physicians' emotional attachment to the hospital and moderation effect of the exchange with the head physicians were considered. METHODS: Self-employed physicians of six hospitals participated in a survey. Descriptive analyses and linear regression were used to analyse the data. RESULTS: The results indicate that affective commitment mediated the relationship between psychological contract fulfillment and mission statement motivation. In addition, the quality of exchange with the Chief Medical Officer moderated the relationship between the fulfillment of administrative obligations and affective commitment positively. CONCLUSION: This study extends our understanding of social exchange processes and mission statement motivation of physicians. We showed that when physicians perceive a high level of fulfillment of their psychological contract they are more committed and more motivated to contribute to the mission statement. A high quality relationship between physician and Chief Medical Officer can enhance this reciprocity dynamic.

3D-printing techniques in a medical setting: a systematic literature review.

BACKGROUND: Three-dimensional (3D) printing has numerous applications and has gained much interest in the medical world. The constantly improving quality of 3D-printing applications has contributed to their increased use on patients. This paper summarizes the literature on surgical 3D-printing applications used on patients, with a focus on reported clinical and economic outcomes. METHODS: Three major literature databases were screened for case series (more than three cases described in the same study) and trials of surgical applications of 3D printing in humans. RESULTS: 227 surgical papers were analyzed and summarized using an evidence table. The papers described the use of 3D printing for surgical guides, anatomical models, and custom implants. 3D printing is used in multiple surgical domains, such as orthopedics, maxillofacial surgery, cranial surgery, and spinal surgery. In general, the advantages of 3D-printed parts are said to include reduced surgical time, improved medical outcome, and decreased radiation exposure. The costs of printing and additional scans generally increase the overall cost of the procedure. CONCLUSION: 3D printing is well integrated in surgical practice and research. Applications vary from anatomical models mainly intended for surgical planning to surgical guides and implants. Our research suggests that there are several advantages to 3D-printed applications, but that further research is needed to determine whether the increased intervention costs can be balanced with the observable advantages of this new technology. There is a need for a formal cost-effectiveness analysis.

Are patients ready for communication with radiologists? Results of the R2P2 survey.

BACKGROUND: Patient empowerment requires that patients have enough information to make decisions concerning their own health. If patients are to discuss imaging results with radiologists, they have to know who these medical professionals are and what they do. PURPOSE: To examine whether patients understand the role of radiologists, and if particular subgroups are better informed than other ones. MATERIAL AND METHODS: Consecutive radiology outpatients in eight radiology centers could complete a web-based or printed questionnaire. Respondents indicated on a five-point Likert scale their level of agreement with 18 statements on the role of radiologists and their preferences concerning contacts with radiologists. Results were rearranged to allow comparison of predetermined subgroups. Dichotomous results were analyzed using χ(2) statistics. RESULTS: A total of 1,146 questionnaires were found eligible for analysis. Results showed confusion as to the question whether radiologists are medically qualified and enjoy all the privileges thereof. Medically qualified or highly educated respondents were modestly better informed. Patients in private practice were better informed than outpatients in hospitals. CONCLUSION: Patient empowerment requires better understanding of the role of radiologists. Different population subgroups necessitate specific information strategies.

The impact of economic and noneconomic exchange on physicians' organizational attitudes: The moderating effects of the Chief Medical Officer.

BACKGROUND: Hospital-physician relationships are critical to hospitals' organizational success. A distinction can be drawn between economic and noneconomic physician-hospital exchange. Physician senior leadership could be an important component of managerial strategies aimed at optimizing hospital-physician relationships. PURPOSE: The purpose of this study was to investigate the moderating role of the quality of exchange with the Chief Medical Officer (CMO) in the relationship between economic and noneconomic exchange and physicians' key organizational attitudes. METHODOLOGY: Self-employed physicians practicing at six Belgian hospitals were surveyed. Economic exchange was conceptualized by the concepts of distributive and procedural justice, whereas noneconomic exchange was conceptualized by the concepts of administrative and professional psychological contract. Our outcomes comprise three key organizational attitudes identified in the literature (job satisfaction, affective organizational commitment, and intention to leave). The moderating role of leader-member exchange with the CMO in these relationships was assessed. FINDINGS: Our results showed a relationship between both psychological contract breach and organizational justice and physicians' organizational attitudes. The quality of exchange with the CMO buffered the negative effect of psychological contract breach and reinforced the positive effects of organizational justice with respect to physicians' organizational attitudes. PRACTICE IMPLICATIONS: Our results demonstrate that both economic and noneconomic aspects are important when considering physicians' key organizational attitudes. The reciprocity dynamic between physician and hospital can be enhanced by high-quality exchange with the CMO.

Determinants of using (non-)fluoroscopy-guided positioning for radiographs: a case study research.

This study examines the determinants of using (non-)fluoroscopy-guided positioning (FGP) for radiographs, in order to improve the use of non-FGP imaging techniques. We focused on knowledge and attitudes of radiographers and radiologists with respect to applying non-FGP in radiography and organizational factors. We analyzed data from an in-depth multiple case study that includes observations and field notes, interviews, documents and images collected from the radiology departments of four hospitals. The unified theory of acceptance and use of technology (UTAUT) was used to frame the findings. We found that inadequate skills and insufficient knowledge of positioning techniques and negative attitudes towards non-FGP were present. More precisely, staff expressed concerns with respect to the impact on the workload and workflow. Besides facilitating organizational conditions, the social influence of peers and the clinical leadership of RLs were found to be important. Adequate supervision, regular feedback and coaching were identified as important enabling factors for increasing the quality of the applied imaging techniques. In the conclusion we state that determinants of using non-FGP are quite complex. Therefore we argue that a holistic approach considering all these aspects is needed to improve imaging practices.

The Mediating Role of Psychological Contract Violation Between Psychological Contract Breach And Nurses' Organizational Attitudes.

This study draws on psychological contract theory, according to which organizational members reciprocate detrimental treatment they perceive with negative work-related attitudes and behaviors. Organizational attitudes were predicted by both breach and violation. This study demonstrates the importance of psychological contract breach and violation to nurses. Nursing administrators and leaders are advised to monitor and balance the expectations of nurses. They should recognize the importance of the interpretive process leading to feelings of betrayal and anger, thus providing the opportunity to manage perceptions of breach.

Fulfilment of administrative and professional organisational obligations and nurses' customer-oriented behaviours.

AIM: The aim of the study was to examine the relationship between the perceived quality of organisational exchange and nurses' customer-oriented behaviours. BACKGROUND: Hospitals face increasing competitive market conditions. Registered nurses interact closely with patients and therefore play an important front-office role towards patients. METHODS: A cross-sectional study was conducted. Registered nurses (n = 151) of a Belgian hospital received a questionnaire to assess the fulfilment of administrative and professional organisational obligations and their customer-oriented behaviours. RESULTS: We found a positive relationship between psychological contract fulfilment and nurses' customer-oriented behaviours. More precisely administrative and professional psychological contract fulfilment relates significantly to nurses' service delivery and external representation. In case of internal influence only administrative psychological contract fulfilment was significantly related. CONCLUSIONS: Nurses' perceptions of the fulfilment of administrative and professional obligations are important to their customer-oriented behaviours. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers must be aware of the impact of fulfilling both administrative and professional obligations of registered nurses in order to optimise their customer-oriented behaviours.

The impact of professional and organizational identification on the relationship between hospital-physician exchange and customer-oriented behaviour of physicians.

BACKGROUND: Hospitals face increasingly competitive market conditions. In this challenging environment, hospitals have been struggling to build high-quality hospital-physician relationships. In the literature, two types of managerial strategies for optimizing relationships have been identified. The first focuses on optimizing the economic relationship; the second focuses on the noneconomic dimension and emphasizes the cooperative structure and collaborative nature of the hospital-physician relationship. We investigate potential spillover effects between the perceptions of physicians of organizational exchange and their customer-oriented behaviors. METHODS: A cross-sectional study was conducted on 130 self-employed physicians practicing at six Belgian hospitals. Economic exchange was measured using the concept of distributive justice (DJ); noneconomic exchange was measured by the concept of perceived organizational support (POS). Our outcomes consist of three types of customer-oriented behaviours: internal influence (II), external representation (ER), and service delivery (SD). RESULTS: Our results show a positive relationship between DJ and II (adjusted R(2) = 0.038, t = 2.35; p = 0.028) and ER (adjusted R(2) = 0.15, t = 4.59; p < 0.001) and a positive relationship between POS and II (adjusted R(2) = 0.032, t = 2.26; p = 0.026) and ER (adjusted R(2) = 0.22, t = 5.81; p < 0.001). No relationship was present between DJ (p = 0.54) or POS (p = 0.57) and SD. Organizational identification positively moderates the relationship between POS and ER (p = 0.045) and between DJ and ER (p = 0.056). The relationships between POS and II (p = 0.54) and between DJ and II (p = 0.99) were not moderated by OI. Professional identification did not moderate the studied relationships. CONCLUSION: Our results demonstrate that both perceptions of economic and noneconomic exchange are important to self-employed physicians' customer-oriented behaviours. Fostering organizational identification could enhance this reciprocity dynamic.

Hospital-physician relations: the relative importance of economic, relational and professional attributes to organizational attractiveness.

BACKGROUND: Belgian hospitals face a growing shortage of physicians and increasingly competitive market conditions. In this challenging environment hospitals are struggling to build effective hospital-physician relationships which are considered to be a critical determinant of organizational success. METHODS: Employed physicians of a University hospital were surveyed. Organizational attributes were identified through the literature and two focus groups. Variables were measured using validated questionnaires. Descriptive analyses and linear regression were used to test the model and relative importance analyses were performed. RESULTS: The selected attributes predict hospital attractiveness significantly (79.3%). The relative importance analysis revealed that hospital attractiveness is most strongly predicted by professional attributes (35.3%) and relational attributes (29.7%). In particular, professional development opportunities (18.8%), hospital prestige (16.5%), organizational support (17.2%) and leader support (9.3%) were found to be most important. Besides these non-economic aspects, the employed physicians indicated pay and financial benefits (7.4%) as a significant predictor of hospital attractiveness. Work-life balance and job security were not significantly related to hospital attractiveness. CONCLUSIONS: This study shows that initiatives aimed at strengthening physicians' positive perceptions of professional and relational aspects of practicing medicine in hospitals, while assuring satisfactory financial conditions, may offer useful avenues for increasing the level of perceived hospital attractiveness. Overall, hospitals are advised to use a differentiated approach to increase their attractiveness to physicians.

Front-office/back-office configurations and operational performance in complex health services.

BACKGROUND: Acquired brain injury (ABI) occurs from various causes at different ages and leads to many different types of healthcare needs. Several Dutch ABI-networks installed a local co-ordination and contact point (CCP) which functions as a central and easily accessible service for people to consult when they have questions related to ABI. GOALS: To explore the relationship between front/back office design and operational performance by investigating the particular enquiry service provided by different CCPs for people affected by an ABI. METHODS: In-depth interviews with 14 FO/BO employees from three case organizations, complemented with information from desk research and three one-day field visits. RESULTS: The CCPs applied different FO/BO configurations in terms of customer contact and in terms of grouping of front and/or back office activities into tasks for one employee. DISCUSSION: It is the complexity of the enquiry that determines which approach is more appropriate. For complex enquiries, the level of decoupling is high in all CCPs. This allows multiple experts to be involved in the process. For regular enquiries, CCPs have a choice: either working in the same way as in the complex enquiries or coupling FO/BO activities to be able to serve clients faster and without handovers.

The impact of organizational support and leader-member exchange on the work-related behaviour of nursing professionals: the moderating effect of professional and organizational identification.

AIM: The aim of this study was to examine the relations between perceived organizational support, the quality of leader-member exchange, in-role and extra-role behaviour, professional identification and organizational identification among registered nurses and nurse assistants. BACKGROUND: Theoretically, employees will reciprocate received beneficial treatment with positive attitudes and behaviour. Recently, it has been shown that this principle may be more complex than originally anticipated. DESIGN: A quantitative, cross-sectional survey design was used. The quality of social exchange and identification was scored by the involved registered nurses and nurse assistants; in-role and extra-role behaviour was rated by the head nurse. METHODS: The survey was administered to nurses and nurse assistants (n = 196) working in five Belgian nursing homes. Data were collected from February-March 2012. Pearson correlation analyses, t-test analyses and hierarchical regression were used to analyse the data. RESULTS: Our results showed no relationship between perceived organizational support and leader-member exchange and in-role behaviour. A positive relationship was found between perceived organizational support and extra-role behaviour and a trend towards significance between leader-member exchange and extra-role behaviour. Organizational and professional identification moderated the relationship between perceived organizational support and extra-role behaviour. CONCLUSIONS: Our study demonstrates the importance of social exchange to nurses and nurse assistants and therefore nursing administrators and leaders. When registered nurses and nurse assistants perceive high-quality social exchange, they are more likely to go the extra mile on behalf of the organization. Fostering social identification could enhance this.

The importance of social exchange to nurses and nurse assistants: impact on retention factors.

AIM: The purpose of this study was to test the norm of reciprocity by examining relationships between perceived organisational support (POS), the quality of leader-member exchange (LMX) and psychological contract breach (PCB) and important nurse retention factors identified in the literature. BACKGROUND: A major cause of turnover among nurses is related to unsatisfying workplaces. Previous research, mainly outside the nursing setting, found that social exchange affects employees' work-related attitudes. METHOD: A cross-sectional survey was conducted on 217 nurses and nursing assistants to test and refine a model linking POS, LMX, PCB with job satisfaction, trust and turnover intentions. RESULTS: Hierarchical multiple linear regression revealed that POS, PCB and LMX explained significant variance in all three retention factors: job satisfaction (adjusted R² = 0.502), trust (adjusted R² = 0.462) and turnover intentions (adjusted R² = 0.196). POS and PCB predicted most strongly job satisfaction (P < 0.001) and trust (P < 0.001 and P < 0.01, respectively). LMX predicted most strongly intention to leave (P < 0.01). CONCLUSION: In our study, POS, the quality of LMX and PCB were strongly related to job satisfaction, trust and turnover intentions. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers and leaders should recognize the importance of social exchange within their organisation to build trust, satisfy and retain scarce nurses and nursing assistants.

Validation of the Psychological Empowerment Scale and Client-Centered Care Questionnaire in budget holders with disabilities.

PURPOSE: Several high-income countries install Cash-for-Care Schemes (CCSs) by granting budgets to care users. However, little quantitative evidence exist on empowerment and client-centered care levels, due to a lack of validated scales. This research aimed to validate the Psychological Empowerment Scale (PE scale) and Client-Centered Care Questionnaire (CCCQ) in budget holders with disabilities. METHODS: A survey was developed based on a literature review and experts and budget holders input. Principal Axis Factoring with direct oblimin rotation, Cronbach's Alpha, and hypotheses testing with socio-demographic and budget characteristics as independent variables, and PE scale and CCCQ as dependent, were undertaken to assess both scales' internal consistency and validity. RESULTS: A convenience sample of 224 Flemish (proxy) budget holders completed the survey. Our analysis showed a two-factor solution for both scales; for the PE scale consisting of "meaning" and "competence," and "self-determination" and "impact," for CCCQ consisting of items 1-7 (conduct by caregiver) and items 8-15 (autonomy). Cronbach's Alpha of both scales was 0.94. The majority of our hypotheses were confirmed. CONCLUSIONS: The findings show that both scales are valid and internally consistent, meaning that they can be further tested in a respondent sample of people with disabilities and in other care contexts.

In light of the current trends in the (health)care sector to stimulate empowerment and client-centered care in care users, the monitoring of this experience is important.The Psychological Empowerment Scale (PE scale) measures empowerment by means of four cognitions (meaning, competence, impact, and self-determination), while the Client-Centered Care Questionnaire (CCCQ) measures the level of client-centered care.The PE scale and CCCQ are valid and internally consistent in our sample of (proxy) budget holders with disabilities.

Do governance choices matter in health care networks?: an exploratory configuration study of health care networks.

BACKGROUND: Health care networks are widely used and accepted as an organizational form that enables integrated care as well as dealing with complex matters in health care. However, research on the governance of health care networks lags behind. The research aim of our study is to explore the type and importance of governance structure and governance mechanisms for network effectiveness. METHODS: The study has a multiple case study design and covers 22 health care networks. Using a configuration view, combinations of network governance and other network characteristics were studied on the level of the network. Based on interview and questionnaire data, network characteristics were identified and patterns in the data looked for. RESULTS: Neither a dominant (or optimal) governance structure or mechanism nor a perfect fit among governance and other characteristics were revealed, but a number of characteristics that need further study might be related to effective networks such as the role of governmental agencies, legitimacy, and relational, hierarchical, and contractual governance mechanisms as complementary factors. CONCLUSIONS: Although the results emphasize the situational character of network governance and effectiveness, they give practitioners in the health care sector indications of which factors might be more or less crucial for network effectiveness.

Do Cash-For-Care Schemes Increase Care Users' Experience of Empowerment? A Systematic Review.

BACKGROUND: In cash-for-care schemes, care users are granted a budget or given a voucher to purchase care services, under the assumption that this will enable them to become engaged and empowered customers, leading to more person-centered care. However, opponents of such schemes argue that the responsibility of organizing care is thereby shifted from governments to care users, thus reducing care users' experience of empowerment. The tension between these opposing discourses supposes that other factors affect care users' experience of empowerment. OBJECTIVE: This systematic review explores the experiences of empowerment and person-centered care of budget holders in cash-for-care schemes and the antecedents that can affect this experience. METHOD: We screened seven databases up to October 10, 2022. To be included, articles needed to be peer-reviewed, written in English or French, and contain empirical evidence of the experience of empowerment of budget holders in the form of qualitative or quantitative data. RESULTS: The initial search identified 10,966 records of which 90 articles were retained for inclusion. The results show that several contextual and personal characteristics determine whether cash-for-care schemes increase empowerment. The identified contextual factors are establishing a culture of change, supportive financial climate, flexible regulatory framework, and access to support and information. The identified personal characteristics refer to the financial, social, and personal resources of the care user. CONCLUSION: This review confirms that multiple factors can affect care users' experience of empowerment. However, active cooperation and communication between care user and care provider are essential if policy makers wish to increase care users' experience of empowerment.