[The development and validation of two scales on retribution practices: PRG-13 and PRE-21].

PubMed

Boada-Grau, Joan; Costa-Solé, Jordi; Gil-Ripoll, Carme; Vigil-Colet, Andreu

2012-01-01

The present study outlines the development process of two scales that measure general and specific retribution practices in organisations. Historically, retribution has been the subject of research of other social sciences such as Sociology and Business Administration. In Psychology, and more specifically in Work and Organisational Psychology, there are hardly any studies or inventories designed to evaluate retribution practices. In order to accomplish the objectives, a sample of 237 employees was selected, 42.6% of whom were women and 57.4% were men. We performed and exploratory factorial analysis using principal axis factoring as extraction method and an oblique rotation (oblimin) to analyse the two scales. The former is made up of four factors and the latter is a two-factor scale. The reliability coefficients of the six subscales we obtained ranged between .72 and .89. External validity was analysed using the correlations obtained between the two inventories and the Balanced Scorecard. The two tools were found to be two potentially useful scales to evaluate retribution practices.

Exploring the Interconnectedness among Strategy Development, Shared Mental Models, Organisational Learning and Organisational Change

ERIC Educational Resources Information Center

Malan, Renee

2011-01-01

The cognitive psychological processes related to learning and change behaviour are factors that impact on organisational strategy development. Strategy development is dependent on strategic thinking that is reciprocally influenced by shared mental models, organisational learning and organisational change. Although strategy development, shared…

The effects of cyclic tensile strain on the organisation and expression of cytoskeletal elements in bovine intervertebral disc cells: an in vitro study.

PubMed

Li, S; Jia, X; Duance, V C; Blain, E J

2011-06-20

It is still relatively unclear how intervertebral disc (IVD) cells sense a mechanical stimulus and convert this signal into a biochemical response. Previous studies demonstrated that the cytoskeletal elements are mechano-responsive in many cell types and may contribute to mechano-signalling pathways. The objective of this study was to determine the response of cells from the outer annulus fibrosus (OAF) to physiological levels of cyclic tensile strain; further, cells from the nucleus pulposus (NP) were also subjected to an identical loading regime to compare biological responses across the IVD populations. We determined whether the organisation and expression of the major cytoskeletal elements and their associated accessory proteins are responsive to mechanical stimulation in these cells, and whether these changes correlated with either a catabolic or anabolic phenotype. OAF and NP cells from immature bovine IVD were seeded onto Flexcell® type I collagen coated plates. Cells were subjected to cyclic tensile strain (10 %, 1 Hz) for 60 minutes. Post-loading, cells were processed for immunofluorescence microscopy, RNA extracted for quantitative PCR and protein extracted for Western blotting analysis. F-actin reorganisation was evident in OAF and NP cells subjected to tensile strain; strain induced β-actin at the transcriptional and translational level in OAF cells. β-tubulin mRNA and protein synthesis increased in strained OAF cells, but vimentin expression was significantly inhibited. Cytoskeletal element organisation and expression were less responsive to strain in NP cells. Tensile strain increased type I collagen and differentially regulated extracellular matrix (ECM)-degrading enzymes' mRNA levels in OAF cells. Strain induced type II collagen transcription in NP cells, but had no effect on the transcription of any other genes analysed. Tensile strain induces different mechano-responses in the organisation and/or expression of cytoskeletal elements and on markers of IVD metabolism. Differential mechano-regulation of anabolic and catabolic ECM components in the OAF and NP populations reflects their respective mechanical environments in situ.

Public release of performance data in changing the behaviour of healthcare consumers, professionals or organisations

PubMed Central

Ketelaar, Nicole ABM; Faber, Marjan J; Flottorp, Signe; Rygh, Liv Helen; Deane, Katherine HO; Eccles, Martin P

2014-01-01

Background It is becoming increasingly common to release information about the performance of hospitals, health professionals or providers, and healthcare organisations into the public domain. However, we do not know how this information is used and to what extent such reporting leads to quality improvement by changing the behaviour of healthcare consumers, providers and purchasers, or to what extent the performance of professionals and providers can be affected. Objectives To determine the effectiveness of the public release of performance data in changing the behaviour of healthcare consumers, professionals and organisations. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Effective Practice and Organisation of Care (EPOC) Trials Register, MEDLINE Ovid (from 1966), EMBASE Ovid (from 1979), CINAHL, PsycINFO Ovid (from 1806) and DARE up to 2011. Selection criteria We searched for randomised or quasi-randomised trials, interrupted time series and controlled before-after studies of the effects of publicly releasing data regarding any aspect of the performance of healthcare organisations or individuals. The papers had to report at least one main outcome related to selecting or changing care. Other outcome measures were awareness, attitude, views and knowledge of performance data and costs. Data collection and analysis Two review authors independently screened studies for eligibility and extracted data. For each study, we extracted data about the target groups (healthcare consumers, healthcare providers and healthcare purchasers), performance data, main outcomes (choice of healthcare provider and improvement by means of changes in care) and other outcomes (awareness, attitude, views, knowledge of performance data and costs). Main results We included four studies containing more than 35,000 consumers, and 1560 hospitals. Three studies were conducted in the USA and examined consumer behaviour after the public release of performance data. Two studies found no effect of Consumer Assessment of Healthcare Providers and Systems information on health plan choice in a Medicaid population. One interrupted time series study found a small positive effect of the publishing of data on patient volumes for coronary bypass surgery and low-complication outliers for lumbar discectomy, but these effects did not persist longer than two months after each public release. No effects on patient volumes for acute myocardial infarction were found. One cluster-randomised controlled trial, conducted in Canada, studied improvement changes in care after the public release of performance data for patients with acute myocardial infarction and congestive heart failure. No effects for the composite process-of-care indicators for either condition were found, but there were some improvements in the individual process-of-care indicators. There was an effect on the mortality rates for acute myocardial infarction. More quality improvement activities were initiated in response to the publicly-released report cards. No secondary outcomes were reported. Authors’ conclusions The small body of evidence available provides no consistent evidence that the public release of performance data changes consumer behaviour or improves care. Evidence that the public release of performance data may have an impact on the behaviour of healthcare professionals or organisations is lacking. PMID:22071813

The role of global public health strategy in non-profit organisational change at country level: lessons from the joining of Save the Children and Merlin in Myanmar.

PubMed

Campbell, Fiona M; Balabanova, Dina; Howard, Natasha

2018-01-01

The paper presents a case study that critically assesses the role of global strategy 'Public Health on the Frontline 2014-2015' ('the Strategy') in supporting Merlin and Save the Children's organisational change and future programme of the combined organisation in Myanmar. Research was undertaken in 2014 in Myanmar. Twenty-six individual and three group interviews were conducted with stakeholders, and 10 meetings relevant to the country organisational transition process were observed. A conceptual framework was developed to assess the role of the global strategy in supporting the country change process. Several positive aspects of the global strategy were found, as well as critical shortcomings in its support to the organisational change process at country level. The strategy was useful in signalling Save the Children's intention to scale up humanitarian health provision. However, it had only limited influence on the early change process and outcomes in Myanmar. Results highlight several aspects that would enhance the role of a global strategy at country level. Lessons can be applied by organisations undertaking a similar process. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Strengthening expertise for health technology assessment and priority-setting in Africa

PubMed Central

Doherty, Jane E; Wilkinson, Thomas; Edoka, Ijeoma; Hofman, Karen

2017-01-01

ABSTRACT Background: Achieving sustainable universal health coverage depends partly on fair priority-setting processes that ensure countries spend scarce resources wisely. While general health economics capacity-strengthening initiatives exist in Africa, less attention has been paid to developing the capacity of individuals, institutions and networks to apply economic evaluation in support of health technology assessment and effective priority-setting. Objective: On the basis of international  lessons, to identify how research organisations and partnerships could contribute to capacity strengthening for health technology assessment and priority-setting in Africa. Methods: A rapid scan was conducted of international formal and grey literature and lessons extracted from the deliberations of two international and regional workshops relating to capacity-building for health technology assessment. ‘Capacity’ was defined in broad terms, including a conducive political environment, strong public institutional capacity to drive priority-setting, effective networking between experts, strong research organisations and skilled researchers. Results: Effective priority-setting requires more than high quality economic research. Researchers have to engage with an array of stakeholders, network closely other research organisations, build partnerships with different levels of government and train the future generation of researchers and policy-makers. In low- and middle-income countries where there are seldom government units or agencies dedicated to health technology assessment, they also have to support the development of an effective priority-setting process that is sensitive to societal and government needs and priorities. Conclusions: Research organisations have an important role to play in contributing to the development of health technology assessment and priority-setting capacity. In Africa, where there are resource and capacity challenges, effective partnerships between local and international researchers, and with key government stakeholders, can leverage existing skills and knowledge to generate a critical mass of individuals and institutions. These would help to meet the priority-setting needs of African countries and contribute to sustainable universal health coverage. PMID:29035166

The relative contribution of neurocognition and social cognition to 6-month vocational outcomes following Individual Placement and Support in first-episode psychosis.

PubMed

Allott, Kelly A; Cotton, Susan M; Chinnery, Gina L; Baksheev, Gennady N; Massey, Jessica; Sun, Pamela; Collins, Zoe; Barlow, Emma; Broussard, Christina; Wahid, Tasha; Proffitt, Tina-Marie; Jackson, Henry J; Killackey, Eoin

2013-10-01

To examine whether baseline neurocognition and social cognition predict vocational outcomes over 6 months in patients with first-episode psychosis (FEP) enrolled in a randomised controlled trial of Individual Placement and Support (IPS) versus treatment as usual (TAU). 135 FEP participants (IPS n=69; TAU n=66) completed a comprehensive neurocognitive and social cognitive battery. Principal axis factor analysis using PROMAX rotation was used to determine the underlying cognitive structure of the battery. Setwise (hierarchical) logistic and multivariate linear regressions were used to examine predictors of: (a) enrolment in education and employment; and (b) hours of employment over 6 months. Neurocognition and social cognition factors were entered into the models after accounting for premorbid IQ, baseline functioning and treatment group. Six cognitive factors were extracted: (i) social cognition; (ii) information processing speed; (iii) verbal learning and memory; (iv) attention and working memory; (v) visual organisation and memory; and (vi) verbal comprehension. Enrolment in education over 6 months was predicted by enrolment in education at baseline (p=.002) and poorer visual organisation and memory (p=.024). Employment over 6 months was predicted by employment at baseline (p=.041) and receiving IPS (p=.020). Better visual organisation and memory predicted total hours of paid work over 6 months (p<.001). Visual organisation and memory predicted the enrolment in education and duration of employment, after accounting for premorbid IQ, baseline functioning and treatment. Social cognition did not contribute to the prediction of vocational outcomes. Neurocognitive interventions may enhance employment duration in FEP. © 2013 Elsevier B.V. All rights reserved.

Managing workplace stress in community pharmacy organisations: lessons from a review of the wider stress management and prevention literature.

PubMed

Jacobs, Sally; Johnson, Sheena; Hassell, Karen

2018-02-01

Workplace stress in community pharmacy is increasing internationally due, in part, to pharmacists' expanding roles and escalating workloads. Whilst the business case for preventing and managing workplace stress by employers is strong, there is little evidence for the effectiveness of organisational stress management interventions in community pharmacy settings. To identify and synthesise existing evidence for the effectiveness of organisational solutions to workplace stress from the wider organisational literature which may be adaptable to community pharmacies. A secondary synthesis of existing reviews. Publications were identified through keyword searches of electronic databases and the internet; inclusion and exclusion criteria were applied; data about setting, intervention, method of evaluation, effectiveness and conclusions (including factors for success) were extracted and synthesised. Eighteen reviews of the stress management and prevention literature were identified. A comprehensive list of organisational interventions to prevent or manage workplace stress, ordered by prevalence of evidence of effectiveness, was produced, together with an ordered list of the benefits both to the individual and employing organisation. An evidence-based model of best practice was derived specifying eight factors for success: top management support, context-specific interventions, combined organisational and individual interventions, a participative approach, clearly delineated tasks and responsibilities, buy-in from middle management, change agents as facilitators and change in organisational culture. This literature review provides community pharmacy organisations with evidence from which to develop effective and successful stress management strategies to support pharmacists and pharmacy staff. Well-designed trials of stress management interventions in community pharmacy organisations are still required. © 2017 Royal Pharmaceutical Society.

Harnessing ISO/IEC 12207 to Examine the Extent of SPI Activity in an Organisation

NASA Astrophysics Data System (ADS)

Clarke, Paul; O'Connor, Rory

The quality of the software development process directly affects the quality of the software product. To be successful, software development organisations must respond to changes in technology and business circumstances, and therefore software process improvement (SPI) is required. SPI activity relates to any modification that is performed to the software process in order to improve an aspect of the process. Although multiple process assessments could be employed to examine SPI activity, they present an inefficient tool for such an examination. This paper presents an overview of a new survey-based resource that utilises the process reference model in ISO/IEC 12207 in order to expressly and directly determine the level of SPI activity in a software development organisation. This survey instrument can be used by practitioners, auditors and researchers who are interested in determining the extent of SPI activity in an organisation.

The translation of sports injury prevention and safety promotion knowledge: insights from key intermediary organisations.

PubMed

Bekker, Sheree; Paliadelis, Penny; Finch, Caroline F

2017-03-28

A recognised research-to-practice gap exists in the health research field of sports injury prevention and safety promotion. There is a need for improved insight into increasing the relevancy, accessibility and legitimacy of injury prevention and safety promotion research knowledge for sport settings. The role of key organisations as intermediaries in the process of health knowledge translation for sports settings remains under-explored, and this paper aims to determine, and describe, the processes of knowledge translation undertaken by a set of key organisations in developing and distributing injury prevention and safety promotion resources. The National Guidance for Australian Football Partnerships and Safety (NoGAPS) project provided the context for this study. Representatives from five key NoGAPS organisations participated in individual face-to-face interviews about organisational processes of knowledge translation. A qualitative descriptive methodology was used to analyse participants' descriptions of knowledge translation activities undertaken at their respective organisations. Several themes emerged around health knowledge translation processes and considerations, including (1) identifying a need for knowledge translation, (2) developing and disseminating resources, and (3) barriers and enablers to knowledge translation. This study provides insight into the processes that key organisations employ when developing and disseminating injury prevention and safety promotion resources within sport settings. The relevancy, accessibility and legitimacy of health research knowledge is foregrounded, with a view to increasing the influence of research on the development of health-related resources suitable for community sport settings.

Analysis of a municipal wastewater treatment plant using a neural network-based pattern analysis

USGS Publications Warehouse

Hong, Y.-S.T.; Rosen, Michael R.; Bhamidimarri, R.

2003-01-01

This paper addresses the problem of how to capture the complex relationships that exist between process variables and to diagnose the dynamic behaviour of a municipal wastewater treatment plant (WTP). Due to the complex biological reaction mechanisms, the highly time-varying, and multivariable aspects of the real WTP, the diagnosis of the WTP are still difficult in practice. The application of intelligent techniques, which can analyse the multi-dimensional process data using a sophisticated visualisation technique, can be useful for analysing and diagnosing the activated-sludge WTP. In this paper, the Kohonen Self-Organising Feature Maps (KSOFM) neural network is applied to analyse the multi-dimensional process data, and to diagnose the inter-relationship of the process variables in a real activated-sludge WTP. By using component planes, some detailed local relationships between the process variables, e.g., responses of the process variables under different operating conditions, as well as the global information is discovered. The operating condition and the inter-relationship among the process variables in the WTP have been diagnosed and extracted by the information obtained from the clustering analysis of the maps. It is concluded that the KSOFM technique provides an effective analysing and diagnosing tool to understand the system behaviour and to extract knowledge contained in multi-dimensional data of a large-scale WTP. ?? 2003 Elsevier Science Ltd. All rights reserved.

Can learning organizations survive in the newer NHS?

PubMed Central

Sheaff, Rod; Pilgrim, David

2006-01-01

Background This paper outlines the principal characteristics of a learning organisation and the organisational features that define it. It then compares these features with the organisational conditions that currently obtain, or are being created, within the British NHS. The contradictory development of recent British health policy, resulting in the NHS becoming both more marketised and more bureaucratised has correspondingly ambiguous implications for attempts to implement a 'learning organisation' model. Methods Texts that define and debate the characteristics of a learning organisation were found by snowballing references from the founding learning organisation books and published papers, and then by searching a database specifically devised for a literature review on organisational structures and processes in health care. COPAC and ABI-Info databases for subsequent peer-reviewed publications that also appeared relevant to the present study were searched. Results The outcomes of the above search are summarised and mapped onto the current constituent organisations of the NHS to identify the extent to which they achieve or approximate to a learning organisation status. Conclusion Because of the complexity of the NHS and the contradictory processes of marketisation and bureaucratisation characterising it, it cannot, as a whole system, become a learning organisation. However, it is possible that its constituent organisations may achieve this status to varying degrees. Constraints upon NHS managers to speak their minds freely place an ultimate limit on learning organisation development. This limitation suggests that current British health service policy encourages organisational learning-but not too openly and not too much. PMID:17074083

Organisational development in a rural hospital in Australia.

PubMed

Young, Suzanne; Leggat, Sandra; Stanton, Pauline; Bartram, Tim

2015-04-01

This paper analyses an organisational development project that aimed to change the organisational culture and improve people management systems and processes. The questions addressed were: was the change process a success; how was success defined; and what were the barriers to its progress? We examined the process of change over a 3-year period. The organisational development intervention is described and analysed. Qualitative methods, including document review, in-depth interviews and focus groups, participant observation, newsletters and diary entries were used to gather the data. A variant of competing values was used to analyse the data. We sought to build trust with all managers and encouraged reflection by conducting feedback sessions, presentations, workshops and one-on-one and group discussions. A cross-site action group was established to encourage organisation-wide participation in the project. However, it was clear that stakeholders had different understandings and perceptions of the problems facing the organisation. The project faltered when a leadership development intervention was organised. The existence of at least four different organisational 'worlds' and identities, according to different professional groupings with different goals, languages and values, was evident. The relationship between the researcher and subjects was key in terms of whether the researcher is seen as an 'expert' or as a 'facilitator'. In bringing about change, we need to work with the Chief Executive Officer in empowering others. Hence, the researchers need to engage in continual dialogue across boundaries and within groups as well as at individual levels to provide support for organisational change.

Fuzzylot: a novel self-organising fuzzy-neural rule-based pilot system for automated vehicles.

PubMed

Pasquier, M; Quek, C; Toh, M

2001-10-01

This paper presents part of our research work concerned with the realisation of an Intelligent Vehicle and the technologies required for its routing, navigation, and control. An automated driver prototype has been developed using a self-organising fuzzy rule-based system (POPFNN-CRI(S)) to model and subsequently emulate human driving expertise. The ability of fuzzy logic to represent vague information using linguistic variables makes it a powerful tool to develop rule-based control systems when an exact working model is not available, as is the case of any vehicle-driving task. Designing a fuzzy system, however, is a complex endeavour, due to the need to define the variables and their associated fuzzy sets, and determine a suitable rule base. Many efforts have thus been devoted to automating this process, yielding the development of learning and optimisation techniques. One of them is the family of POP-FNNs, or Pseudo-Outer Product Fuzzy Neural Networks (TVR, AARS(S), AARS(NS), CRI, Yager). These generic self-organising neural networks developed at the Intelligent Systems Laboratory (ISL/NTU) are based on formal fuzzy mathematical theory and are able to objectively extract a fuzzy rule base from training data. In this application, a driving simulator has been developed, that integrates a detailed model of the car dynamics, complete with engine characteristics and environmental parameters, and an OpenGL-based 3D-simulation interface coupled with driving wheel and accelerator/ brake pedals. The simulator has been used on various road scenarios to record from a human pilot driving data consisting of steering and speed control actions associated to road features. Specifically, the POPFNN-CRI(S) system is used to cluster the data and extract a fuzzy rule base modelling the human driving behaviour. Finally, the effectiveness of the generated rule base has been validated using the simulator in autopilot mode.

Collaboration processes and perceived effectiveness of integrated care projects in primary care: a longitudinal mixed-methods study.

PubMed

Valentijn, Pim P; Ruwaard, Dirk; Vrijhoef, Hubertus J M; de Bont, Antoinette; Arends, Rosa Y; Bruijnzeels, Marc A

2015-10-09

Collaborative partnerships are considered an essential strategy for integrating local disjointed health and social services. Currently, little evidence is available on how integrated care arrangements between professionals and organisations are achieved through the evolution of collaboration processes over time. The first aim was to develop a typology of integrated care projects (ICPs) based on the final degree of integration as perceived by multiple stakeholders. The second aim was to study how types of integration differ in changes of collaboration processes over time and final perceived effectiveness. A longitudinal mixed-methods study design based on two data sources (surveys and interviews) was used to identify the perceived degree of integration and patterns in collaboration among 42 ICPs in primary care in The Netherlands. We used cluster analysis to identify distinct subgroups of ICPs based on the final perceived degree of integration from a professional, organisational and system perspective. With the use of ANOVAs, the subgroups were contrasted based on: 1) changes in collaboration processes over time (shared ambition, interests and mutual gains, relationship dynamics, organisational dynamics and process management) and 2) final perceived effectiveness (i.e. rated success) at the professional, organisational and system levels. The ICPs were classified into three subgroups with: 'United Integration Perspectives (UIP)', 'Disunited Integration Perspectives (DIP)' and 'Professional-oriented Integration Perspectives (PIP)'. ICPs within the UIP subgroup made the strongest increase in trust-based (mutual gains and relationship dynamics) as well as control-based (organisational dynamics and process management) collaboration processes and had the highest overall effectiveness rates. On the other hand, ICPs with the DIP subgroup decreased on collaboration processes and had the lowest overall effectiveness rates. ICPs within the PIP subgroup increased in control-based collaboration processes (organisational dynamics and process management) and had the highest effectiveness rates at the professional level. The differences across the three subgroups in terms of the development of collaboration processes and the final perceived effectiveness provide evidence that united stakeholders' perspectives are achieved through a constructive collaboration process over time. Disunited perspectives at the professional, organisation and system levels can be aligned by both trust-based and control-based collaboration processes.

[Anaesthetists learn--do institutions also learn? Importance of institutional learning and corporate culture in clinics].

PubMed

Schüpfer, G; Gfrörer, R; Schleppers, A

2007-10-01

In only a few contexts is the need for substantial learning more pronounced than in health care. For a health care provider, the ability to learn is essential in a changing environment. Although individual humans are programmed to learn naturally, organisations are not. Learning that is limited to individual professions and traditional approaches to continuing medical education is not sufficient to bring about substantial changes in the learning capacity of an institution. Also, organisational learning is an important issue for anaesthesia departments. Future success of an organisation often depends on new capabilities and competencies. Organisational learning is the capacity or processes within an organisation to maintain or improve performance based on experience. Learning is seen as a system-level phenomenon as it stays in the organisation regardless of the players involved. Experience from other industries shows that learning strategies tend to focus on single loop learning, with relatively little double loop learning and virtually no meta-learning or non-learning. The emphasis on team delivery of health care reinforces the need for team learning. Learning organisations make learning an intrinsic part of their organisations and are a place where people continually learn how to learn together. Organisational learning practice can help to improve existing skills and competencies and to change outdated assumptions, procedures and structures. So far, learning theory has been ignored in medicine, due to a wide variety of complex political, economic, social, organisational culture and medical factors that prevent innovation and resist change. The organisational culture is central to every stage of the learning process. Learning organisations move beyond simple employee training into organisational problem solving, innovation and learning. Therefore, teamwork and leadership are necessary. Successful organisations change the competencies of individuals, the systems, the organisation, the strategy and the culture.

The relationship between quality management practices and organisational performance: A structural equation modelling approach

NASA Astrophysics Data System (ADS)

Jamaluddin, Z.; Razali, A. M.; Mustafa, Z.

2015-02-01

The purpose of this paper is to examine the relationship between the quality management practices (QMPs) and organisational performance for the manufacturing industry in Malaysia. In this study, a QMPs and organisational performance framework is developed according to a comprehensive literature review which cover aspects of hard and soft quality factors in manufacturing process environment. A total of 11 hypotheses have been put forward to test the relationship amongst the six constructs, which are management commitment, training, process management, quality tools, continuous improvement and organisational performance. The model is analysed using Structural Equation Modeling (SEM) with AMOS software version 18.0 using Maximum Likelihood (ML) estimation. A total of 480 questionnaires were distributed, and 210 questionnaires were valid for analysis. The results of the modeling analysis using ML estimation indicate that the fits statistics of QMPs and organisational performance model for manufacturing industry is admissible. From the results, it found that the management commitment have significant impact on the training and process management. Similarly, the training had significant effect to the quality tools, process management and continuous improvement. Furthermore, the quality tools have significant influence on the process management and continuous improvement. Likewise, the process management also has a significant impact to the continuous improvement. In addition the continuous improvement has significant influence the organisational performance. However, the results of the study also found that there is no significant relationship between management commitment and quality tools, and between the management commitment and continuous improvement. The results of the study can be used by managers to prioritize the implementation of QMPs. For instances, those practices that are found to have positive impact on organisational performance can be recommended to managers so that they can allocate resources to improve these practices to get better performance.

Analysing barriers to service improvement using a multi-level theory of innovation: the case of glaucoma outpatient clinics.

PubMed

Turner, Simon; Vasilakis, Christos; Utley, Martin; Foster, Paul; Kotecha, Aachal; Fulop, Naomi J

2018-05-01

The development and implementation of innovation by healthcare providers is understood as a multi-determinant and multi-level process. Theories at different analytical levels (i.e. micro and organisational) are needed to capture the processes that influence innovation by providers. This article combines a micro theory of innovation, actor-network theory, with organisational level processes using the 'resource based view of the firm'. It examines the influence of, and interplay between, innovation-seeking teams (micro) and underlying organisational capabilities (meso) during innovation processes. We used ethnographic methods to study service innovations in relation to ophthalmology services run by a specialist English NHS Trust at multiple locations. Operational research techniques were used to support the ethnographic methods by mapping the care process in the existing and redesigned clinics. Deficiencies in organisational capabilities for supporting innovation were identified, including manager-clinician relations and organisation-wide resources. The article concludes that actor-network theory can be combined with the resource-based view to highlight the influence of organisational capabilities on the management of innovation. Equally, actor-network theory helps to address the lack of theory in the resource-based view on the micro practices of implementing change. © 2018 The Authors. Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for SHIL.

Organisational development in general practice: lessons from practice and professional development plans (PPDPs)

PubMed Central

Elwyn, Glyn; Hocking, Paul

2000-01-01

Background Improving the quality and effectiveness of clinical practice is becoming a key task within all health services. Primary medical care, as organised in the UK is composed of clinicians who work in independent partnerships (general practices) that collaborate with other health care professionals. Although many practices have successfully introduced innovations, there are no organisational development structures in place that support the evolution of primary medical care towards integrated care processes. Providing incentives for attendance at passive educational events and promoting 'teamwork' without first identifying organisational priorities are interventions that have proved to be ineffective at changing clinical processes. A practice and professional development plan feasibility study was evaluated in Wales and provided the experiential basis for a summary of the lessons learnt on how best to guide organisational development systems for primary medical care. Results Practice and professional development plans are hybrids produced by the combination of ideas from management (the applied behavioural science of organisational development) and education (self-directed adult learning theories) and, in conceptual terms, address the lack of effectiveness of passive educational strategies by making interventions relevant to identified system wide needs. In the intervention, each practice participated in a series of multidisciplinary workshops (minimum 4) where the process outcome was the production of a practice development plan and a set of personal portfolios, and the final outcome was a realised organisational change. It was apparent during the project that organisational admission to a process of developmental planning needed to be a stepwise process, where initial interest can lead to a fuller understanding, which subsequently develops into motivation and ownership, sufficient to complete the exercise. The advantages of introducing expert external facilitation were clear: evaluations of internal group processes were possible, strategic issues could be raised and explored and financial probity ensured. These areas are much more difficult to examine when only internal stakeholders are engaged in a planning process. Conclusions It is not possible to introduce practice and professional development plans (organisational development and organisational learning projects) in a publicly funded health care system without first addressing existing educational and management structures. Existing systems are based on educational credits for attendance and emerging accountability frameworks (criteria checklists) for clinical governance. Moving to systems that are less summative and more formative, and based on the philosophies of continual quality improvement, require changes to be made in the relevant support systems in order achieve policy proposals. PMID:11178111

Temporal context and the organisational impairment of memory search in schizophrenia.

PubMed

Polyn, Sean M; McCluey, Joshua D; Morton, Neal W; Woolard, Austin A; Luksik, Andrew S; Heckers, Stephan

2015-01-01

An influential theory of schizophrenic deficits in executive function suggests that patients have difficulty maintaining and utilising an internal contextual representation, whose function is to ensure that stimuli are processed in a task-appropriate manner. In basic research on episodic memory, retrieved-context theories propose that an internal contextual representation is critically involved in memory search, facilitating the retrieval of task-appropriate memories. This contextual machinery is thought to give rise to temporal organisation during free recall: the tendency for successive recall responses to correspond to items from nearby positions on the study list. If patients with schizophrenia have a generalised contextual deficit, then this leads to the prediction that these patients will exhibit reduced temporal organisation in free recall. Using a combination of classic and recently developed organisational measures, we characterised recall organisation in 75 patients with schizophrenia and 72 nondisordered control participants performing a multi-trial free-recall task. Patients with schizophrenia showed diminished temporal organisation, as well as diminished subjective organisation of their recall sequences relative to control participants. The two groups showed similar amounts of semantic organisation during recall. The observation of reduced temporal organisation in the patient group is consistent with the proposal that the memory deficit in schizophrenia can be characterised as a deficit in contextual processing.

Analysis of Chromatin Organisation

ERIC Educational Resources Information Center

Szeberenyi, Jozsef

2011-01-01

Terms to be familiar with before you start to solve the test: chromatin, nucleases, sucrose density gradient centrifugation, melting point, gel electrophoresis, ethidium bromide, autoradiography, Southern blotting, Northern blotting, Sanger sequencing, restriction endonucleases, exonucleases, linker DNA, chloroform extraction, nucleosomes,…

Technology adoption and implementation in organisations: comparative case studies of 12 English NHS Trusts

PubMed Central

Ahmad, Raheelah; Holmes, Alison

2012-01-01

Objectives To understand organisational technology adoption (initiation, adoption decision, implementation) by looking at the different types of innovation knowledge used during this process. Design Qualitative, multisite, comparative case study design. Setting One primary care and 11 acute care organisations (trusts) across all health regions in England in the context of infection prevention and control. Participants and data analysis 121 semistructured individual and group interviews with 109 informants, involving clinical and non-clinical staff from all organisational levels and various professional groups. Documentary evidence and field notes were also used. 38 technology adoption processes were analysed using an integrated approach combining inductive and deductive reasoning. Main findings Those involved in the process variably accessed three types of innovation knowledge: ‘awareness’ (information that an innovation exists), ‘principles’ (information about an innovation's functioning principles) and ‘how-to’ (information required to use an innovation properly at individual and organisational levels). Centralised (national, government-led) and local sources were used to obtain this knowledge. Localised professional networks were preferred sources for all three types of knowledge. Professional backgrounds influenced an asymmetric attention to different types of innovation knowledge. When less attention was given to ‘how-to’ compared with ‘principles’ knowledge at the early stages of the process, this contributed to 12 cases of incomplete implementation or discontinuance after initial adoption. Conclusions Potential adopters and change agents often overlooked or undervalued ‘how-to’ knowledge. Balancing ‘principles’ and ‘how-to’ knowledge early in the innovation process enhanced successful technology adoption and implementation by considering efficacy as well as strategic, structural and cultural fit with the organisation's context. This learning is critical given the policy emphasis for health organisations to be innovation-ready. PMID:22492183

The Ghosts of Higher Education Reform: On the Organisational Processes Surrounding Policy Borrowing

ERIC Educational Resources Information Center

Brøgger, Katja

2014-01-01

The Bologna Process is one of the most extensive examples of policy borrowing processes. Based on qualitative data, this article argues in favour of studying part of this process as "global smallness", centring on the organisational effects of the implementation of a globalised curriculum. Through Derrida's notion on hauntology,…

Sustainability reporting in public sector organisations: Exploring the relation between the reporting process and organisational change management for sustainability.

PubMed

Domingues, Ana Rita; Lozano, Rodrigo; Ceulemans, Kim; Ramos, Tomás B

2017-05-01

Sustainability Reporting has become a key element in different organisations. Although there have been a number of academic publications discussing the adoption of sustainability reports in the public sector, their numbers have been quite low when compared to those focussing on corporate reports. Additionally, there has been little research on the link between sustainability reporting in Public Sector Organisations (PSOs) and Organisational Change Management for Sustainability (OCMS). This paper focuses on the contribution of sustainability reporting to OCMS. A survey was sent to all PSOs that have published at least one sustainability report based on the GRI guidelines. The study provides a critical analysis of the relation between sustainability reporting and OCMS in PSOs, including the drivers for reporting, the impacts on organisation change management, and the role of stakeholders in the process. Despite still lagging in sustainability reporting journey, PSOs are starting to use sustainability reporting as a communication tool, and this could drive organisational changes for sustainability. Copyright © 2017 Elsevier Ltd. All rights reserved.

A qualitative synthesis of the positive and negative impacts related to delivery of peer-based health interventions in prison settings.

PubMed

South, Jane; Woodall, James; Kinsella, Karina; Bagnall, Anne-Marie

2016-09-29

Peer interventions involving prisoners in delivering peer education and peer support in a prison setting can address health need and add capacity for health services operating in this setting. This paper reports on a qualitative synthesis conducted as part of a systematic review of prison-based peer interventions. One of the review questions aimed to investigate the positive and negative impacts of delivering peer interventions within prison settings. This covered organisational and process issues relating to peer interventions, including prisoner and staff views. A qualitative synthesis of qualitative and mixed method studies was undertaken. The overall study design comprised a systematic review involving searching, study selection, data extraction and validity assessment. Studies reporting interventions with prisoners or ex-prisoners delivering education or support to prisoners resident in any type of prison or young offender institution, all ages, male and female, were included. A thematic synthesis was undertaken with a subset of studies reporting qualitative data (n = 33). This involved free coding of text reporting qualitative findings to develop a set of codes, which were then grouped into thematic categories and mapped back to the review question. Themes on process issues and wider impacts were grouped into four thematic categories: peer recruitment training and support; organisational support; prisoner relationships; prison life. There was consistent qualitative evidence on the need for organisational support within the prison to ensure smooth implementation and on managing security risks when prisoners were involved in service delivery. A suite of factors affecting the delivery of peer interventions and the wider organisation of prison life were identified. Alongside reported benefits of peer delivery, some reasons for non-utilisation of services by other prisoners were found. There was weak qualitative evidence on wider impacts on the prison system, including better communication between staff and prisoners. Gaps in evidence were identified. The quality of included studies limited the strength of the conclusions. The main conclusion is that peer interventions cannot be seen as independent of prison life and health services need to work in partnership with prison services to deliver peer interventions. More research is needed on long-term impacts. PROSPERO ref: CRD42012002349 .

Introducing peer worker roles into UK mental health service teams: a qualitative analysis of the organisational benefits and challenges.

PubMed

Gillard, Steve G; Edwards, Christine; Gibson, Sarah L; Owen, Katherine; Wright, Christine

2013-05-24

The provision of peer support as a component of mental health care, including the employment of Peer Workers (consumer-providers) by mental health service organisations, is increasingly common internationally. Peer support is strongly advocated as a strategy in a number of UK health and social care policies. Approaches to employing Peer Workers are proliferating. There is evidence to suggest that Peer Worker-based interventions reduce psychiatric inpatient admission and increase service user (consumer) empowerment. In this paper we seek to address a gap in the empirical literature in understanding the organisational challenges and benefits of introducing Peer Worker roles into mental health service teams. We report the secondary analysis of qualitative interview data from service users, Peer Workers, non-peer staff and managers of three innovative interventions in a study about mental health self-care. Relevant data was extracted from interviews with 41 participants and subjected to analysis using Grounded Theory techniques. Organisational research literature on role adoption framed the analysis. Peer Workers were highly valued by mental health teams and service users. Non-peer team members and managers worked hard to introduce Peer Workers into teams. Our cases were projects in development and there was learning from the evolutionary process: in the absence of formal recruitment processes for Peer Workers, differences in expectations of the Peer Worker role can emerge at the selection stage; flexible working arrangements for Peer Workers can have the unintended effect of perpetuating hierarchies within teams; the maintenance of protective practice boundaries through supervision and training can militate against the emergence of a distinctive body of peer practice; lack of consensus around what constitutes peer practice can result in feelings for Peer Workers of inequality, disempowerment, uncertainty about identity and of being under-supported. This research is indicative of potential benefits for mental health service teams of introducing Peer Worker roles. Analysis also suggests that if the emergence of a distinctive body of peer practice is not adequately considered and supported, as integral to the development of new Peer Worker roles, there is a risk that the potential impact of any emerging role will be constrained and diluted.

Evidence use in decision-making on introducing innovations: a systematic scoping review with stakeholder feedback.

PubMed

Turner, Simon; D'Lima, Danielle; Hudson, Emma; Morris, Stephen; Sheringham, Jessica; Swart, Nick; Fulop, Naomi J

2017-12-04

A range of evidence informs decision-making on innovation in health care, including formal research findings, local data and professional opinion. However, cultural and organisational factors often prevent the translation of evidence for innovations into practice. In addition to the characteristics of evidence, it is known that processes at the individual level influence its impact on decision-making. Less is known about the ways in which processes at the professional, organisational and local system level shape evidence use and its role in decisions to adopt innovations. A systematic scoping review was used to review the health literature on innovations within acute and primary care and map processes at the professional, organisational and local system levels which influence how evidence informs decision-making on innovation. Stakeholder feedback on the themes identified was collected via focus groups to test and develop the findings. Following database and manual searches, 31 studies reporting primary qualitative data met the inclusion criteria: 24 were of sufficient methodological quality to be included in the thematic analysis. Evidence use in decision-making on innovation is influenced by multi-level processes (professional, organisational, local system) and interactions across these levels. Preferences for evidence vary by professional group and health service setting. Organisations can shape professional behaviour by requiring particular forms of evidence to inform decision-making. Pan-regional organisations shape innovation decision-making at lower levels. Political processes at all levels shape the selection and use of evidence in decision-making. The synthesis of results from primary qualitative studies found that evidence use in decision-making on innovation is influenced by processes at multiple levels. Interactions between different levels shape evidence use in decision-making (e.g. professional groups and organisations can use local systems to validate evidence and legitimise innovations, while local systems can tailor or frame evidence to influence activity at lower levels). Organisational leaders need to consider whether the environment in which decisions are made values diverse evidence and stakeholder perspectives. Further qualitative research on decision-making practices that highlights how and why different types of evidence come to count during decisions, and tracks the political aspects of decisions about innovation, is needed.

[Process orientation as a tool of strategic approaches to corporate governance and integrated management systems].

PubMed

Sens, Brigitte

2010-01-01

The concept of general process orientation as an instrument of organisation development is the core principle of quality management philosophy, i.e. the learning organisation. Accordingly, prestigious quality awards and certification systems focus on process configuration and continual improvement. In German health care organisations, particularly in hospitals, this general process orientation has not been widely implemented yet - despite enormous change dynamics and the requirements of both quality and economic efficiency of health care processes. But based on a consistent process architecture that considers key processes as well as management and support processes, the strategy of excellent health service provision including quality, safety and transparency can be realised in daily operative work. The core elements of quality (e.g., evidence-based medicine), patient safety and risk management, environmental management, health and safety at work can be embedded in daily health care processes as an integrated management system (the "all in one system" principle). Sustainable advantages and benefits for patients, staff, and the organisation will result: stable, high-quality, efficient, and indicator-based health care processes. Hospitals with their broad variety of complex health care procedures should now exploit the full potential of total process orientation. Copyright © 2010. Published by Elsevier GmbH.

The spatial organisation of joint surface chondrocytes: review of its potential roles in tissue functioning, disease and early, preclinical diagnosis of osteoarthritis.

PubMed

Aicher, Wilhelm K; Rolauffs, Bernd

2014-04-01

Chondrocytes display within the articular cartilage depth-dependent variations of their many properties that are comparable to the depth-dependent changes of the properties of the surrounding extracellular matrix. However, not much is known about the spatial organisation of the chondrocytes throughout the tissue. Recent studies revealed that human chondrocytes display distinct spatial patterns of organisation within the articular surface, and each joint surface is dominated in a typical way by one of four basic spatial patterns. The resulting complex spatial organisations correlate with the specific diarthrodial joint type, suggesting an association of the chondrocyte organisation within the joint surface with the occurring biomechanical forces. In response to focal osteoarthritis (OA), the superficial chondrocytes experience a destruction of their spatial organisation within the OA lesion, but they also undergo a defined remodelling process distant from the OA lesion in the remaining, intact cartilage surface. One of the biological insights that can be derived from this spatial remodelling process is that the chondrocytes are able to respond in a generalised and coordinated fashion to distant focal OA. The spatial characteristics of this process are tremendously different from the cellular aggregations typical for OA lesions, suggesting differences in the underlying mechanisms. Here we summarise the available information on the spatial organisation of chondrocytes and its potential roles in cartilage functioning. The spatial organisation could be used to diagnose early OA onset before manifest OA results in tissue destruction and clinical symptoms. With further development, this concept may become clinically suitable for the diagnosis of preclinical OA.

[Business organization theory: its potential use in the organization of the operating room].

PubMed

Bartz, H-J

2005-07-01

The paradigm of patient care in the German health system is changing. The introduction of German Diagnosis Related Groups (G-DRGs), a diagnosis-related coding system, has made process-oriented thinking increasingly important. The treatment process is viewed and managed as a whole from the admission to the discharge of the patient. The interfaces of departments and sectors are diminished. A main objective of these measures is to render patient care more cost efficient. Within the hospital, the operating room (OR) is the most expensive factor accounting for 25 - 50 % of the costs of a surgical patient and is also a bottleneck in the surgical patient care. Therefore, controlling of the perioperative treatment process is getting more and more important. Here, the business organisation theory can be a very useful tool. Especially the concepts of process organisation and process management can be applied to hospitals. Process-oriented thinking uncovers and solves typical organisational problems. Competences, responsibilities and tasks are reorganised by process orientation and the enterprise is gradually transformed to a process-oriented system. Process management includes objective-oriented controlling of the value chain of an enterprise with regard to quality, time, costs and customer satisfaction. The quality of the process is continuously improved using process-management techniques. The main advantage of process management is consistent customer orientation. Customer orientation means to be aware of the customer's needs at any time during the daily routine. The performance is therefore always directed towards current market requirements. This paper presents the basics of business organisation theory and to point out its potential use in the organisation of the OR.

Organisational Capability in Internalising Quality Culture in Higher Institution

ERIC Educational Resources Information Center

Bello, Muhammad Ibrahim; Ibrahim, Burhan Muhammad Bn; Bularafa, Mohammed Waziri

2015-01-01

The study examines the influence of leadership roles related to organisational capability consisting of directing setting, strategic and organisational process, alignment, intervention and strategic capability on depending variable internalising quality culture in IIUM. The study used 100 samples consisting of lecturers, non-academic staff and…

Exploring the Best HRM Practices-Performance Relationship: An Empirical Approach

ERIC Educational Resources Information Center

Theriou, George N.; Chatzoglou, Prodromos D.

2009-01-01

Purpose: This paper aims to empirically examine the linkages between best human resource (HRM) practices, knowledge management, organisational learning, organisational capabilities and organisational performance. The proposed framework and findings intend to add to the understanding of the specific processes that mediate between best HRM practices…

Exploring organisational competences in Human Factors and UX project work: managing careers, project tactics and organisational strategy.

PubMed

Furniss, Dominic; Curzon, Paul; Blandford, Ann

2018-06-01

Organisational competence in Human Factors and UX (user experience) has not been looked at before despite its relevance to project success. We define organisational competence as the collective competence of the individuals, bringing together their complementary abilities to deliver an outcome that is typically more than the sum of its parts. Twenty-two UX and Human Factors practitioners were interviewed about their project work in two contrasting domains: web design and safety-critical systems to explore organisational competences. Through doing a FRAM analysis, 29 functions and 6 main areas of competences were identified: the central project process; the process of learning about the problem; maintaining and developing client relations; staff development; evolving practices; and the management of documentation for audit and quality control. These dynamic and situated competences form a web of interactions. Managing competences is essential for project success. Implications for managing careers, project tactics and organisational strategy are discussed. Practitioner Summary: Organisational competences impact how routine and non-routine project work is performed, but these have received little attention in the literature. Six key areas of competences in Human Factors and UX project work were identified from practitioner interviews. Managing combinations of adaptive competences is important for developing careers, project tactics and organisational strategies.

Rethinking capacity building for knowledge mobilisation: developing multilevel capabilities in healthcare organisations.

PubMed

Kislov, Roman; Waterman, Heather; Harvey, Gill; Boaden, Ruth

2014-11-15

Knowledge mobilisation in healthcare organisations is often carried out through relatively short-term projects dependent on limited funding, which raises concerns about the long-term sustainability of implementation and improvement. It is becoming increasingly recognised that the translation of research evidence into practice has to be supported by developing the internal capacity of healthcare organisations to engage with and apply research. This process can be supported by external knowledge mobilisation initiatives represented, for instance, by professional associations, collaborative research partnerships and implementation networks. This conceptual paper uses empirical and theoretical literature on organisational learning and dynamic capabilities to enhance our understanding of intentional capacity building for knowledge mobilisation in healthcare organisations. The discussion is structured around the following three themes: (1) defining and classifying capacity building for knowledge mobilisation; (2) mechanisms of capability development in organisational context; and (3) individual, group and organisational levels of capability development. Capacity building is presented as a practice-based process of developing multiple skills, or capabilities, belonging to different knowledge domains and levels of complexity. It requires an integration of acquisitive learning, through which healthcare organisations acquire knowledge and skills from knowledge mobilisation experts, and experience-based learning, through which healthcare organisations adapt, absorb and modify their knowledge and capabilities through repeated practice. Although the starting point for capability development may be individual-, team- or organisation-centred, facilitation of the transitions between individual, group and organisational levels of learning within healthcare organisations will be needed. Any initiative designed to build capacity for knowledge mobilisation should consider the subsequent trajectory of newly developed knowledge and skills within the recipient healthcare organisations. The analysis leads to four principles underpinning a practice-based approach to developing multilevel knowledge mobilisation capabilities: (1) moving from 'building' capacity from scratch towards 'developing' capacity of healthcare organisations; (2) moving from passive involvement in formal education and training towards active, continuous participation in knowledge mobilisation practices; (3) moving from lower-order, project-specific capabilities towards higher-order, generic capabilities allowing healthcare organisations to adapt to change, absorb new knowledge and innovate; and (4) moving from single-level to multilevel capability development involving transitions between individual, group and organisational learning.

Organisational Change: A Solution-Focused Approach

ERIC Educational Resources Information Center

Morgan, Gavin

2016-01-01

This study investigates the effectiveness of a solution-focused approach to organisational change. Planning Alternative Tomorrows with Hope (PATH) is an intervention more commonly applied to individuals. In this study the intervention is used with groups of people working in educational organisations to help manage the change process. The approach…

CogStack - experiences of deploying integrated information retrieval and extraction services in a large National Health Service Foundation Trust hospital.

PubMed

Jackson, Richard; Kartoglu, Ismail; Stringer, Clive; Gorrell, Genevieve; Roberts, Angus; Song, Xingyi; Wu, Honghan; Agrawal, Asha; Lui, Kenneth; Groza, Tudor; Lewsley, Damian; Northwood, Doug; Folarin, Amos; Stewart, Robert; Dobson, Richard

2018-06-25

Traditional health information systems are generally devised to support clinical data collection at the point of care. However, as the significance of the modern information economy expands in scope and permeates the healthcare domain, there is an increasing urgency for healthcare organisations to offer information systems that address the expectations of clinicians, researchers and the business intelligence community alike. Amongst other emergent requirements, the principal unmet need might be defined as the 3R principle (right data, right place, right time) to address deficiencies in organisational data flow while retaining the strict information governance policies that apply within the UK National Health Service (NHS). Here, we describe our work on creating and deploying a low cost structured and unstructured information retrieval and extraction architecture within King's College Hospital, the management of governance concerns and the associated use cases and cost saving opportunities that such components present. To date, our CogStack architecture has processed over 300 million lines of clinical data, making it available for internal service improvement projects at King's College London. On generated data designed to simulate real world clinical text, our de-identification algorithm achieved up to 94% precision and up to 96% recall. We describe a toolkit which we feel is of huge value to the UK (and beyond) healthcare community. It is the only open source, easily deployable solution designed for the UK healthcare environment, in a landscape populated by expensive proprietary systems. Solutions such as these provide a crucial foundation for the genomic revolution in medicine.

eHealth adoption factors in medical hospitals: A focus on the Netherlands.

PubMed

Faber, Sander; van Geenhuizen, Marina; de Reuver, Mark

2017-04-01

Despite strong policy interest in eHealth, actual adoption in many European hospitals is low. This study develops and tests in a preliminary way an organisational eHealth adoption model rooted in several adoption frameworks to improve understanding of this phenomenon. The model is explored through a survey among hospitals in the Netherlands using a Structural Equation Modelling (SEM) approach. Specific attention is paid to measurement of organisational readiness and to adoption as a process including different stages. Our results suggest a sharp decrease in the adoption process by hospitals after the stage of interest/commitment. Adoption tends to be significantly affected by size of the hospital, organisational readiness including technical aspects, and top management support. eHealth adoption tends to be not a linear process nor a linear function of contextual antecedents. Organisational readiness is an important antecedent for eHealth adoption. The paper concludes with organisational strategies and policies to foster eHealth adoption in hospitals and suggestions for future study. Copyright © 2017 Elsevier B.V. All rights reserved.

Outsourcing in private healthcare organisations: a Greek perspective.

PubMed

Moschuris, Socrates J; Kondylis, Michael N

2007-01-01

The purpose of this paper is to present a study carried out to investigate the extent of outsourcing, the decision-making process, the impact of outsourcing, and the future trend of outsourcing in private healthcare organisations in Greece. A survey instrument was designed and mailed to a random sample of 100 private healthcare organisations in Greece. A total of 25 usable questionnaires were received, representing a response rate of 25 percent. The survey instrument focused on the extent to which private healthcare organisations outsource services, the decision-making process for choosing an external service provider, the impact of outsourcing, and the future trend of outsourcing. Private healthcare organisations in Greece outsource a variety of activities. Cost savings, customisation, and customer satisfaction are the main factors affecting the outsourcing decision. The cooperation with a contract service provider has led to an improvement in customer satisfaction and to a cost reduction. Most users are highly satisfied with the performance of these companies and believe that there will be a future increase in the usage of these services. The paper provides a framework regarding outsourcing in private healthcare organisations. This research fills the gap in the area of outsourcing in private healthcare organisations in Greece.

The influence of social challenges when implementing information systems in a Swedish health-care organisation.

PubMed

Nilsson, Lina; Eriksén, Sara; Borg, Christel

2016-09-01

To describe and obtain a deeper understanding of social challenges and their influence on the implementation process when implementing Information systems in a Swedish health-care organisation. Despite positive effects when implementing Information systems in health-care organisations, there are difficulties in the implementation process. Nurses' experiences of being neglected have been dismissed as reasons for setbacks in implementation. An Institutional Ethnography design was used. A deductive content analysis was made influenced by empirically identified social challenges of power, professional identity and encounters. An abstraction was made of the analysis. Nineteen nurses at macro, meso and micro levels were interviewed in focus groups. Organisational levels are lost in different ways in how to control the reformation, how to introduce Information systems as reformation strategies and in how to translate new tools and assumptions that do not fit traditional ways of working in shaping professional identities. Different focus may affect the reformation of health-care organisations and implementation and knowledge processes. An implementation climate is needed where the system standards fit the values of the users. Nursing management needs to be visionary, engaged and work with risk factors in order to reform the hierarchical health-care organisation. © 2016 John Wiley & Sons Ltd.

Understanding innovators' experiences of barriers and facilitators in implementation and diffusion of healthcare service innovations: a qualitative study

PubMed Central

2011-01-01

Background Healthcare service innovations are considered to play a pivotal role in improving organisational efficiency and responding effectively to healthcare needs. Nevertheless, healthcare organisations encounter major difficulties in sustaining and diffusing innovations, especially those which concern the organisation and delivery of healthcare services. The purpose of the present study was to explore how healthcare innovators of process-based initiatives perceived and made sense of factors that either facilitated or obstructed the innovation implementation and diffusion. Methods A qualitative study was designed. Fifteen primary and secondary healthcare organisations in the UK, which had received health service awards for successfully generating and implementing service innovations, were studied. In-depth, semi structured interviews were conducted with the organisational representatives who conceived and led the development process. The data were recorded, transcribed and thematically analysed. Results Four main themes were identified in the analysis of the data: the role of evidence, the function of inter-organisational partnerships, the influence of human-based resources, and the impact of contextual factors. "Hard" evidence operated as a proof of effectiveness, a means of dissemination and a pre-requisite for the initiation of innovation. Inter-organisational partnerships and people-based resources, such as champions, were considered an integral part of the process of developing, establishing and diffusing the innovations. Finally, contextual influences, both intra-organisational and extra-organisational were seen as critical in either impeding or facilitating innovators' efforts. Conclusions A range of factors of different combinations and co-occurrence were pointed out by the innovators as they were reflecting on their experiences of implementing, stabilising and diffusing novel service initiatives. Even though the innovations studied were of various contents and originated from diverse organisational contexts, innovators' accounts converged to the significant role of the evidential base of success, the inter-personal and inter-organisational networks, and the inner and outer context. The innovators, operating themselves as important champions and being often willing to lead constructive efforts of implementation to different contexts, can contribute to the promulgation and spread of the novelties significantly. PMID:22176739

Understanding innovators' experiences of barriers and facilitators in implementation and diffusion of healthcare service innovations: a qualitative study.

PubMed

Barnett, Julie; Vasileiou, Konstantina; Djemil, Fayika; Brooks, Laurence; Young, Terry

2011-12-16

Healthcare service innovations are considered to play a pivotal role in improving organisational efficiency and responding effectively to healthcare needs. Nevertheless, healthcare organisations encounter major difficulties in sustaining and diffusing innovations, especially those which concern the organisation and delivery of healthcare services. The purpose of the present study was to explore how healthcare innovators of process-based initiatives perceived and made sense of factors that either facilitated or obstructed the innovation implementation and diffusion. A qualitative study was designed. Fifteen primary and secondary healthcare organisations in the UK, which had received health service awards for successfully generating and implementing service innovations, were studied. In-depth, semi structured interviews were conducted with the organisational representatives who conceived and led the development process. The data were recorded, transcribed and thematically analysed. Four main themes were identified in the analysis of the data: the role of evidence, the function of inter-organisational partnerships, the influence of human-based resources, and the impact of contextual factors. "Hard" evidence operated as a proof of effectiveness, a means of dissemination and a pre-requisite for the initiation of innovation. Inter-organisational partnerships and people-based resources, such as champions, were considered an integral part of the process of developing, establishing and diffusing the innovations. Finally, contextual influences, both intra-organisational and extra-organisational were seen as critical in either impeding or facilitating innovators' efforts. A range of factors of different combinations and co-occurrence were pointed out by the innovators as they were reflecting on their experiences of implementing, stabilising and diffusing novel service initiatives. Even though the innovations studied were of various contents and originated from diverse organisational contexts, innovators' accounts converged to the significant role of the evidential base of success, the inter-personal and inter-organisational networks, and the inner and outer context. The innovators, operating themselves as important champions and being often willing to lead constructive efforts of implementation to different contexts, can contribute to the promulgation and spread of the novelties significantly.

European Organisation for Research and Treatment of Cancer (EORTC) Pathobiology Group standard operating procedure for the preparation of human tumour tissue extracts suited for the quantitative analysis of tissue-associated biomarkers.

PubMed

Schmitt, Manfred; Mengele, Karin; Schueren, Elisabeth; Sweep, Fred C G J; Foekens, John A; Brünner, Nils; Laabs, Juliane; Malik, Abha; Harbeck, Nadia

2007-03-01

With the new concept of 'individualized treatment and targeted therapies', tumour tissue-associated biomarkers have been given a new role in selection of cancer patients for treatment and in cancer patient management. Tumour biomarkers can give support to cancer patient stratification and risk assessment, treatment response identification, or to identifying those patients who are expected to respond to certain anticancer drugs. As the field of tumour-associated biomarkers has expanded rapidly over the last years, it has become increasingly apparent that a strong need exists to establish guidelines on how to easily disintegrate the tumour tissue for assessment of the presence of tumour tissue-associated biomarkers. Several mechanical tissue (cell) disruption techniques exist, ranging from bead mill homogenisation and freeze-fracturing through to blade or pestle-type homogenisation, to grinding and ultrasonics. Still, only a few directives have been given on how fresh-frozen tumour tissues should be processed for the extraction and determination of tumour biomarkers. The PathoBiology Group of the European Organisation for Research and Treatment of Cancer therefore has devised a standard operating procedure for the standardised preparation of human tumour tissue extracts which is designed for the quantitative analysis of tumour tissue-associated biomarkers. The easy to follow technical steps involved require 50-300 mg of deep-frozen cancer tissue placed into small size (1.2 ml) cryogenic tubes. These are placed into the shaking flask of a Mikro-Dismembrator S machine (bead mill) to pulverise the tumour tissue in the capped tubes in the deep-frozen state by use of a stainless steel ball, all within 30 s of exposure. RNA is isolated from the pulverised tissue following standard procedures. Proteins are extracted from the still frozen pulverised tissue by addition of Tris-buffered saline to obtain the cytosol fraction of the tumour or by the Tris buffer supplemented with the non-ionic detergent Triton X-100, and, after high-speed centrifugation, are found in the tissue supernatant. The resulting tissue cell debris sediment is a rich source of genomic DNA.

The comprehensive health care orientation process indicators explain hospital organisation's attractiveness: a Bayesian analysis of newly hired nurse and physician survey data.

PubMed

Peltokoski, Jaana; Vehviläinen-Julkunen, Katri; Pitkäaho, Taina; Mikkonen, Santtu; Miettinen, Merja

2015-10-01

To examine the relationship of a comprehensive health care orientation process with a hospital's attractiveness. Little is known about indicators of the employee orientation process that most likely explain a hospital organisation's attractiveness. Empirical data collected from registered nurses (n = 145) and physicians (n = 37) working in two specialised hospital districts. A Naive Bayes Classification was applied to examine the comprehensive orientation process indicators that predict hospital's attractiveness. The model was composed of five orientation process indicators: the contribution of the orientation process to nurses' and physicians' intention to stay; the defined responsibilities of the orientation process; interaction between newcomer and colleagues; responsibilities that are adapted for tasks; and newcomers' baseline knowledge assessment that should be done before the orientation phase. The Naive Bayes Classification was used to explore employee orientation process and related indicators. The model constructed provides insight that can be used in designing and implementing the orientation process to promote the hospital organisation's attractiveness. Managers should focus on developing fluently organised orientation practices based on the indicators that predict the hospital's attractiveness. For the purpose of personalised orientation, employees' baseline knowledge and competence level should be assessed before the orientation phase. © 2014 John Wiley & Sons Ltd.

A case of the birth and death of a high reliability healthcare organisation.

PubMed

Roberts, K H; Madsen, P; Desai, V; Van Stralen, D

2005-06-01

High reliability organisations (HROs) are those in which errors rarely occur. To accomplish this they conduct relatively error free operations over long periods of time and make consistently good decisions resulting in high quality and reliability. Some organisational processes that characterise HROs are process auditing, implementing appropriate reward systems, avoiding quality degradation, appropriately perceiving that risk exists and developing strategies to deal with it, and command and control. Command and control processes include migrating decision making, redundancy in people or hardware, developing situational awareness, formal rules and procedures, and training. These processes must be tailored to the specific organisation implementing them. These processes were applied to a paediatric intensive care unit (PICU) where care was derived from problem solving methodology rather than protocol. After a leadership change, the unit returned to the hierarchical medical model of care. Important outcome variables such as infant mortality, patient return to the PICU after discharge, days on the PICU, air transports, degraded. Implications for clinical practice include providing caregivers with sufficient flexibility to meet changing situations, encouraging teamwork, and avoiding shaming, naming, and blaming.

A cross-sectional study to identify organisational processes associated with nurse-reported quality and patient safety

PubMed Central

Tvedt, Christine; Sjetne, Ingeborg Strømseng; Helgeland, Jon; Bukholm, Geir

2012-01-01

Objectives The purpose of this study was to identify organisational processes and structures that are associated with nurse-reported patient safety and quality of nursing. Design This is an observational cross-sectional study using survey methods. Setting Respondents from 31 Norwegian hospitals with more than 85 beds were included in the survey. Participants All registered nurses working in direct patient care in a position of 20% or more were invited to answer the survey. In this study, 3618 nurses from surgical and medical wards responded (response rate 58.9). Nurses' practice environment was defined as organisational processes and measured by the Nursing Work Index Revised and items from Hospital Survey on Patient Safety Culture. Outcome measures Nurses' assessments of patient safety, quality of nursing, confidence in how their patients manage after discharge and frequency of adverse events were used as outcome measures. Results Quality system, nurse–physician relation, patient safety management and staff adequacy were process measures associated with nurse-reported work-related and patient-related outcomes, but we found no associations with nurse participation, education and career and ward leadership. Most organisational structures were non-significant in the multilevel model except for nurses’ affiliations to medical department and hospital type. Conclusions Organisational structures may have minor impact on how nurses perceive work-related and patient-related outcomes, but the findings in this study indicate that there is a considerable potential to address organisational design in improvement of patient safety and quality of care. PMID:23263021

Caseload midwifery as organisational change: the interplay between professional and organisational projects in Denmark.

PubMed

Burau, Viola; Overgaard, Charlotte

2015-05-27

The large obstetric units typical of industrialised countries have come under criticism for fragmented and depersonalised care and heavy bureaucracy. Interest in midwife-led continuity models of care is growing, but knowledge about the accompanying processes of organisational change is scarce. This study focuses on midwives' role in introducing and developing caseload midwifery. Sociological studies of midwifery and organisational studies of professional groups were used to capture the strong interests of midwives in caseload midwifery and their key role together with management in negotiating organisational change. We studied three hospitals in Denmark as arenas for negotiating the introduction and development of caseload midwifery and the processes, interests and resources involved. A qualitative multi-case design was used and the selection of hospitals aimed at maximising variance. Ten individual and 14 group interviews were conducted in spring 2013. Staff were represented by caseload midwives, ward midwives, obstetricians and health visitors, management by chief midwives and their deputies. Participants were recruited to maximise the diversity of experience. The data analysis adopted a thematic approach, using within- and across-case analysis. The analysis revealed a highly interdependent interplay between organisational and professional projects in the change processes involved in the introduction and development of caseload midwifery. This was reflected in three ways: first, in the key role of negotiations in all phases; second, in midwives' and management's engagement in both types of projects (as evident from their interests and resources); and third in a high capacity for resolving tensions between the two projects. The ward midwives' role as a third party in organisational change further complicated the process. For managers tasked with the introduction and development of caseload midwifery, our study underscores the importance of understanding the complexity of the underlying change processes and of activating midwives' and managers' interests and resources in addressing the challenges. Further studies of female-dominated professions such as midwifery should offer good opportunities for detailed analysis of the deep-seated interdependence of professional and organisational projects and for identifying the key dimensions of this interdependence.

Are "High Potential" Executives Capable of Building Learning-Oriented Organisations? Reflections on the French Case

ERIC Educational Resources Information Center

Belet, Daniel

2007-01-01

Purpose: The author's interest in learning organisation development leads him to examine large French companies' practices regarding "high potential" executives policies and to question their selection and development processes and their capabilities to develop learning oriented organisations.The author also tries to explain why most…

Storing and Sharing Knowledge: Supporting the Management of Knowledge Made Explicit in Transnational Organisations

ERIC Educational Resources Information Center

Coakes, Elayne

2006-01-01

Purpose: The purpose of this paper is to indicate and illustrate the potential for use of different types of technologies to support knowledge process in transnational organisations. Design/methodology/approach: The paper uses a standard literature review plus illustrations from case organisations to demonstrate the potential applications and…

An ergonomics action research demonstration: integrating human factors into assembly design processes.

PubMed

Village, J; Greig, M; Salustri, F; Zolfaghari, S; Neumann, W P

2014-01-01

In action research (AR), the researcher participates 'in' the actions in an organisation, while simultaneously reflecting 'on' the actions to promote learning for both the organisation and the researchers. This paper demonstrates a longitudinal AR collaboration with an electronics manufacturing firm where the goal was to improve the organisation's ability to integrate human factors (HF) proactively into their design processes. During the three-year collaboration, all meetings, workshops, interviews and reflections were digitally recorded and qualitatively analysed to inform new 'actions'. By the end of the collaboration, HF tools with targets and sign-off by the HF specialist were integrated into several stages of the design process, and engineers were held accountable for meeting the HF targets. We conclude that the AR approach combined with targeting multiple initiatives at different stages of the design process helped the organisation find ways to integrate HF into their processes in a sustainable way. Researchers acted as a catalyst to help integrate HF into the engineering design process in a sustainable way. This paper demonstrates how an AR approach can help achieve HF integration, the benefits of using a reflective stance and one method for reporting an AR study.

Organisational benefits of a strong research culture in a health service: a systematic review.

PubMed

Harding, Katherine; Lynch, Lauren; Porter, Judi; Taylor, Nicholas F

2017-03-01

Objective The aim of the present study was to determine whether there is an association between having research culture in a health service and better organisational performance. Methods Using systematic review methods, databases were searched, inclusion criteria applied and study quality appraised. Data were extracted from selected studies and the results were synthesised descriptively. Results Eight studies were selected for review. Five studies compared health services with high versus low levels of research activity among the workforce. Three studies evaluated the effect of specific interventions focused on the health workforce. All studies reported a positive association between research activity and organisational performance. Improved organisational performance included lower patient mortality rates (two of two studies), higher levels of patient satisfaction (one of one study), reduced staff turnover (two of two studies), improved staff satisfaction (one of two studies) and improved organisational efficiency (four of five studies). Conclusions A stronger research culture appears to be associated with benefits to patients, staff and the organisation. What is known about this topic? Research investment in the health workforce can increase research productivity of the health workforce. In addition, investment in clinical research can lead to positive health outcomes. However, it is not known whether a positive research culture among the health workforce is associated with improved organisational performance. What does this paper add? The present systematic review of the literature provides evidence that a positive research culture and interventions directed at the health workforce are associated with patient, staff and organisational benefits. What are the implications for practitioners? For health service managers and policy makers, one interpretation of the results could be to provide support for initiatives directed at the health workforce to increase a research culture in health services. However, because association does not imply causation, managers need to interpret the results with caution and evaluate the effect of any initiatives to increase the research culture of the health workforce on the performance of their organisation.

System Constellations as a Tool Supporting Organisational Learning and Change Processes

ERIC Educational Resources Information Center

Birkenkrahe, Marcus

2008-01-01

Originally developed in the context of family therapy, system constellations are introduced using an organisational learning and system theoretical framework. Constellations are systemic group interventions using a spatial representation of the system elements. They correspond to deutero-learning processes and use higher-order systemic thinking.…

'Twin2twin' an innovative method of empowering midwives to strengthen their professional midwifery organisations.

PubMed

Cadée, Franka; Perdok, Hilde; Sam, Betty; de Geus, Myrte; Kweekel, Liselotte

2013-10-01

midwives need professional support from a national midwifery organisation to be able to provide the services that are by regulatory mechanisms and accreditation expected of them. Not all midwives in the world are united in a professional organisation. The aim of this project was to strengthen the midwifery organisations of Sierra Leone and the Netherlands. During the process of the project it was realised that the development of a platform of exchange at organisational level would be enhanced by introducing personal exchange between individual midwives. In response to this new insight the original project plan was adjusted by incorporating the twin2twin method. twin2twin is a feminist methodology of mutual exchange between twenty pairs of midwives from different organisations (in this case Sierra Leone and the Netherlands). The method can be distinguished by 10 specific steps. It was developed, used and (re)evaluated through focus group discussions, storytelling and written evaluations. twinning of organisations was strengthened by adding a human component to the process. With the use of the 'twin2twin' method, midwives were encouraged to invested in a professional and personal bond with their 'twin sister'. This bond was independent and went beyond the relatively short four year project period. Through personal engagement and mutual exchange of knowledge and skills, midwives empowered each other to build and strengthen their midwifery organisations both in Sierra Leone and the Netherlands. (Empowerment refers to the expansion in people's ability to make strategic life choices in a context where this ability was previously denied to them (Narayan, 2005); organisational empowerment includes processes and structures that enhance members' skills and provides them with the mutual support necessary to effect community level change (Zimmerman, 1995).). despite challenges we are convinced that twin2twin can be of additional benefit for the success of other projects involved in strengthening midwifery organisations in the long term. It can be used independently or alongside other forms of (co)development not only in midwifery but also in other professions. © 2013 Elsevier Ltd. All rights reserved.

Managing Distributed Innovation Processes in Virtual Organizations by Applying the Collaborative Network Relationship Analysis

NASA Astrophysics Data System (ADS)

Eschenbächer, Jens; Seifert, Marcus; Thoben, Klaus-Dieter

Distributed innovation processes are considered as a new option to handle both the complexity and the speed in which new products and services need to be prepared. Indeed most research on innovation processes was focused on multinational companies with an intra-organisational perspective. The phenomena of innovation processes in networks - with an inter-organisational perspective - have been almost neglected. Collaborative networks present a perfect playground for such distributed innovation processes whereas the authors highlight in specific Virtual Organisation because of their dynamic behaviour. Research activities supporting distributed innovation processes in VO are rather new so that little knowledge about the management of such research is available. With the presentation of the collaborative network relationship analysis this gap will be addressed. It will be shown that a qualitative planning of collaboration intensities can support real business cases by proving knowledge and planning data.

Power relations and contrasting conceptions of evidence in patient-involvement processes used to inform health funding decisions in Australia.

PubMed

Lopes, Edilene; Carter, Drew; Street, Jackie

2015-06-01

We collected and analysed views of key stakeholders on the processes used to involve patient organisations in health care funding decision making in Australia. We conducted 12 semi-structured interviews with patient organisation representatives and members of Advisory Committees that provide advice to the Australian Department of Health and employ Health Technology Assessment (HTA) as an evaluation framework. Using two theoretical frameworks, we analysed structural and contextual elements pertaining to the involvement processes. The findings reported in this article relate to interviewees' perspectives on contextual elements, analysed using a Foucauldian lens. These elements include: the perspectives of marginalised voices; the diversity of views on what ought to be considered valid evidence in a HTA setting; and the relationships between stakeholders, along with how these relationships impact on involvement processes and the outcomes of those processes. The findings demonstrate that the involvement processes currently used are deemed inadequate by both patient organisation representatives and Advisory Committee members, but for different reasons connected to how different stakeholders conceptualise evidence. Advisory Committee members viewed evidence as encompassing clinical outcomes and patient preferences, whereas patient organisation representatives tended to view evidence as encompassing aspects not directly related to a disease entity, such as the social and emotional aspects of patients' experiences in living with illness. Patient organisation representatives reported interacting with other stakeholders (especially industry) to increase the influence of their conception of evidence on decision making. The use of this strategy by interviewees illustrates how power struggles occur in government decision-making processes which involve both medical expertise and patients' accounts. Such struggles, and the power differentials they reflect, need to be considered by those responsible for designing and implementing meaningful public- and patient-involvement processes. Copyright © 2015 Elsevier Ltd. All rights reserved.

Filling the Gaps: The Role and Impact of International Non-Governmental Organisations in "Education for All"

ERIC Educational Resources Information Center

Tota, Pasqua Marina

2014-01-01

This article discusses the involvement of international non-governmental organisations (INGOs) in transnational education policy-making, with particular reference to the global initiative Education for All (EFA). EFA is a policy process carried out by international governmental organisations (IGOs) with the main aim to achieve basic education for…

Organisational Learning as an Emerging Process: The Generative Role of Digital Tools in Informal Learning Practices

ERIC Educational Resources Information Center

Za, Stefano; Spagnoletti, Paolo; North-Samardzic, Andrea

2014-01-01

Increasing attention is paid to organisational learning, with the success of contemporary organisations strongly contingent on their ability to learn and grow. Importantly, informal learning is argued to be even more significant than formal learning initiatives. Given the widespread use of digital technologies in the workplace, what requires…

Educators and the Quality of Their Work Environment: An Analysis of the Organisational Climate in Primary Schools

ERIC Educational Resources Information Center

Vos, D.; van der Westhuizen, Philip C.; Mentz, P. J.; Ellis, S. M.

2012-01-01

The prevalent organisational climate in primary schools in the North West Province was determined in order to formulate management strategies to increase the organisational climate. For this purpose, a quantitative research method, founded in post-positivistic points of departure, was applied. In the process, the Organizational Climate Description…

Role of institutional entrepreneurship in building adaptive capacity in community-based healthcare organisations: realist review protocol

PubMed Central

Iyengar, Sweatha; Katz, Aaron; Durham, Jo

2016-01-01

Introduction Over the past 3 decades, there has been a substantial shift to the marketisation of government-funded health services. For organisations traditionally buffered from the competitive pressures of for-profit enterprises, such as community-based organisations, this means developing the capacity to adapt to competitive tendering processes, shifting client expectations, and increasing demands for greater accountability. Drawing on ideas of institutional entrepreneurship, we believe that attempts to build adaptive capacity require the transformation of existing institutional arrangements. Key in this may be identifying and fostering institutional entrepreneurs—actors who take the lead in being the impetus for, and giving direction to, structural change. This study focuses on the strategies used by institutional entrepreneurs to build adaptive capacity in the community-based healthcare sector. Methods and analysis The research will use an adapted rapid realist review. The review will find underlying theories that explain the circumstances surrounding the implementation of capacity-building strategies that shape organisational response and generate outcomes by activating causal mechanisms. An early scoping of the literature, and consultations with key stakeholders, will be undertaken to identify an initial programme theory. We will search for relevant journal articles and grey literature. Data will be extracted based on contextual factors, mechanisms and outcomes, and their configurations. The analysis will seek patterns and regularities in these configurations and will focus on confirming, refuting or refining our programme theory. Ethics and dissemination The study does not involve primary research and, therefore, does not require formal ethical approval. However, ethical standards of utility, usefulness, feasibility, propriety, accuracy and accountability will be followed. The results will be written up according to the Realist and Meta-Review Evidence Synthesis: Evolving Standards guidelines. Once completed, findings will be published in a peer-reviewed journal. Trial registration number CRD42015026487. PMID:27013599

Role of institutional entrepreneurship in building adaptive capacity in community-based healthcare organisations: realist review protocol.

PubMed

Iyengar, Sweatha; Katz, Aaron; Durham, Jo

2016-03-24

Over the past 3 decades, there has been a substantial shift to the marketisation of government-funded health services. For organisations traditionally buffered from the competitive pressures of for-profit enterprises, such as community-based organisations, this means developing the capacity to adapt to competitive tendering processes, shifting client expectations, and increasing demands for greater accountability. Drawing on ideas of institutional entrepreneurship, we believe that attempts to build adaptive capacity require the transformation of existing institutional arrangements. Key in this may be identifying and fostering institutional entrepreneurs--actors who take the lead in being the impetus for, and giving direction to, structural change. This study focuses on the strategies used by institutional entrepreneurs to build adaptive capacity in the community-based healthcare sector. The research will use an adapted rapid realist review. The review will find underlying theories that explain the circumstances surrounding the implementation of capacity-building strategies that shape organisational response and generate outcomes by activating causal mechanisms. An early scoping of the literature, and consultations with key stakeholders, will be undertaken to identify an initial programme theory. We will search for relevant journal articles and grey literature. Data will be extracted based on contextual factors, mechanisms and outcomes, and their configurations. The analysis will seek patterns and regularities in these configurations and will focus on confirming, refuting or refining our programme theory. The study does not involve primary research and, therefore, does not require formal ethical approval. However, ethical standards of utility, usefulness, feasibility, propriety, accuracy and accountability will be followed. The results will be written up according to the Realist and Meta-Review Evidence Synthesis: Evolving Standards guidelines. Once completed, findings will be published in a peer-reviewed journal. CRD42015026487. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Quality as Sense-Making

ERIC Educational Resources Information Center

Marshall, Stephen

2016-01-01

Sense-making is a process of engaging with complex and dynamic environments that provides organisations and their leaders with a flexible and agile model of the world. The seven key properties of sense-making describe a process that is social and that respects the range of different stakeholders in an organisation. It also addresses the need to…

Action Learning--A Process Which Supports Organisational Change Initiatives

ERIC Educational Resources Information Center

Joyce, Pauline

2012-01-01

This paper reflects on how action learning sets (ALSs) were used to support organisational change initiatives. It sets the scene with contextualising the inclusion of change projects in a masters programme. Action learning is understood to be a dynamic process where a team meets regularly to help individual members address issues through a highly…

Enabling Ethical Code Embeddedness in Construction Organizations: A Review of Process Assessment Approach.

PubMed

Oladinrin, Olugbenga Timo; Ho, Christabel Man-Fong

2016-08-01

Several researchers have identified codes of ethics (CoEs) as tools that stimulate positive ethical behavior by shaping the organisational decision-making process, but few have considered the information needed for code implementation. Beyond being a legal and moral responsibility, ethical behavior needs to become an organisational priority, which requires an alignment process that integrates employee behavior with the organisation's ethical standards. This paper discusses processes for the responsible implementation of CoEs based on an extensive review of the literature. The internationally recognized European Foundation for Quality Management Excellence Model (EFQM model) is proposed as a suitable framework for assessing an organisation's ethical performance, including CoE embeddedness. The findings presented herein have both practical and research implications. They will encourage construction practitioners to shift their attention from ethical policies to possible enablers of CoE implementation and serve as a foundation for further research on ethical performance evaluation using the EFQM model. This is the first paper to discuss the model's use in the context of ethics in construction practice.

Implementation of data management and effect on chronic disease coding in a primary care organisation: A parallel cohort observational study.

PubMed

Greiver, Michelle; Wintemute, Kimberly; Aliarzadeh, Babak; Martin, Ken; Khan, Shahriar; Jackson, Dave; Leggett, Jannet; Lambert-Lanning, Anita; Siu, Maggie

2016-10-12

Consistent and standardized coding for chronic conditions is associated with better care; however, coding may currently be limited in electronic medical records (EMRs) used in Canadian primary care.Objectives To implement data management activities in a community-based primary care organisation and to evaluate the effects on coding for chronic conditions. Fifty-nine family physicians in Toronto, Ontario, belonging to a single primary care organisation, participated in the study. The organisation implemented a central analytical data repository containing their EMR data extracted, cleaned, standardized and returned by the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), a large validated primary care EMR-based database. They used reporting software provided by CPCSSN to identify selected chronic conditions and standardized codes were then added back to the EMR. We studied four chronic conditions (diabetes, hypertension, chronic obstructive pulmonary disease and dementia). We compared changes in coding over six months for physicians in the organisation with changes for 315 primary care physicians participating in CPCSSN across Canada. Chronic disease coding within the organisation increased significantly more than in other primary care sites. The adjusted difference in the increase of coding was 7.7% (95% confidence interval 7.1%-8.2%, p < 0.01). The use of standard codes, consisting of the most common diagnostic codes for each condition in the CPCSSN database, increased by 8.9% more (95% CI 8.3%-9.5%, p < 0.01). Data management activities were associated with an increase in standardized coding for chronic conditions. Exploring requirements to scale and spread this approach in Canadian primary care organisations may be worthwhile.

Auditing emergency management programmes: Measuring leading indicators of programme performance.

PubMed

Tomsic, Heather

Emergency Management Programmes benefit from review and measurement against established criteria. By measuring current vs required programme elements for their actual currency, completeness and effectiveness, the resulting timely reports of achievements and documentation of identified gaps can effectively be used to rationally support prioritised improvement. Audits, with their detailed, triangulated and objectively weighted processes, are the ultimate approach in terms of programme content measurement. Although Emergency Management is often presented as a wholly separate operational mechanism, distinct and functionally different from the organisation's usual management structure, this characterisation is only completely accurate while managing an emergency itself. Otherwise, an organisation's Emergency Management Programme is embedded within that organisation and dependent upon it. Therefore, the organisation's culture and structure of management, accountability and measurement must be engaged for the programme to exist, much less improve. A wise and successful Emergency Management Coordinator does not let the separate and distinct nature of managing an emergency obscure their realisation of the need for an organisation to understand and manage all of the other programme components as part of its regular business practices. This includes its measurement. Not all organisations are sufficiently large or capable of supporting the use of an audit. This paper proposes that alternate, less formal, yet effective mechanisms can be explored, as long as they reflect and support organisational management norms, including a process of relatively informal measurement focused on the organisation's own perception of key Emergency Management Programme performance indicators.

Research on the impact of LMX leadership theory on mutual trust and organisational commitment of employees in Bosnia and Herzegovina

NASA Astrophysics Data System (ADS)

Strukan, E.; Nikolić, M.

2017-05-01

The paper presents the theoretical foundations of leadership based on the LMX exchange leader-member theory which essentially involves leadership process where a continuous and creative interaction between leaders and followers is at the centre of attention, during which the leader, among other things, affects the degree of mutual trust and organisational commitment and the quality of relationships in his/her organisation, which actually has a direct impact on organisational performances, effectiveness of the organisation’s business and its market positioning. Also, the paper presents the results of research conducted in organisations in Bosnia and Herzegovina, which undoubtedly point to the fact that the dimensions of leadership based on the LMX exchange leader-member theory, is strongly correlated with the dimensions of mutual trust and organisational commitment, and to have a significant positive impact on them, and therefore on organisational performances and effectiveness of business organisations that were included in this study.

Organisational learning and self-adaptation in dynamic disaster environments.

PubMed

Corbacioglu, Sitki; Kapucu, Naim

2006-06-01

This paper examines the problems associated with inter-organisational learning and adaptation in the dynamic environments that characterise disasters. The research uses both qualitative and quantitative methods to investigate whether organisational learning took place during and in the time in between five disaster response operations in Turkey. The availability of information and its exchange and distribution within and among organisational actors determine whether self-adaptation happens in the course of a disaster response operation. Organisational flexibility supported by an appropriate information infrastructure creates conditions conducive to essential interaction and permits the flow of information. The study found that no significant organisational learning occurred within Turkish disaster management following the earthquakes in Erzincan (1992), Dinar (1995) and Ceyhan (1998). By contrast, the 'symmetry-breaking' Marmara earthquake of 1999 initiated a 'double loop' learning process that led to change in the organisational, technical and cultural aspects of Turkish disaster management, as revealed by the Duzce earthquake response operations.

Split-mouth comparison of physics forceps and extraction forceps in orthodontic extraction of upper premolars.

PubMed

Hariharan, Samyuktha; Narayanan, Vinod; Soh, Chen Loong

2014-12-01

We compared outcome variables (operative complications, inflammatory complications, and operating time) in patients being treated by orthodontic extraction of upper premolars with the Physics forceps or the universal extraction forceps. We organised a single blind, split-mouth clinical trial to compare the outcomes of the 2 groups (n=54 premolars). The Physics forceps group had lower mean (SD) visual analogue scores (VAS) for pain (0.59 (0.57)) on the first postoperative day than the other group (1.04 (0.85)) (p=0.03). There were no other significant differences between the 2 groups in any other variable studied. Copyright © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Critical steps in learning from incidents: using learning potential in the process from reporting an incident to accident prevention.

PubMed

Drupsteen, Linda; Groeneweg, Jop; Zwetsloot, Gerard I J M

2013-01-01

Many incidents have occurred because organisations have failed to learn from lessons of the past. This means that there is room for improvement in the way organisations analyse incidents, generate measures to remedy identified weaknesses and prevent reoccurrence: the learning from incidents process. To improve that process, it is necessary to gain insight into the steps of this process and to identify factors that hinder learning (bottlenecks). This paper presents a model that enables organisations to analyse the steps in a learning from incidents process and to identify the bottlenecks. The study describes how this model is used in a survey and in 3 exploratory case studies in The Netherlands. The results show that there is limited use of learning potential, especially in the evaluation stage. To improve learning, an approach that considers all steps is necessary.

Factors affecting implementation of accreditation programmes and the impact of the accreditation process on quality improvement in hospitals: a SWOT analysis.

PubMed

Ng, G K B; Leung, G K K; Johnston, J M; Cowling, B J

2013-10-01

The objectives of this review were to identify factors that influence implementation of hospital accreditation programmes and to assess the impact of the accreditation process on quality improvement in public hospitals. Two electronic databases, Medline (OvidSP) and PubMed, were systematically searched. "Public hospital", "hospital accreditation", and "quality improvement" were used as the search terms. A total of 348 citations were initially identified. After critical appraisal and study selection, 26 articles were included in the review. The data were extracted and analysed using a SWOT (strengths, weaknesses, opportunities, threats) analysis. Increased staff engagement and communication, multidisciplinary team building, positive changes in organisational culture, and enhanced leadership and staff awareness of continuous quality improvement were identified as strengths. Weaknesses included organisational resistance to change, increased staff workload, lack of awareness about continuous quality improvement, insufficient staff training and support for continuous quality improvement, lack of applicable accreditation standards for local use, and lack of performance outcome measures. Opportunities included identification of improvement areas, enhanced patient safety, additional funding, public recognition, and market advantage. Threats included opportunistic behaviours, funding cuts, lack of incentives for participation, and a regulatory approach to mandatory participation. By relating the findings to the operational issues of accreditation, this review discussed the implications for successful implementation and how accreditation may drive quality improvement. These findings have implications for various stakeholders (government, the public, patients and health care providers), when it comes to embarking on accreditation exercises.

Alternative Organisational Learning Therapy: An Empirical Case Study Using Behaviour and U Theory

ERIC Educational Resources Information Center

Ho, Li-An; Kuo, Tsung-Hsien

2009-01-01

This paper draws on the concept and process of deeper learning, namely the U theory (Senge, Scharmer, Jaworski, & Flowers, 2004a). As a driver to get a deeper exploration of organisational change process, the theory of U goes beyond the interpersonal aspects of learning, instead focusing on a deeper personal generative learning that emphasizes…

Quality Assurance Processes in Finnish Universities: Direct and Indirect Outcomes and Organisational Conditions

ERIC Educational Resources Information Center

Haapakorpi, Arja

2011-01-01

In Finland, quality assurance related to the Bologna process has been adapted to existing systems of higher education at the national level and a form of implementation is also recognised at the level of the higher education institution. In universities, varied outcomes of quality assurance are based on interaction of organisational structures,…

Foucauldian Iterative Learning Conversations--An Example of Organisational Change: Developing Conjoint-Work between EPS and Social Workers

ERIC Educational Resources Information Center

Apter, Brian

2014-01-01

An organisational change-process in a UK local authority (LA) over two years is examined using transcribed excerpts from three meetings. The change-process is analysed using a Foucauldian analytical tool--Iterative Learning Conversations (ILCS). An Educational Psychology Service was changed from being primarily an education-focussed…

Introducing peer worker roles into UK mental health service teams: a qualitative analysis of the organisational benefits and challenges

PubMed Central

2013-01-01

Background The provision of peer support as a component of mental health care, including the employment of Peer Workers (consumer-providers) by mental health service organisations, is increasingly common internationally. Peer support is strongly advocated as a strategy in a number of UK health and social care policies. Approaches to employing Peer Workers are proliferating. There is evidence to suggest that Peer Worker-based interventions reduce psychiatric inpatient admission and increase service user (consumer) empowerment. In this paper we seek to address a gap in the empirical literature in understanding the organisational challenges and benefits of introducing Peer Worker roles into mental health service teams. Methods We report the secondary analysis of qualitative interview data from service users, Peer Workers, non-peer staff and managers of three innovative interventions in a study about mental health self-care. Relevant data was extracted from interviews with 41 participants and subjected to analysis using Grounded Theory techniques. Organisational research literature on role adoption framed the analysis. Results Peer Workers were highly valued by mental health teams and service users. Non-peer team members and managers worked hard to introduce Peer Workers into teams. Our cases were projects in development and there was learning from the evolutionary process: in the absence of formal recruitment processes for Peer Workers, differences in expectations of the Peer Worker role can emerge at the selection stage; flexible working arrangements for Peer Workers can have the unintended effect of perpetuating hierarchies within teams; the maintenance of protective practice boundaries through supervision and training can militate against the emergence of a distinctive body of peer practice; lack of consensus around what constitutes peer practice can result in feelings for Peer Workers of inequality, disempowerment, uncertainty about identity and of being under-supported. Conclusions This research is indicative of potential benefits for mental health service teams of introducing Peer Worker roles. Analysis also suggests that if the emergence of a distinctive body of peer practice is not adequately considered and supported, as integral to the development of new Peer Worker roles, there is a risk that the potential impact of any emerging role will be constrained and diluted. PMID:23705767

An investigation of strategies used in alcohol brand marketing and alcohol-related health promotion on Facebook.

PubMed

Lim, Megan Sc; Hare, James D; Carrotte, Elise R; Dietze, Paul M

2016-01-01

Alcohol brands are incorporating social networking sites (SNS) into their marketing programmes. SNS are also being used to reduce alcohol consumption and harms by health promotion organisations. Marketing via SNS can attempt to influence consumers using a range of strategies from traditional marketing, social media, and behaviour change theory. This study systematically quantifies marketing strategies used by alcohol brands and health promoters on Facebook. We identified the 10 most popular alcohol brands and health promotion organisations in Australia on Facebook and extracted all posts from April 2014. A framework was developed, listing 33 SNS marketing strategies. The frequency of use of each strategy in posts was counted for all profiles. The median number of fans of alcohol brands was 189,290 compared with 7562 for health promotion pages. A total of 210 Facebook posts were analysed. Popular marketing strategies included visual attraction, connecting with other organisations, and links to culture and events. Time-specific and day-specific posts and tweets were used more regularly by alcohol brands than health promotion agencies. Alcohol brands remain substantially more popular than health promotion organisations, and this difference is likely driven by offline factors rather than specific use of marketing strategies. However, health promotion organisations can learn from the strategies used by popular brands, particularly in the use of time and day-specific content.

Piloting a logic-based framework for understanding organisational change process for a health IT implementation.

PubMed

Diment, Kieren; Garrety, Karin; Yu, Ping

2011-01-01

This paper describes how a method for evaluating organisational change based on the theory of logical types can be used for classifying organisational change processes to understand change after the implementation of an electronic documentation system in a residential aged care facility. In this instance we assess the organisational change reflected by care staff's perceptions of the benefits of the new documentation system at one site, at pre-implementation, and at 12 months post-implementation. The results show how a coherent view from the staff as a whole of the personal benefits, the benefits for others and the benefits for the organization create a situation of positive feedback leading to embeddedness of the documentation system into the site, and a broader appreciation of the potential capabilities of the electronic documentation system.

Knowledge mobilisation in healthcare: a critical review of health sector and generic management literature.

PubMed

Ferlie, Ewan; Crilly, Tessa; Jashapara, Ashok; Peckham, Anna

2012-04-01

The health policy domain has displayed increasing interest in questions of knowledge management and knowledge mobilisation within healthcare organisations. We analyse here the findings of a critical review of generic management and health-related literatures, covering the period 2000-2008. Using 29 pre-selected journals, supplemented by a search of selected electronic databases, we map twelve substantive domains classified into four broad groups: taxonomic and philosophical (e.g. different types of knowledge); theoretical discourse (e.g. critical organisational studies); disciplinary fields (e.g. organisational learning and Information Systems/Information Technology); and organisational processes and structures (e.g. organisational form). We explore cross-overs and gaps between these traditionally separate literature streams. We found that health sector literature has absorbed some generic concepts, notably Communities of Practice, but has not yet deployed the performance-oriented perspective of the Resource Based View (RBV) of the Firm. The generic literature uses healthcare sites to develop critical analyses of power and control in knowledge management, rooted in neo-Marxist/labour process and Foucauldian approaches. The review generates three theoretically grounded statements to inform future enquiry, by: (a) importing the RBV stream; (b) developing the critical organisational studies perspective further; and (c) exploring the theoretical argument that networks and other alternative organisational forms facilitate knowledge sharing. Copyright © 2012 Elsevier Ltd. All rights reserved.

Modelling and analysis of workflow for lean supply chains

NASA Astrophysics Data System (ADS)

Ma, Jinping; Wang, Kanliang; Xu, Lida

2011-11-01

Cross-organisational workflow systems are a component of enterprise information systems which support collaborative business process among organisations in supply chain. Currently, the majority of workflow systems is developed in perspectives of information modelling without considering actual requirements of supply chain management. In this article, we focus on the modelling and analysis of the cross-organisational workflow systems in the context of lean supply chain (LSC) using Petri nets. First, the article describes the assumed conditions of cross-organisation workflow net according to the idea of LSC and then discusses the standardisation of collaborating business process between organisations in the context of LSC. Second, the concept of labelled time Petri nets (LTPNs) is defined through combining labelled Petri nets with time Petri nets, and the concept of labelled time workflow nets (LTWNs) is also defined based on LTPNs. Cross-organisational labelled time workflow nets (CLTWNs) is then defined based on LTWNs. Third, the article proposes the notion of OR-silent CLTWNS and a verifying approach to the soundness of LTWNs and CLTWNs. Finally, this article illustrates how to use the proposed method by a simple example. The purpose of this research is to establish a formal method of modelling and analysis of workflow systems for LSC. This study initiates a new perspective of research on cross-organisational workflow management and promotes operation management of LSC in real world settings.

Delivering organisational adaptation through legislative mechanisms: Evidence from the Adaptation Reporting Power (Climate Change Act 2008).

PubMed

Jude, S R; Drew, G H; Pollard, S J T; Rocks, S A; Jenkinson, K; Lamb, R

2017-01-01

There is increasing recognition that organisations, particularly in key infrastructure sectors, are potentially vulnerable to climate change and extreme weather events, and require organisational responses to ensure they are resilient and adaptive. However, detailed evidence of how adaptation is facilitated, implemented and reported, particularly through legislative mechanisms is lacking. The United Kingdom Climate Change Act (2008), introduced the Adaptation Reporting Power, enabling the Government to direct so-called reporting authorities to report their climate change risks and adaptation plans. We describe the authors' unique role and experience supporting the Department for Environment, Food and Rural Affairs (Defra) during the Adaptation Reporting Power's first round. An evaluation framework, used to review the adaptation reports, is presented alongside evidence on how the process provides new insights into adaptation activities and triggered organisational change in 78% of reporting authorities, including the embedding of climate risk and adaptation issues. The role of legislative mechanisms and risk-based approaches in driving and delivering adaptation is discussed alongside future research needs, including the development of organisational maturity models to determine resilient and well adapting organisations. The Adaptation Reporting Power process provides a basis for similar initiatives in other countries, although a clear engagement strategy to ensure buy-in to the process and research on its long-term legacy, including the potential merits of voluntary approaches, is required. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

Exploring the adoption of Schwartz Center Rounds as an organisational innovation to improve staff well-being in England, 2009–2015

PubMed Central

Philippou, Julia; Leamy, Mary; Reynolds, Ellie; Ross, Shilpa; Bennett, Laura; Taylor, Cath; Shuldham, Caroline; Maben, Jill

2017-01-01

Objectives Schwartz Center Rounds (‘Rounds’) are a multidisciplinary forum in which healthcare staff within an organisation discuss the psychological, emotional and social challenges associated with their work in a confidential and safe environment. Implemented in over 375 North American organisations, since 2009, they have been increasingly adopted in England. This study aimed to establish how many and what types of organisations have adopted Rounds in England, and to explore why they did so. Setting Public healthcare organisations in England. Participants Secondary data analysis was used to map and profile all 116 public healthcare organisations that had adopted Rounds in England by July 2015. Semistructured telephone interviews were conducted with 45 Round coordinators within adopting organisations. Results The rate of adoption increased after a major national report in 2013. Rounds were typically adopted in order to improve staff well-being. Adopting organisations scored better on staff engagement than non-adopters; among adopting organisations, those performing better on patient experience were more likely to adopt earlier. Most adoption decision-making processes were straightforward. A confluence of factors—a generally favourable set of innovation attributes (including low cost), advocacy from opinion leaders in different professional networks, active dissemination by change agents and a felt need to be seen to be addressing staff well-being—initially led to Rounds being seen as ‘an idea whose time had come’. More recent adoption patterns have been shaped by the timing of charitable and other agency funding in specific geographical areas and sectors, as well as several forms of ‘mimetic pressure’. Conclusions The innate attributes of Rounds, favourable circumstances and the cumulative impact of a sequence of distinct informal and formal social processes have shaped the pattern of their adoption in England. PMID:28057662

The relationship between organisational communication and perception.

PubMed

Marynissen, H M F

2011-01-01

Both researchers and managers search for the most appropriate form of organisational communication. The aim of such an organisational communication is to influence the receivers' perception to confirm, adapt or change behaviour according to the sender's intention. This paper argues that to influence the receivers' perception, a specific form of communication that is embedded in a specific organisational culture is required. It also demands prior knowledge of the existing organisational schemata and the current perception concerning the topic that has to be communicated. The rationale is that three obstacles hinder the objectives of traditional communication strategies to influence perception according to the sender's objectives. The first challenge is that a receiver of a certain message never garners one single, clearly pronounced message conveyed by one single person. Yet, few studies are based on multiple messages from various sources. This makes most of the communication strategies in use obsolete. The second strain is the dual mode of thinking that forms organisational members' perceptions: the heuristic and the cogitative (Taleb, 2010). Most organisational communication theories are based on the paradigm in which receivers of information process this information in a rational way, while research in the field of neurobiology (Lehrer, 2009) indicates that rationality is dominated by emotions. The third difficulty is that organisational members constrain to well-established, ingrained schemas (Labianca et al., 2000; Balogun and Johnson, 2004). Based on these existing schemas, the scattered information from multiple sources, and the inability to process that information through cognitive reasoning, organisational members construct perceptions that are not in line with the objectives of the sender's communication. This article reviews different communication theories, points out key concepts in the literature on individual and collective perceptions, and suggests directions to further research.

Healthcare professionals' organisational barriers to health information technologies-a literature review.

PubMed

Lluch, Maria

2011-12-01

This literature review identifies and categorises, from an organisational management perspective, barriers to the use of HIT or ICT for health. Based on the review, it offers policy interventions. This systematic literature review was carried out during December 2009 and January 2010. Additional on-going reviews of updates through automated system alerts took place up until this paper was submitted. A total of thirty-one sources were searched including nine software platforms/databases, fifteen specialised websites/targeted databases, Google Scholar, ISI Science Citation Index and five journals hand-searched. The study covers seventy-nine articles on organisational barriers to ICT adoption by healthcare professionals. These are categorised under five main headings - (I) Structure of healthcare organisations; (II) Tasks; (III) People policies; (IV) Incentives; and (V) Information and decision processes. A total of ten subcategories are also identified. By adopting an organisational management approach, some recommendations to remove organisational management barriers are made. Despite their apparent promise, health information technologies (HIT) have proved difficult to implement. This systematic review reveals the implementation barriers associated to organisational management and their interrelations. Several important future directions in the field are also suggested: (1) there is a need for further research providing evidence of HIT cost-effectiveness as well as the development of optimal HIT applications; (2) more information is needed regarding organisational change, incentives, liability issues, end-users HIT competences and skills, structure and work process issues involved in realising the benefits from HIT. Future policy interventions should consider the five dimensions identified when addressing the impact of HIT in healthcare organisational systems, and how the impact of an intervention aimed at a particular dimension would interrelate with others. 2011 Elsevier Ireland Ltd. All rights reserved.

Object-based image analysis for the assessment of mineral extraction in conflict regions - a case study in the Democratic Republic of the Congo

NASA Astrophysics Data System (ADS)

Kranz, Olaf; Schoepfer, Elisabeth; Spröhnle, Kristin; Lang, Stefan

2016-06-01

In this study object-based image analysis (OBIA) techniques were applied to assess land cover changes related to mineral extraction in a conflict-affected area of the eastern Democratic Republic of the Congo (DRC) over a period of five years based on very high resolution (VHR) satellite data of different sensors. Object-based approaches explicitly consider spatio-temporal aspects which allow extracting important information to document mining activities. The use of remote sensing data as an independent, up-to-date and reliable data source provided hints on the general development of the mining sector in relation to socio-economic and political decisions. While in early 2010, the situation was still characterised by an intensification of mineral extraction, a mining ban between autumn 2010 and spring 2011 marked the starting point for a continuous decrease of mining activities. The latter can be substantiated through a decrease in the extend of the mining area as well as of the number of dwellings in the nearby settlement. A following demilitarisation and the mentioned need for accountability with respect to the origin of certain minerals led to organised, more industrialized exploitation. This development is likewise visible on satellite imagery as typical clearings within forested areas. The results of the continuous monitoring in turn facilitate non-governmental organisations (NGOs) to further foster the mentioned establishment of responsible supply chains by the mining industry throughout the entire period of investigation.

Initial investigation of organisational factors associated with the implementation of active support.

PubMed

Fyffe, Chris; McCubbery, Jeffrey; Reid, Katharine J

2008-09-01

Active support (AS) has been shown to increase the amount of time that residents in shared residential settings are involved in purposeful activities. The organisational processes required to implement AS have been less well researched. Staff in community houses answered questions about the occurrence of organisational activities and processes thought to assist AS implementation (e.g., training and teamwork), their understanding of engagement, and their experience of changes in staff practice consistent with AS (including implementation problems). Non-house-based managers were also interviewed about their role in AS implementation. Reported occurrence of organisational activities and processes (e.g., training and teamwork) and understanding of engagement were associated with more reports of changes in staff practice and fewer staff reports of implementation problems. Staff reports on the role of non-house-based managers were not associated with reports of changes in staff practice or with reports of fewer AS implementation problems. Non-house-based managers' reports overestimated their role in AS implementation when compared with reports from house-based staff groups. While there are limitations in the research design (including the reliance on staff reports), the findings support the importance of wider organisational factors (beyond training programs for direct support staff) as integral to the implementation of AS. There is a need for further research on AS implementation.

Programme Evaluation Theory: The Next Step toward a Synthesis of Logic Models and Organisational Theory

ERIC Educational Resources Information Center

Fear, William J.

2007-01-01

This paper argues that the formulation of policy, at whatever level, to whatever scale or scope, is any different to the myriad of processes involved in strategic planning within and between organisations, and the attendant decision making processes that abound in such an environment (Hage, 1980; Hickson, 1987; Thompson, 1967; Weick, 1976). Those…

Development of a set of process and structure indicators for palliative care: the Europall project

PubMed Central

2012-01-01

Background By measuring the quality of the organisation of palliative care with process and structure quality indicators (QIs), patients, caregivers and policy makers are able to monitor to what extent recommendations are met, like those of the council of the WHO on palliative care and guidelines. This will support the implementation of public programmes, and will enable comparisons between organisations or countries. Methods As no European set of indicators for the organisation of palliative care existed, such a set of QIs was developed. An update of a previous systematic review was made and extended with more databases and grey literature. In two project meetings with practitioners and experts in palliative care the development process of a QI set was finalised and the QIs were categorized in a framework, covering the recommendations of the Council of Europe. Results The searches resulted in 151 structure and process indicators, which were discussed in steering group meetings. Of those QIs, 110 were eligible for the final framework. Conclusions We developed the first set of QIs for the organisation of palliative care. This article is the first step in a multi step project to identify, validate and pilot QIs. PMID:23122255

Individual influences on lifestyle change to reduce vascular risk: a qualitative literature review

PubMed Central

Murray, Jenni; Honey, Stephanie; Hill, Kate; Craigs, Cheryl; House, Allan

2012-01-01

Background Management of cardiovascular risk includes adoption of healthy lifestyles. Uptake and completion rates for lifestyle programmes are low and many barriers and facilitators to lifestyle behaviour change have been reported in the literature. Clarity on which barriers and facilitators to target during consultations in primary care may support a more systematic approach to lifestyle behaviour change in those at high risk of cardiovascular events. Aim To identify the main barriers and facilitators to lifestyle behaviour change in individuals at high risk of cardiovascular events. Design A content synthesis of the qualitative literature reporting patient-level influences on lifestyle change. Method Qualitative studies involving patients at high risk of cardiovascular events were identified through electronic searching and screening against predefined selection criteria. Factors (reported influences) were extracted and, using a clustering technique, organised into categories that were then linked to key themes through relationship mapping. Results A total of 348 factors were extracted from 33 studies. Factors were organised into 20 categories and from these categories five key themes were identified: emotions, beliefs, information and communication, friends and family support, and cost/transport. Conclusion It is possible to organise the large number of self-reported individual influences on lifestyle behaviours into a small number of themes. Further research is needed to clarify which of these patient-level barriers and facilitators are the best predictors of uptake and participation in programmes aimed at helping people to change lifestyle. PMID:22687232

Professional relations in sport healthcare: workplace responses to organisational change.

PubMed

Malcolm, Dominic; Scott, Andrea

2011-02-01

This article examines the impact of organisational changes in UK elite sport on the professional relations among and between different healthcare providers. The article describes the processes by which demand for elite sport healthcare has increased in the UK. It further charts the subsequent response within medicine and physiotherapy and, in particular, the institutionalisation of sport-specific sub-disciplines through the introduction of specialist qualifications. Drawing on semi-structured interviews with 14 doctors and 14 physiotherapists, the article argues that organisational changes have led to intra-professional tensions within both professional groups but in qualitatively different forms reflecting the organisational traditions and professional identities of the respective disciplines. Organisational changes promoting multi-disciplinary healthcare teams have also fostered an environment conducive to high levels of inter-professional cooperation though significant elements of inter-professional conflict remain. This study illustrates how intra-professional relations are affected by specialisation, how legitimation discourses are used by different professions, and how intra- and inter-professional conflict and cooperation should be seen as highly interdependent processes. Copyright © 2010 Elsevier Ltd. All rights reserved.

Organisational systems and services for children of parents with mental illness and their families: processes of change and sustainability.

PubMed

Owen, Susanne

2010-09-01

Adult mental illness in the community including depression and anxiety has achieved greater public awareness and visibility in recent years and this has also resulted in increased recognition about the widespread impact on dependent children. During the past decade in Australia, policies and specific programs for infants, children and youth in terms of prevention, early intervention and promotion in relation to children of parents with a mental illness ('copmi') have been devised. However, these have generally been disconnected projects, essentially supported only by non-recurrent funding. In more recent years, systematic and interconnected responses involving a wider range of government, non-government and consumer and carer organisations to build sustainability have become the focus. However, little research about change processes affecting the organisational systems serving children of parents with mental illness and their families has been undertaken. This aim of the current study is to describe the enablers and barriers that contribute to change in systems and government and non-government organisations in relation to children of parents with a mental illness in Australia over the past decade, within the context of sustainability. The study involved interviews, focus groups and website and literature searches regarding systems change across Australian states and territories and nationally in relation to the enablers, barriers and future directions. Strategic and intentional processes within organisations, more evolutionary ongoing cross-agency processes and links to sustained changes are key systems change findings. Relevance for change in other health services is highlighted.

Parent participation in decision-making in health-care services for children: an integrative review.

PubMed

Aarthun, Antje; Akerjordet, Kristin

2014-03-01

To describe and synthesize previous research on parents' perceptions of their participation in decision making in child health-care services. Health policy in the area of user involvement emphasizes parent participation in decision-making (DM), thus ensuring that services are provided in accordance with their child's needs and enhancing parents' control over their child's health-care services. A systematic literature search, covering the period January 2000 to February 2011, found 18 studies that met the inclusion criteria. The analysis process involved data extraction, reduction, comparison and synthesizing. Three themes emerged: (1) relational factors and interdependence, (2) personal factors and attitudes and (3) organisational factors. Parents highlighted the importance of the parent-health professional relationship, professionals' competence and the possibility of varying the degree of participation in decision making. Challenges involved asymmetry in authority and power, professionals' attitudes and competence and organisational shortcomings in health-care services. Health professionals need to become more aware of their critical role and responsibility in involving parents in DM. Health professionals' attitudes and competence can be improved by knowledge of user involvement and research and facilitating the inclusion of parents in decision making by influencing the culture, routines and resources in the health service. © 2012 John Wiley & Sons Ltd.

Measures to assess the performance of an Australian non-government charitable non-acute health service: A Delphi Survey of Organisational Stakeholders.

PubMed

Colbran, Richard; Ramsden, Robyn; Stagnitti, Karen; Adams, Samantha

2018-02-01

Organisation performance measurement is relevant for non-profit charitable organisations as they strive for security in an increasingly competitive funding environment. This study aimed to identify the priority measures and indicators of organisational performance of an Australian non-government charitable organisation that delivers non-acute health services. Seventy-seven and 59 participants across nine stakeholder groups responded to a two-staged Delphi technique study of a case study organisation. The stage one questionnaire was developed using information garnered through a detailed review of literature. Data from the first round were aggregated and analysed for the stage two survey. The final data represented a group consensus. Quality of care was ranked the most important of six organisational performance measures. Service user satisfaction was ranked second followed by financial performance, internal processes, employee learning and growth and community engagement. Thirteen priority indicators were determined across the six measures. Consensus was reached on the priority organisational performance measures and indicators. Stakeholders of the case study organisation value evidence-based practice, technical strength of services and service user satisfaction over more commercially orientated indicators.

Towards a Cognitive Organisational Framework for Knowledge Management

DTIC Science & Technology

2001-09-01

of knowledge now exist only at the bottom of the organisation, with management uninformed on specific detail. For many knowledge- based ...the organisation’ s internal context - its internal management practices, learning culture and knowledge base . This has particularly been found to...of the process is based in ’Kaizen’. Within the Western culture we may well have ignored important insights in our own tradition. Traditionally, in

Multi-scale structural community organisation of the human genome.

PubMed

Boulos, Rasha E; Tremblay, Nicolas; Arneodo, Alain; Borgnat, Pierre; Audit, Benjamin

2017-04-11

Structural interaction frequency matrices between all genome loci are now experimentally achievable thanks to high-throughput chromosome conformation capture technologies. This ensues a new methodological challenge for computational biology which consists in objectively extracting from these data the structural motifs characteristic of genome organisation. We deployed the fast multi-scale community mining algorithm based on spectral graph wavelets to characterise the networks of intra-chromosomal interactions in human cell lines. We observed that there exist structural domains of all sizes up to chromosome length and demonstrated that the set of structural communities forms a hierarchy of chromosome segments. Hence, at all scales, chromosome folding predominantly involves interactions between neighbouring sites rather than the formation of links between distant loci. Multi-scale structural decomposition of human chromosomes provides an original framework to question structural organisation and its relationship to functional regulation across the scales. By construction the proposed methodology is independent of the precise assembly of the reference genome and is thus directly applicable to genomes whose assembly is not fully determined.

Technological changes in the healthcare sector. A method to assess change readiness.

PubMed

Kristensen, M; Nøhr, C

2000-01-01

This paper describes the theory, method and recent results of a study developing methods for assessment of change readiness. The empirical focus is on development and implementation of clinical IT systems in the Danish healthcare sector. To assess change readiness, a questionnaire has been developed. The questionnaire has been tested in a hospital department as a part of a pre analysis related to development and implementation of an IT quality assurance system. The study shows a general positive attitude to the IT system and the organisational changes, related to the implementation and use of the system. It also supplies the project organisation with specific information, useful to the project organisation to continue the essential dialogue with the healthcare professionals during the change process. Furthermore it provides a useful tool for planning the ongoing developing processes. Several other healthcare organisations are at the moment entering the study.

Web-Based Knowledge Exchange through Social Links in the Workplace

ERIC Educational Resources Information Center

Filipowski, Tomasz; Kazienko, Przemyslaw; Brodka, Piotr; Kajdanowicz, Tomasz

2012-01-01

Knowledge exchange between employees is an essential feature of recent commercial organisations on the competitive market. Based on the data gathered by various information technology (IT) systems, social links can be extracted and exploited in knowledge exchange systems of a new kind. Users of such a system ask their queries and the system…

Organisational readiness: exploring the preconditions for success in organisation-wide patient safety improvement programmes.

PubMed

Burnett, Susan; Benn, Jonathan; Pinto, Anna; Parand, Anam; Iskander, Sandra; Vincent, Charles

2010-08-01

Patient safety has been high on the agenda for more than a decade. Despite many national initiatives aimed at improving patient safety, the challenge remains to find coherent and sustainable organisation-wide safety-improvement programmes. In the UK, the Safer Patients' Initiative (SPI) was established to address this challenge. Important in the success of such an endeavour is understanding 'readiness' at the organisational level, identifying the preconditions for success in this type of programme. This article reports on a case study of the four NHS organisations participating in the first phase of SPI, examining the perceptions of organisational readiness and the relationship of these factors with impact by those actively involved in the initiative. A mixed-methods design was used, involving a survey and semistructured interviews with senior executive leads, the principal SPI programme coordinator and the four operational leads in each of the SPI clinical work areas in all four organisations taking part in the first phase of SPI. This preliminary work would suggest that prior to the start of organisation-wide quality- and safety-improvement programmes, organisations would benefit from an assessment of readiness with time spent in the preparation of the organisational infrastructure, processes and culture. Furthermore, a better understanding of the preconditions that mark an organisation as ready for improvement work would allow policymakers to set realistic expectations about the outcomes of safety campaigns.

The Many Organisational Factors Relevant to Planning Change in Emergency Care Departments: A Qualitative Study to Inform a Cluster Randomised Controlled Trial Aiming to Improve the Management of Patients with Mild Traumatic Brain Injuries.

PubMed

Bosch, Marije; Tavender, Emma J; Brennan, Sue E; Knott, Jonathan; Gruen, Russell L; Green, Sally E

2016-01-01

The Neurotrauma Evidence Translation (NET) Trial aims to design and evaluate the effectiveness of a targeted theory-and evidence-informed intervention to increase the uptake of evidence-based recommended practices for the management of patients who present to an emergency department (ED) with mild head injuries. When designing interventions to bring about change in organisational settings such as the ED, it is important to understand the impact of the context to ensure successful implementation of practice change. Few studies explicitly use organisational theory to study which factors are likely to be most important to address when planning change processes in the ED. Yet, this setting may have a unique set of organisational pressures that need to be taken into account when implementing new clinical practices. This paper aims to provide an in depth analysis of the organisational context in which ED management of mild head injuries and implementation of new practices occurs, drawing upon organisational level theory. Semi-structured interviews were conducted with ED staff in Australia. The interviews explored the organisational context in relation to change and organisational factors influencing the management of patients presenting with mild head injuries. Two researchers coded the interview transcripts using thematic content analysis. The "model of diffusion in service organisations" was used to guide analyses and organisation of the results. Nine directors, 20 doctors and 13 nurses of 13 hospitals were interviewed. With regard to characteristics of the innovation (i.e. the recommended practices) the most important factor was whether they were perceived as being in line with values and needs. Tension for change (the degree to which stakeholders perceive the current situation as intolerable or needing change) was relatively low for managing acute mild head injury symptoms, and mixed for managing longer-term symptoms (higher change commitment, but relatively low change efficacy). Regarding implementation processes, the importance of (visible) senior leadership for all professions involved was identified as a critical factor. An unpredictable and hectic environment brings challenges in creating an environment in which team-based and organisational learning can thrive (system antecedents for innovation). In addition, the position of the ED as the entry-point of the hospital points to the relevance of securing buy-in from other units. We identified several organisational factors relevant to realising change in ED management of patients who present with mild head injuries. These factors will inform the intervention design and process evaluation in a trial evaluating the effectiveness of our implementation intervention.

Training Drivers, Competitive Strategy and Clients' Needs: Case Studies of Three Business Process Outsourcing Organisations

ERIC Educational Resources Information Center

Malik, Ashish

2009-01-01

Purpose: The purpose of this paper is to examine the factors that drive a firm's decision to invest in training in India's IT-enabled services/business process outsourcing (ITeS/BPO) sector. It aims to consider a much-neglected area and an often-cited need to consider external factors, especially the needs of an organisation's clients in a firm's…

Practice and professional development plans (PPDPs): results of a feasibility study.

PubMed

Elwyn, G; Carlisle, S; Hocking, P; Smail, S

2001-01-01

Dissatisfaction with uniprofessional education structures as a means of improving the quality of healthcare has led to proposals to develop ways of integrating professional learning and organisational development. Test the feasibility of introducing practice and professional development plans using a centrally sponsored project in Wales. Qualitative observational study. All 541 practices in Wales were alerted to the project and invited to apply. A selection process was suggested to Health Authorities but not always efficiently conducted: 23 practices were selected and 18 participated in the process. Central funding was made available to health authorities. The project framework was designed by an educational department and conceptualised as the development of personal portfolios linked to one key organisation change in each practice, facilitated by external consultants who would typically hold workshops or other events. An independent researcher using non-participant observation techniques at workshops and practices undertook documentary analysis and fieldwork in four health authorities. Difficulties were encountered with the process of implementing the project: marketing and practice selection inconsistencies delayed the work and it was difficult to recruit practices into the project. The lack of experienced individuals to do the work and practitioner suspicion about perceived 'management' agendas were significant problems. After initial hesitancies most practices appreciated the value of developing wider ownership and commitment to proposed practice changes. Organisations found it difficult to support individual completion of the personal portfolio component of the plans. The ability to develop systems for clinical services was dependent on having already established a culture of effective teamwork in the organisation. This work supports the view that organisational development has considerable potential for bringing about effective change, and individual contributions could form a valuable component of personal portfolios. We believe that the existing structures in education and management in the health service are not yet able to support these processes. Evidence from the fields of risk management and quality improvement all point to the need to develop effective organisational systems and the results of this feasibility study indicate that alternative models of sustaining organisational development need careful evaluation.

Practice and professional development plans (PPDPs): results of a feasibility study

PubMed Central

Elwyn, Glyn; Carlisle, Sandra; Hocking, Paul; Smail, Simon

2001-01-01

Background Dissatisfaction with uniprofessional education structures as a means of improving the quality of healthcare has led to proposals to develop ways of integrating professional learning and organisational development. Aims Test the feasibility of introducing practice and professional development plans using a centrally sponsored project in Wales. Design Qualitative observational study. Study sample All 541 practices in Wales were alerted to the project and invited to apply. A selection process was suggested to Health Authorities but not always efficiently conducted: 23 practices were selected and 18 participated in the process. Method Central funding was made available to health authorities. The project framework was designed by an educational department and conceptualised as the development of personal portfolios linked to one key organisation change in each practice, facilitated by external consultants who would typically hold workshops or other events. An independent researcher using non-participant observation techniques at workshops and practices undertook documentary analysis and fieldwork in four health authorities. Results Difficulties were encountered with the process of implementing the project: marketing and practice selection inconsistencies delayed the work and it was difficult to recruit practices into the project. The lack of experienced individuals to do the work and practitioner suspicion about perceived 'management' agendas were significant problems. After initial hesitancies most practices appreciated the value of developing wider ownership and commitment to proposed practice changes. Organisations found it difficult to support individual completion of the personal portfolio component of the plans. The ability to develop systems for clinical services was dependent on having already established a culture of effective teamwork in the organisation. Conclusions This work supports the view that organisational development has considerable potential for bringing about effective change, and individual contributions could form a valuable component of personal portfolios. We believe that the existing structures in education and management in the health service are not yet able to support these processes. Evidence from the fields of risk management and quality improvement all point to the need to develop effective organisational systems and the results of this feasibility study indicate that alternative models of sustaining organisational development need careful evaluation. PMID:11299046

Effect of spatial organisation behaviour on upscaling the overland flow formation in an arable land

NASA Astrophysics Data System (ADS)

Silasari, Rasmiaditya; Blöschl, Günter

2014-05-01

Overland flow during rainfall events on arable land is important to investigate as it affects the land erosion process and water quality in the river. The formation of overland flow may happen through different ways (i.e. Hortonian overland flow, saturation excess overland flow) which is influenced by the surface and subsurface soil characteristics (i.e. land cover, soil infiltration rate). As the soil characteristics vary throughout the entire catchment, it will form distinct spatial patterns with organised or random behaviour. During the upscaling of hydrological processes from plot to catchment scale, this behaviour will become substantial since organised patterns will result in higher spatial connectivity and thus higher conductivity. However, very few of the existing studies explicitly address this effect of spatial organisations of the patterns in upscaling the hydrological processes to the catchment scale. This study will assess the upscaling of overland flow formation with concerns of spatial organisation behaviour of the patterns by application of direct field observations under natural conditions using video camera and soil moisture sensors and investigation of the underlying processes using a physical-based hydrology model. The study area is a Hydrological Open Air Laboratory (HOAL) located at Petzenkirchen, Lower Austria. It is a 64 ha catchment with land use consisting of arable land (87%), forest (6%), pasture (5%) and paved surfaces (2%). A video camera is installed 7m above the ground on a weather station mast in the middle of the arable land to monitor the overland flow patterns during rainfall events in a 2m x 6m plot scale. Soil moisture sensors with continuous measurement at different depth (5, 10, 20 and 50cm) are installed at points where the field is monitored by the camera. The patterns of overland flow formation and subsurface flow state at the plot scale will be generated using a coupled surface-subsurface flow physical-based hydrology model. The observation data will be assimilated into the model to verify the corresponding processes between surface and subsurface flow during the rainfall events. The patterns of conductivity then will be analyzed at catchment scale using the spatial stochastic analysis based on the classification of soil characteristics of the entire catchment. These patterns of conductivity then will be applied in the model at catchment scale to see how the organisational behaviour can affect the spatial connectivity of the hydrological processes and the results of the catchment response. A detailed modelling of the underlying processes in the physical-based model will allow us to see the direct effect of the spatial connectivity to the occurring surface and subsurface flow. This will improve the analysis of the effect of spatial organisations of the patterns in upscaling the hydrological processes from plot to catchment scale.

How do consumer leaders co-create value in mental health organisations?

PubMed

Scholz, Brett; Bocking, Julia; Happell, Brenda

2017-10-01

Objectives Contemporary mental health policies call for consumers to be involved in decision-making processes within mental health organisations. Some organisations have embraced leadership roles for consumers, but research suggests consumers remain disempowered within mental health services. Drawing on a service-dominant logic, which emphasises the co-creation of value of services, the present study provides an overview of consumer leadership within mental health organisations in the Australian Capital Territory. Methods Mental health organisations subscribing to the local peak body mailing list were invited to complete a survey about consumer leadership. Survey data were summarised using descriptive statistics and interpreted through the lens of service-dominant logic. Results Ways in which organisations may create opportunities for consumers to co-create value within their mental health services included soliciting feedback, involving consumer leaders in service design, having consumer leaders involved in hiring decisions and employing consumer leaders as staff or on boards. Strategies that organisations used to develop consumer leaders included induction, workshops and training in a variety of organisational processes and skills. Conclusions The findings of the present study extend the application of a service-dominant logic framework to consumer leadership within mental health organisations through consideration of the diverse opportunities that organisations can provide for consumer co-creation of service offerings. What is known about the topic? Policy calls for consumer involvement in all levels of mental health service planning, implementation and delivery. The extent to which service organisations have included consumer leaders varies, but research suggests that this inclusion can be tokenistic or that organisations choose to work with consumers who are less likely to challenge the status quo. Service literature has explored the way consumers can co-create value of their own health care, but is yet to explore consumers' co-creation of value at a systemic level. What does the paper add? This paper outlines ways in which mental health organisations report involving consumers in leadership positions, including having consumers on boards, having consumers on recruitment panels and providing leadership training for consumers. These initiatives are considered in terms of the potential value co-created within mental health services by consumers in leadership, suggesting that consumer leaders are a resource to mental health organisations in terms of the value brought to service offerings. What are the implications for practitioners? Research suggests that medical professionals have been resistant to increased consumer leadership within mental health services. The findings of the present study emphasise the value that can be brought to service organisations by consumer leaders, suggesting that mental health practitioners may reconsider their approach and attitudes towards consumer leadership in the sector.

Evolutionary Connectionism: Algorithmic Principles Underlying the Evolution of Biological Organisation in Evo-Devo, Evo-Eco and Evolutionary Transitions.

PubMed

Watson, Richard A; Mills, Rob; Buckley, C L; Kouvaris, Kostas; Jackson, Adam; Powers, Simon T; Cox, Chris; Tudge, Simon; Davies, Adam; Kounios, Loizos; Power, Daniel

2016-01-01

The mechanisms of variation, selection and inheritance, on which evolution by natural selection depends, are not fixed over evolutionary time. Current evolutionary biology is increasingly focussed on understanding how the evolution of developmental organisations modifies the distribution of phenotypic variation, the evolution of ecological relationships modifies the selective environment, and the evolution of reproductive relationships modifies the heritability of the evolutionary unit. The major transitions in evolution, in particular, involve radical changes in developmental, ecological and reproductive organisations that instantiate variation, selection and inheritance at a higher level of biological organisation. However, current evolutionary theory is poorly equipped to describe how these organisations change over evolutionary time and especially how that results in adaptive complexes at successive scales of organisation (the key problem is that evolution is self-referential, i.e. the products of evolution change the parameters of the evolutionary process). Here we first reinterpret the central open questions in these domains from a perspective that emphasises the common underlying themes. We then synthesise the findings from a developing body of work that is building a new theoretical approach to these questions by converting well-understood theory and results from models of cognitive learning. Specifically, connectionist models of memory and learning demonstrate how simple incremental mechanisms, adjusting the relationships between individually-simple components, can produce organisations that exhibit complex system-level behaviours and improve the adaptive capabilities of the system. We use the term "evolutionary connectionism" to recognise that, by functionally equivalent processes, natural selection acting on the relationships within and between evolutionary entities can result in organisations that produce complex system-level behaviours in evolutionary systems and modify the adaptive capabilities of natural selection over time. We review the evidence supporting the functional equivalences between the domains of learning and of evolution, and discuss the potential for this to resolve conceptual problems in our understanding of the evolution of developmental, ecological and reproductive organisations and, in particular, the major evolutionary transitions.

Exploring the adoption of Schwartz Center Rounds as an organisational innovation to improve staff well-being in England, 2009-2015.

PubMed

Robert, Glenn; Philippou, Julia; Leamy, Mary; Reynolds, Ellie; Ross, Shilpa; Bennett, Laura; Taylor, Cath; Shuldham, Caroline; Maben, Jill

2017-01-05

Schwartz Center Rounds ('Rounds') are a multidisciplinary forum in which healthcare staff within an organisation discuss the psychological, emotional and social challenges associated with their work in a confidential and safe environment. Implemented in over 375 North American organisations, since 2009, they have been increasingly adopted in England. This study aimed to establish how many and what types of organisations have adopted Rounds in England, and to explore why they did so. Public healthcare organisations in England. Secondary data analysis was used to map and profile all 116 public healthcare organisations that had adopted Rounds in England by July 2015. Semistructured telephone interviews were conducted with 45 Round coordinators within adopting organisations. The rate of adoption increased after a major national report in 2013. Rounds were typically adopted in order to improve staff well-being. Adopting organisations scored better on staff engagement than non-adopters; among adopting organisations, those performing better on patient experience were more likely to adopt earlier. Most adoption decision-making processes were straightforward. A confluence of factors-a generally favourable set of innovation attributes (including low cost), advocacy from opinion leaders in different professional networks, active dissemination by change agents and a felt need to be seen to be addressing staff well-being-initially led to Rounds being seen as 'an idea whose time had come'. More recent adoption patterns have been shaped by the timing of charitable and other agency funding in specific geographical areas and sectors, as well as several forms of 'mimetic pressure'. The innate attributes of Rounds, favourable circumstances and the cumulative impact of a sequence of distinct informal and formal social processes have shaped the pattern of their adoption in England. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Influence of faith-based organisations on HIV prevention strategies in Africa: a systematic review.

PubMed

Ochillo, Marylyn A; van Teijlingen, Edwin; Hind, Martin

2017-09-01

The HIV/AIDS epidemic remains of global significance and there is a need to target sub-Saharan Africa since it is the hardest hit region worldwide. Religion and more specifically faith-based organisations can have an effect on socio-cultural factors that increase or decrease the risk of infection; and offer preventative interventions to the wider community. To understand the influence of faith-based organisations on HIV prevention in Africa. The main search engine of a British university 'mysearch' was used as this incorporates all relevant databases. Studies were also retrieved by searches within Google scholar, PubMed and reference lists of included papers were hand searched. The authors assessed the relevance of each article separately against the inclusion criteria. The data extraction form was piloted by the first author and cross-checked by the other authors. Seven studies met all inclusion criteria and were reviewed. Seven individual themes were identified. However, for the purposes of focus within this paper only two themes were focused on. Given the accessibility of faith-based organisations (FBOs) and the coverage of religion among the population, FBOs are potentially important players in HIV prevention. Therefore, more resources and support should be given to support their health promotion strategies.

Relationship between ethical leadership and organisational commitment of nurses with perception of patient safety culture.

PubMed

Lotfi, Zahra; Atashzadeh-Shoorideh, Foroozan; Mohtashami, Jamileh; Nasiri, Maliheh

2018-03-12

To determine the relationship between ethical leadership, organisational commitment of nurses and their perception of patient safety culture. Patient safety, organisational commitment and ethical leadership styles are very important for improving the quality of nursing care. In this descriptive-correlational study, 340 nurses were selected using random sampling from the hospitals in Tehran in 2016. Data were analysed using descriptive and inferential statistics in SPSS v.20. There was a significant positive relationship between the ethical leadership of nursing managers, perception of patient safety culture and organisational commitment. The regression analysis showed that nursing managers' ethical leadership and nurses' organisational commitment is a predictor of patient safety culture and confirms the relationship between the variables. Regarding the relationship between the nurses' safety performance, ethical leadership and organisational commitment, it seems that the optimisation of the organisational commitment and adherence to ethical leadership by administrators and managers in hospitals could improve the nurses' performance in terms of patient safety. Implementing ethical leadership seems to be one feasible strategy to improve nurses' organisational commitment and perception of patient safety culture. Efforts by nurse managers to develop ethical leadership reinforce organisational commitment to improve patient outcomes. Nurse managers' engagement and performance in this process is vital for a successful result. © 2018 John Wiley & Sons Ltd.

Psychological contract breach among allied health professionals.

PubMed

Rodwell, John; Gulyas, Andre

2015-01-01

Allied health professionals are vital for effective healthcare yet there are continuing shortages of these employees. Building on work with other healthcare professionals, the purpose of this paper is to investigate the influence of psychological contract (PC) breach and types of organisational justice on variables important to retention among allied health professionals: mental health and organisational commitment. The potential effects of justice on the negative outcomes of breach were examined. Multiple regressions analysed data from 113 allied health professionals working in a medium-large Australian healthcare organisation. The main negative impacts on respondents' mental health and commitment were from high PC breach, low procedural and distributive justice and less respectful treatment from organisational representatives. The interaction between procedural justice and breach illustrates that breach may be forgivable if processes are fair. Surprisingly, a betrayal or "aggravated breach effect" may occur after a breach when interpersonal justice is high. Further, negative affectivity was negatively related to respondents' mental health (affective outcomes) but not commitment (work-related attitude). Healthcare organisations should ensure the fairness of decisions and avoid breaking promises within their control. If promises cannot reasonably be kept, transparency of processes behind the breach may allow allied health professionals to understand that the organisation did not purposefully fail to fulfil expectations. This study offers insights into how breach and four types of justice interact to influence employee mental health and work attitudes among allied health professionals.

Retirement on grounds of ill health: cross sectional survey in six organisations in United Kingdom.

PubMed

Poole, C J

1997-03-29

To assess the process and outcome of retirement due to ill health in six large organisations. Cross sectional study of the rate of retirement due to ill health by age, sex, and length of service. Principal diagnoses by age and length of service were also compared. Four public and two private large employers in the United Kingdom. Rates of retirement on the grounds of ill health by age, sex, and length of service of employees contributing to pension schemes. Rates of ill health retirement varied from 20 to 250 per 10,000 contributing members, and in two organisations the rate varied geographically within the same organisation. In the two organisations that provided data by sex, women retired at a greater rate than men under age 40 and over age 50. In four organisations the modal age or length of service coincided with enhancements in benefits. In the four that provided information on diagnoses, musculoskeletal and minor psychiatric illnesses were the most common reasons for retirement. The granting of ill health retirement benefits may not be determined by illness. There is a need for some employers and pension schemes to improve their processes for granting benefits. Doctors should be wary of conflicts of interest and work to guidelines when they advise pension schemes about the merits of an application for benefits.

Participatory redesign of work organisation in hospital nursing: A study of the implementation process.

PubMed

Stab, Nicole; Hacker, Winfried

2018-05-01

The main goal of the study was to apply and analyse a moderated participatory small-group procedure with registered nurses, which aims at the development and implementation of measures to improve work organisation in hospital wards and nursing units. Participation in job redesign is an essential prerequisite of the successful implementation of improvement measures in nursing. The study was carried out in a public hospital of maximum care in Germany. We selected 25 wards with the most critical reported exhaustion and general health and applied a series of moderated small-group sessions in which the registered nurses jointly identified deficits in their work organisation, developed improvement measures, and then implemented and assessed them. Registered nurses of 22 wards actively took part in the small-group procedure. All nursing units jointly identified organisational deficits, developed possible improvement measures, and implemented them. The nursing teams then evaluated the implemented measures which were already assessable at the end of our research period; nearly all (99.0%) showed improvements, while 69.4% actually attained the desired goals. Participatory small-group activities may be successfully applied in hospital nursing in order to improve work organisation. Participatory assessment and redesign of nurses' work organisation should be integrated into regular team meetings. The nursing management should actively support the implementation process. © 2018 John Wiley & Sons Ltd.

The Many Organisational Factors Relevant to Planning Change in Emergency Care Departments: A Qualitative Study to Inform a Cluster Randomised Controlled Trial Aiming to Improve the Management of Patients with Mild Traumatic Brain Injuries

PubMed Central

Bosch, Marije; Tavender, Emma J.; Brennan, Sue E.; Knott, Jonathan; Gruen, Russell L.; Green, Sally E.

2016-01-01

Background The Neurotrauma Evidence Translation (NET) Trial aims to design and evaluate the effectiveness of a targeted theory-and evidence-informed intervention to increase the uptake of evidence-based recommended practices for the management of patients who present to an emergency department (ED) with mild head injuries. When designing interventions to bring about change in organisational settings such as the ED, it is important to understand the impact of the context to ensure successful implementation of practice change. Few studies explicitly use organisational theory to study which factors are likely to be most important to address when planning change processes in the ED. Yet, this setting may have a unique set of organisational pressures that need to be taken into account when implementing new clinical practices. This paper aims to provide an in depth analysis of the organisational context in which ED management of mild head injuries and implementation of new practices occurs, drawing upon organisational level theory. Methods Semi-structured interviews were conducted with ED staff in Australia. The interviews explored the organisational context in relation to change and organisational factors influencing the management of patients presenting with mild head injuries. Two researchers coded the interview transcripts using thematic content analysis. The “model of diffusion in service organisations” was used to guide analyses and organisation of the results. Results Nine directors, 20 doctors and 13 nurses of 13 hospitals were interviewed. With regard to characteristics of the innovation (i.e. the recommended practices) the most important factor was whether they were perceived as being in line with values and needs. Tension for change (the degree to which stakeholders perceive the current situation as intolerable or needing change) was relatively low for managing acute mild head injury symptoms, and mixed for managing longer-term symptoms (higher change commitment, but relatively low change efficacy). Regarding implementation processes, the importance of (visible) senior leadership for all professions involved was identified as a critical factor. An unpredictable and hectic environment brings challenges in creating an environment in which team-based and organisational learning can thrive (system antecedents for innovation). In addition, the position of the ED as the entry-point of the hospital points to the relevance of securing buy-in from other units. Conclusions We identified several organisational factors relevant to realising change in ED management of patients who present with mild head injuries. These factors will inform the intervention design and process evaluation in a trial evaluating the effectiveness of our implementation intervention. PMID:26845772

The role of organisational justice, burnout and commitment in the understanding of absenteeism in the Canadian healthcare sector.

PubMed

Chênevert, Denis; Jourdain, Genevieve; Cole, Nona; Banville, Brigitte

2013-01-01

The purpose of this paper is to integrate Greenberg's perspective on the connection between injustice and stress in order to clarify the role of organisational justice, burnout and organisational commitment in the understanding of absenteeism. The study was carried out among 457 workers of a large healthcare establishment in the Canadian public healthcare sector. The model was tested using structural equation methods. The results reveal that procedural and interactional justices have an indirect effect on exhaustion through distributive injustice. Moreover, it was found that distributive injustice is indirectly linked to short-term absences through exhaustion. By contrast, the relationship between distributive injustice and long-term absence can be explained by two mediating variables, namely, exhaustion and psychosomatic complaints. In spite of the non-longitudinal nature of this study, the results suggest that the stress model and the medical model best explain the relationship between organisational injustice and absenteeism, while the withdrawal model via organisational commitment is not associated in this study with absenteeism. Healthcare managers should consider the possibility of better involving employees in the decision-making process in order to increase their perception of procedural and interactional justice, and indirectly reduce exhaustion and absenteeism through a greater perception of distributive justice. For the healthcare sector, the need to reduce absenteeism is particularly urgent because of budget restrictions and the shortage of labour around the world. This is one of the first studies to provide a complete model that analyses the stress process in terms of how organisational justice affects short- and long-term absences, in a bid to understand the specific process and factors that lead to shorter and longer episodes of absence.

PPI-IRO: a two-stage method for protein-protein interaction extraction based on interaction relation ontology.

PubMed

Li, Chuan-Xi; Chen, Peng; Wang, Ru-Jing; Wang, Xiu-Jie; Su, Ya-Ru; Li, Jinyan

2014-01-01

Mining Protein-Protein Interactions (PPIs) from the fast-growing biomedical literature resources has been proven as an effective approach for the identification of biological regulatory networks. This paper presents a novel method based on the idea of Interaction Relation Ontology (IRO), which specifies and organises words of various proteins interaction relationships. Our method is a two-stage PPI extraction method. At first, IRO is applied in a binary classifier to determine whether sentences contain a relation or not. Then, IRO is taken to guide PPI extraction by building sentence dependency parse tree. Comprehensive and quantitative evaluations and detailed analyses are used to demonstrate the significant performance of IRO on relation sentences classification and PPI extraction. Our PPI extraction method yielded a recall of around 80% and 90% and an F1 of around 54% and 66% on corpora of AIMed and BioInfer, respectively, which are superior to most existing extraction methods.

Managing boundaries in primary care service improvement: a developmental approach to communities of practice.

PubMed

Kislov, Roman; Walshe, Kieran; Harvey, Gill

2012-10-15

Effective implementation of change in healthcare organisations involves multiple professional and organisational groups and is often impeded by professional and organisational boundaries that present relatively impermeable barriers to sharing knowledge and spreading work practices. Informed by the theory of communities of practice (CoPs), this study explored the effects of intra-organisational and inter-organisational boundaries on the implementation of service improvement within and across primary healthcare settings and on the development of multiprofessional and multi-organisational CoPs during this process. The study was conducted within the Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester-a collaborative partnership between the University of Manchester and local National Health Service organisations aiming to undertake applied health research and enhance its implementation in clinical practice. It deployed a qualitative embedded case study design, encompassing semistructured interviews, direct observation and documentary analysis, conducted in 2010-2011. The sample included practice doctors, nurses, managers and members of the CLAHRC implementation team. The study showed that in spite of epistemic and status differences, professional boundaries between general practitioners, practice nurses and practice managers co-located in the same practice over a relatively long period of time could be successfully bridged, leading to the formation of multiprofessional CoPs. While knowledge circulated relatively easily within these CoPs, barriers to knowledge sharing emerged at the boundary separating them from other groups existing in the same primary care setting. The strongest boundaries, however, lay between individual general practices, with inter-organisational knowledge sharing and collaboration between them remaining unequally developed across different areas due to historical factors, competition and strong organisational identification. Manipulated emergence of multi-organisational CoPs in the context of primary care may thus be problematic. In cases when manipulated emergence of new CoPs is problematic, boundary issues could be addressed by adopting a developmental perspective on CoPs, which provides an alternative to the analytical and instrumental perspectives previously described in the CoP literature. This perspective implies a pragmatic, situational approach to mapping existing CoPs and their characteristics and potentially modifying them in the process of service improvement through the combination of internal and external facilitation.

Review article: Methodology for the 'rapid review' series on musculoskeletal injuries in the emergency department.

PubMed

Strudwick, Kirsten; McPhee, Megan; Bell, Anthony; Martin-Khan, Melinda; Russell, Trevor

2018-02-01

Musculoskeletal injuries are a common presentation to the ED, with significant costs involved in the management of these injuries, variances in care within the ED and associated morbidity. A series of rapid review papers were completed to guide best practice for the assessment and management of common musculoskeletal injuries presenting to the ED. This paper presents the methodology used across the rapid reviews. PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites, were searched in 2015. The search was repeated consistently for each topic area (injuries of the foot and ankle, knee, hand and wrist, elbow, shoulder, lumbar spine and cervical spine). English-language primary studies, systematic reviews and guidelines that were published in the last 10 years and addressed acute musculoskeletal injury management were considered for inclusion. Data extraction of each included article was conducted, followed by a quality appraisal. The extracted data from each article was synthesised to group similar evidence together. For each rapid review, the evidence has been organised in a way that a clinician can direct their attention to a specific component of the clinical cycle of care in the ED, such as the assessment, diagnostic tests, management and follow-up considerations from ED. The series of rapid reviews are designed to foster evidence-based practice within the ED, targeting the injuries most commonly presenting. The reviews provide clinicians in EDs with rapid access to the best current evidence, which has been synthesised and organised to assist decision-making. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Application of Business Process Management to drive the deployment of a speech recognition system in a healthcare organization.

PubMed

González Sánchez, María José; Framiñán Torres, José Manuel; Parra Calderón, Carlos Luis; Del Río Ortega, Juan Antonio; Vigil Martín, Eduardo; Nieto Cervera, Jaime

2008-01-01

We present a methodology based on Business Process Management to guide the development of a speech recognition system in a hospital in Spain. The methodology eases the deployment of the system by 1) involving the clinical staff in the process, 2) providing the IT professionals with a description of the process and its requirements, 3) assessing advantages and disadvantages of the speech recognition system, as well as its impact in the organisation, and 4) help reorganising the healthcare process before implementing the new technology in order to identify how it can better contribute to the overall objective of the organisation.

Making Work and Learning More Visible by Reflective Practice

ERIC Educational Resources Information Center

Tikkamäki, Kati; Hilden, Sanna

2014-01-01

Several characteristics are necessary to have a flourishing workplace: one is organisational learning. Modern workplaces call for individual responsibility, ability, and willingness to share expertise, as well as continuous learning. However, critical elements of the process of organisational learning -- participating, knowing, cooperating and…

A structural model of family empowerment for families of children with special needs.

PubMed

Han, Kuem Sun; Yang, Yunkyung; Hong, Yeong Seon

2018-03-01

To explain and predict family empowerment in families of children with special needs. Family empowerment of families of children with special needs can be explained using the Double ABCX model. Although constant stressors such as parenting stress and family demands can have negative effects on family empowerment, family resources and parenting efficacy can mediate the negative effect through effective coping strategies. A cross-sectional research design was employed. A survey was conducted with 240 parents of children with special needs. Upon exclusion of four responses deemed inadequate to the statistics process, 236 responses were selected for the analysis. Based on the items used in the previous research, we used the scale of family demands 38, the scale of parenting stress 24, the scale of parenting efficacy 37, the scale of pattern of organisation 30, the scale of communication process 16 and the scale of family empowerment 32. In families of children with special needs, parenting stress had a negative effect on parenting efficacy and family resources, namely, pattern of organisation and communication process. Family needs had a positive effect on parenting efficacy. Parenting stress and family demands influenced family empowerment through parenting efficacy and family resources (pattern of organisation and communication process), while parenting efficacy contributed to family empowerment. This study empirically analysed the usefulness of the Double ABCX model in predicting family empowerment. Family resource factors (organisation pattern and communication process) and perception or judgement factors (such as parenting efficacy) were found to mediate the negative impact of various stressors experienced by families of children with special needs. The study findings suggest that clinical practice and management should focus on providing efficient intervention methods to lower stress in families of children with special needs. Reinforcing factors contributing to family empowerment, such as parenting efficacy, organisation pattern and communication process, will alleviate families' stress, resulting in a positive educational and developmental impact on children with special needs. © 2017 John Wiley & Sons Ltd.

Implementation of "social and communicative competencies" in medical education. The importance of curriculum, organisational and human resource development.

PubMed

Pruskil, Susanne; Deis, Nicole; Druener, Susanne; Kiessling, Claudia; Philipp, Swetlana; Rockenbauch, Katrin

2015-01-01

With this article we want to support teachers and curriculum planners to be aware of and apply knowledge and recommendations of organisational (OD), curriculums (CD) and human resource development (HRD) ideas already in the planning phase of a project. Taking these into account can influence the process of change successfully and controlled during the introduction and establishment of curricula in the field of communication and social skills in medical education. In the context of a multi-stage developmental process, a recommendation on CD for "Communicative and social competencies" was developed. The basis for it was made during two workshops of the GMA-committee "Communicative and social competencies" and supplemented by the available literature and the experience of communication experts. The "Undeloher Recommendation" (see attachment ) includes a compilation of recommendations and guiding questions, which is geared to the various phases of CD. Additionally, general approaches and recommendations of organisational and human resource development were integrated, which turned out to be particularly relevant in the process of CD. Thus, the "Undeloher recommendation" includes an orientation for each phase of the curriculum development process, the organisation and the staff in order to successfully implement a longitudinal curriculum. In addition to theoretical models the long-term discussion process and the personal experiences of a variety of curriculum planners and teachers have been integrated. The "Undeloher recommendation" can support the implementation processes of curricula in communication and social skills during development and realisation. Its application was reviewed in the context of workshops based on concrete examples. The participating teachers and curriculum planners assessed it to be very helpful. The recommendation goes beyond of what has been described in terms of content models in the CD so fare. In particular, the organisational and human resource development related aspects such as the formation of a steering committee and recommendations for the phase of sustainability.

School-based vaccination programmes: a systematic review of the evidence on organisation and delivery in high income countries.

PubMed

Perman, Sarah; Turner, Simon; Ramsay, Angus I G; Baim-Lance, Abigail; Utley, Martin; Fulop, Naomi J

2017-03-14

Many countries have recently expanded their childhood immunisation programmes. Schools are an increasingly attractive setting for delivery of these new immunisations because of their ability to reach large numbers of children in a short period of time. However, there are organisational challenges to delivery of large-scale vaccination programmes in schools. Understanding the facilitators and barriers is important for improving the delivery of future school-based vaccination programmes. We undertook a systematic review of evidence on school-based vaccination programmes in order to understand the influence of organisational factors on the delivery of programmes. Our eligibility criteria were studies that (1) focused on childhood or adolescent vaccination programmes delivered in schools; (2) considered organisational factors that influenced the preparation or delivery of programmes; (3) were conducted in a developed or high-income country; and (4) had been peer reviewed. We searched for articles published in English between 2000 and 2015 using MEDLINE and HMIC electronic databases. Additional studies were identified by searching the Cochrane Library and bibliographies. We extracted data from the studies, assessed quality and the risk of bias, and categorised findings using a thematic framework of eight organisational factors. We found that most of the recent published literature is from the United States and is concerned with the delivery of pandemic or seasonal flu vaccination programmes at a regional (state) or local level. We found that the literature is largely descriptive and not informed by the use of theory. Despite this, we identified common factors that influence the implementation of programmes. These factors included programme leadership and governance, organisational models and institutional relationships, workforce capacity and roles particularly concerning the school nurse, communication with parents and students, including methods for obtaining consent, and clinic organisation and delivery. This is the first time that information has been brought together on the organisational factors influencing the delivery of vaccination programmes in school-based settings. An understanding of these factors, underpinned by robust theory-informed research, may help policy-makers and managers design and deliver better programmes. We identified several gaps in the research literature to propose a future research agenda, informed by theories of implementation and organisational change.

Lessons from disaster: Creating a business continuity plan that really works.

PubMed

Hatton, Tracy; Grimshaw, Eleanor; Vargo, John; Seville, Erica

Business Continuity Planning (BCP) is well established as a key plank in an organisation's risk management process. But how effective is BCP when disaster strikes? This paper examines the experiences of organisations following the 2010-11 Canterbury, New Zealand earthquakes. The study finds that BCP was helpful for all organisations interviewed but more attention is needed on the management of societal and personal impacts; development of employee resilience, identification of effective crisis leaders; right-sizing plans and planning to seize opportunities post-disaster.

Local implementation of the Essence of Care benchmarks.

PubMed

Jones, Sue

To understand clinical practice benchmarking from the perspective of nurses working in a large acute NHS trust and to determine whether the nurses perceived that their commitment to Essence of Care led to improvements in care, the factors that influenced their role in the process and the organisational factors that influenced benchmarking. An ethnographic case study approach was adopted. Six themes emerged from the data. Two organisational issues emerged: leadership and the values and/or culture of the organisation. The findings suggested that the leadership ability of the Essence of Care link nurses and the value placed on this work by the organisation were key to the success of benchmarking. A model for successful implementation of the Essence of Care is proposed based on the findings of this study, which lends itself to testing by other organisations.

Does Double Loop Learning Create Reliable Knowledge?

ERIC Educational Resources Information Center

Blackman, Deborah; Connelly, James; Henderson, Steven

2004-01-01

This paper addresses doubts concerning the reliability of knowledge being created by double loop learning processes. Popper's ontological worlds are used to explore the philosophical basis of the way that individual experiences are turned into organisational knowledge, and such knowledge is used to generate organisational learning. The paper…

Narcissism--An Adolescent Disorder?

ERIC Educational Resources Information Center

Waddell, Margot

2006-01-01

This paper argues that the adolescent process needs to be accorded its own particularity of reference, especially where narcissism is concerned. The paper draws on literary and clinical examples to describe what is termed the "adolescent organisation". In many ways, this organisation reflects post-Kleinian theory of what constitutes narcissistic…

Organisation and function of the primary motor cortex in chronic pain: protocol for a systematic review and meta-analysis.

PubMed

Chang, Wei-Ju; O'Connell, Neil E; Burns, Emma; Chipchase, Lucy S; Liston, Matthew B; Schabrun, Siobhan M

2015-11-30

Primary motor cortical (M1) adaptation in the form of altered organisation and function is hypothesised to underpin motor dysfunction observed in chronic pain. The aim of this review is to assess the evidence for altered M1 organisation and function in chronic pain. Systematic review and meta-analysis. We will search electronic databases with predetermined search terms to identify relevant studies and evaluate the studies for inclusion and risks of bias. Two independent reviewers will extract data. Any disagreement will be resolved through a third reviewer. Cross-sectional or prospective studies published in English before May 2015 that investigate M1 organisation and function in chronic pain will be included if they meet the eligibility criteria. Primary outcomes will include M1 cortical excitability, spatial cortical representation, the function of inhibitory and facilitatory intracortical networks, cortical reactivity and cortical glucose metabolism. Clinical measures such as pain and disability will be included where the correlation with the primary outcomes of M1 organisation and function were investigated in the included studies. This systematic review does not require ethical approval. The results of this review will be submitted for peer-reviewed publication regardless of outcome and will be presented at relevant conferences. Our systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration number CRD42015014823). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Improving care coordination using organisational routines.

PubMed

Prætorius, Thim

2016-01-01

The purpose of this paper is to systematically apply theory of organisational routines to standardised care pathways. The explanatory power of routines is used to address open questions in the care pathway literature about their coordinating and organising role, the way they change and can be replicated, the way they are influenced by the organisation and the way they influence health care professionals. Theory of routines is systematically applied to care pathways in order to develop theoretically derived propositions. Care pathways mirror routines by being recurrent, collective and embedded and specific to an organisation. In particular, care pathways resemble standard operating procedures that can give rise to recurrent collective action patterns. In all, 11 propositions related to five categories are proposed by building on these insights: care pathways and coordination, change, replication, the organisation and health care professionals. Research limitations/implications - The paper is conceptual and uses care pathways as illustrative instances of hospital routines. The propositions provide a starting point for empirical research. The analysis highlights implications that health care professionals and managers have to consider in relation to coordination, change, replication, the way the organisation influences care pathways and the way care pathways influence health care professionals. Originality/value - Theory on organisational routines offers fundamental, yet unexplored, insights into hospital processes, including in particular care coordination.

The Age of Criminal Responsibility: "The Frontier between Care and Justice"

ERIC Educational Resources Information Center

Gillen, John

2006-01-01

This is an extract from a speech given by Mr Justice Gillen to a conference in Belfast organised by Children Law UK in January 2006. It addresses the potential conflict between the concept of the welfare of children inherent in the family care system and that of responsibility inherent in the criminal justice system. It questions whether the…

The Logic of Relations and the Logic of Management

ERIC Educational Resources Information Center

Buntinx, Wil

2008-01-01

Background: Increasing emphasis on financial and administrative control processes is affecting service culture in support organisations for persons with intellectual disability. This phenomenon is currently obvious in Dutch service organisations that find themselves in transition towards more community care and at the same time under pressure from…

Knowledge Productivity for Sustainable Innovation: Social Capital as HRD Target

ERIC Educational Resources Information Center

Ehlen, Corry; van der Klink, Marcel; Roentgen, Uta; Curfs, Emile; Boshuizen, Henny

2014-01-01

Purpose: The purpose of this paper is to test the feasibility of a conceptual model on relations between organisational innovation, knowledge productivity and social capital. It explores processes of knowledge productivity for sustainable innovation and associated HRD implications in knowledge intensive organisations, taking the perspective that…

Knowledge Management: A System Dynamics Perspective

ERIC Educational Resources Information Center

Saurabh, Kumar

2005-01-01

In the present day market scenario of intense competition, organizations need to know what they know and be able to leverage on its knowledge base to gain competitive advantage. In this knowledge era, organisations can create and sustain competitive advantage through initiation of appropriate knowledge management processes. The organisations that…

Guiding and Modelling Quality Improvement in Higher Education Institutions

ERIC Educational Resources Information Center

Little, Daniel

2015-01-01

The article considers the process of creating quality improvement in higher education institutions from the point of view of current organisational theory and social-science modelling techniques. The author considers the higher education institution as a functioning complex of rules, norms and other organisational features and reviews the social…

Lifelong Learning Characteristics, Adjustment and Extra-Role Performance in Cooperative Education

ERIC Educational Resources Information Center

Drewery, David; Nevison, Colleen; Pretti, T. Judene; Pennaforte, Antoine

2017-01-01

Many organisations hire students from cooperative education (co-op) programmes. These organisations are interested in students' performance, particularly in their "extra-role" performance. Previous studies show that socialisation processes play an important part in establishing adjustment and performance. It may also be the case that…

Strategic Capacity and Organisational Capabilities: A Challenge for Universities

ERIC Educational Resources Information Center

Thoenig, Jean-Claude; Paradeise, Catherine

2016-01-01

Are universities able to operate as strategic actors? An organisational sociology based approach supported by a comparative field research project identifies three types of social, cultural and cognitive processes that play a decisive role in building and implementing local capabilities required to mobilise a strategic capacity. The paper…

The Role of Learner-Centred Assessment in Postsecondary Organisational Change

ERIC Educational Resources Information Center

Webber, Karen L.; Tschepikow, Kyle

2013-01-01

For postsecondary institutions, organisational change is an inevitable and ongoing process. Institutions face a growing need to assess student learning assessment as part of an institution's comprehensive assessment plan. While a growing body of literature suggests that learner-centred assessment is a best practice in higher education pedagogy, it…

Proposal of a service delivery integration index of home care for older persons: application in several European cities

PubMed Central

Henrard, Jean-Claude; Ankri, Joël; Frijters, Dinnus; Carpenter, Iain; Topinkova, Eva; Garms-Homolova, Vjenka; Finne-Soveri, Harriett; Sørbye, Liv Wergeland; Jónsson, Palmi V.; Ljunggren, Gunnar; Schroll, Marianne; Wagner, Cordula; Bernabei, Roberto

2006-01-01

Abstract Purpose To propose an integration index of home care delivery to older persons, to study its validity and to apply it to home care services of European cities. Theory Home care delivery integration was based on two dimensions referring to process-centred integration and organisational structure approach. Method Items considered as part of both dimensions according to an expert consensus (face validity) were extracted from a standardised questionnaire used in “Aged in Home care” (AdHoc) study to capture basic characteristics of home care services. Their summation leads to a services' delivery integration index. This index was applied to AdHoc services. A factor analysis was computed in order to empirically test the validity of the theoretical constructs. The plot of the settings was performed. Results Application of the index ranks home care services in four groups according to their score. Factor analysis identifies a first factor which opposes working arrangement within service to organisational structure bringing together provisions for social care. A second factor corresponds to basic nursing care and therapies. Internal consistency for those three domains ranges from 0.78 to 0.93. When plotting the different settings different models of service delivery appear. Conclusion The proposed index shows that behind a total score several models of care delivery are hidden. Comparison of service delivery integration should take into account this heterogeneity. PMID:17006549

Priority-setting in public health research funding organisations: an exploratory qualitative study among five high-profile funders.

PubMed

Cartier, Yuri; Creatore, Maria I; Hoffman, Steven J; Potvin, Louise

2018-06-22

Priority-driven funding streams for population and public health are an important part of the health research landscape and contribute to orienting future scholarship in the field. While research priorities are often made public through targeted calls for research, less is known about how research funding organisations arrive at said priorities. Our objective was to explore how public health research funding organisations develop priorities for strategic extramural research funding programmes. Content analysis of published academic and grey literature and key informant interviews for five public and private funders of public health research in the United Kingdom, Australia, the United States and France were performed. We found important distinctions in how funding organisations processed potential research priorities through four non-sequential phases, namely idea generation, idea analysis, idea socialisation and idea selection. Funders generally involved the public health research community and public health decision-makers in idea generation and socialisation, but other groups of stakeholders (e.g. the public, advocacy organisations) were not as frequently included. Priority-setting for strategic funding programmes in public health research involves consultation mainly with researchers in the early phase of the process. There is an opportunity for greater breadth of participation and more transparency in priority-setting mechanisms for strategic funding programmes in population and public health research.

Task Delegation Based Access Control Models for Workflow Systems

NASA Astrophysics Data System (ADS)

Gaaloul, Khaled; Charoy, François

e-Government organisations are facilitated and conducted using workflow management systems. Role-based access control (RBAC) is recognised as an efficient access control model for large organisations. The application of RBAC in workflow systems cannot, however, grant permissions to users dynamically while business processes are being executed. We currently observe a move away from predefined strict workflow modelling towards approaches supporting flexibility on the organisational level. One specific approach is that of task delegation. Task delegation is a mechanism that supports organisational flexibility, and ensures delegation of authority in access control systems. In this paper, we propose a Task-oriented Access Control (TAC) model based on RBAC to address these requirements. We aim to reason about task from organisational perspectives and resources perspectives to analyse and specify authorisation constraints. Moreover, we present a fine grained access control protocol to support delegation based on the TAC model.

Lipids in the cell: organisation regulates function.

PubMed

Santos, Ana L; Preta, Giulio

2018-06-01

Lipids are fundamental building blocks of all cells and play important roles in the pathogenesis of different diseases, including inflammation, autoimmune disease, cancer, and neurodegeneration. The lipid composition of different organelles can vary substantially from cell to cell, but increasing evidence demonstrates that lipids become organised specifically in each compartment, and this organisation is essential for regulating cell function. For example, lipid microdomains in the plasma membrane, known as lipid rafts, are platforms for concentrating protein receptors and can influence intra-cellular signalling. Lipid organisation is tightly regulated and can be observed across different model organisms, including bacteria, yeast, Drosophila, and Caenorhabditis elegans, suggesting that lipid organisation is evolutionarily conserved. In this review, we summarise the importance and function of specific lipid domains in main cellular organelles and discuss recent advances that investigate how these specific and highly regulated structures contribute to diverse biological processes.

Ergonomics action research II: a framework for integrating HF into work system design.

PubMed

Neumann, W P; Village, J

2012-01-01

This paper presents a conceptual framework that can support efforts to integrate human factors (HF) into the work system design process, where improved and cost-effective application of HF is possible. The framework advocates strategies of broad stakeholder participation, linking of performance and health goals, and process focussed change tools that can help practitioners engage in improvements to embed HF into a firm's work system design process. Recommended tools include business process mapping of the design process, implementing design criteria, using cognitive mapping to connect to managers' strategic goals, tactical use of training and adopting virtual HF (VHF) tools to support the integration effort. Consistent with organisational change research, the framework provides guidance but does not suggest a strict set of steps. This allows more adaptability for the practitioner who must navigate within a particular organisational context to secure support for embedding HF into the design process for improved operator wellbeing and system performance. There has been little scientific literature about how a practitioner might integrate HF into a company's work system design process. This paper proposes a framework for this effort by presenting a coherent conceptual framework, process tools, design tools and procedural advice that can be adapted for a target organisation.

[Interventions to improve the management of diabetes mellitus in primary health care and outpatient community settings].

PubMed

Hansen, Lars Jørgen; Drivsholm, Thomas B

2002-01-28

This review should be cited as: Renders CM, Valk GD, Griffin S. Wagner EH, Eijk JThM van, Assendelft WJJ. Interventions to improve the management of diabetes mellitus in primary care, outpatient and community settings (Cochrane Review). In: The Cochrane Library, Issue 2, 2001. Oxford: Update Software. A substantive amendment to this systematic review was last made on 29 June 2000. Cochrane reviews are regularly checked and updated if necessary. Diabetes is a common chronic disease that is increasingly managed in primary care. Different systems have been proposed to manage diabetes care. To assess the effects of different interventions, targeted at health professionals or the structure in which they deliver care, on the management of patients with diabetes in primary care, outpatient and community settings. We searched the Cochrane Effective Practice and Organisation of Care Group specialised register, the Cochrane Controlled Trials Register (Issue 4 1999), MEDLINE (1966-1999), EMBASE (1980-1999), Cinahl (1982-1999), and reference lists of articles. Randomised trials (RCTs), controlled clinical trials (CCTs), controlled before and after studies (CBAs) and interrupted time series (ITS) analyses of professional, financial and organisational strategies aimed at improving care for people with Type 1 or Type 2 diabetes. The participants were health care professionals, including physicians, nurses and pharmacists. The outcomes included objectively measured health professional performance or patient outcomes, and self-report measures with known validity and reliability. Two reviewers independently extracted data and assessed study quality. Forty-one studies were included involving more than 200 practices and 48,000 patients. Twenty-seven studies were RCTs, 12 were CBAs, and two were ITS. The studies were heterogeneous in terms of interventions, participants, settings and outcomes. The methodological quality of the studies was often poor. In all studies the intervention strategy was multifaceted. In 12 studies the interventions were targeted at health professionals, in nine they were targeted at the organization of care, and 20 studies targeted both. In 15 studies patient education was added to the professional and organisational interventions. A combination of professional interventions improved process outcomes. The effect on patient outcomes remained less clear as these were rarely assessed. Arrangements for follow-up (organisational intervention) also showed a favourable effect on process outcomes. Multiple interventions in which patient education was added or in which the role of the nurse was enhanced also reported favourable effects on patients' health outcomes. REVIEWERS' CONCLUSION: Multifaceted professional interventions can enhance the performance of health professionals in managing patients with diabetes. Organisational interventions that improve regular prompted recall and review of patients (central computerised tracking systems or nurses who regularly contact the patient) can also improve diabetes management. The addition of patient-oriented interventions can lead to improved patient health outcomes. Nurses can play an important role in patient-oriented interventions, through patient education or facilitating adherence to treatment.

Multi-agent cooperation pursuit based on an extension of AALAADIN organisational model

NASA Astrophysics Data System (ADS)

Souidi, Mohammed El Habib; Songhao, Piao; Guo, Li; Lin, Chang

2016-11-01

An approach of cooperative pursuit for multiple mobile targets based on multi-agents system is discussed. In this kind of problem the pursuit process is divided into two kinds of tasks. The first one (coalition problem) is designed to solve the problem of the pursuit team formation. To achieve this mission, we used an innovative method based on a dynamic organisation and reorganisation of the pursuers' groups. We introduce our coalition strategy extended from the organisational agent, group, role model by assigning an access mechanism to the groups inspired by fuzzy logic principles. The second task (motion problem) is the treatment of the pursuers' motion strategy. To manage this problem we applied the principles of the Markov decision process. Simulation results show the feasibility and validity of the given proposal.

Organisational Pattern Driven Recovery Mechanisms

NASA Astrophysics Data System (ADS)

Giacomo, Valentina Di; Presenza, Domenico; Riccucci, Carlo

The process of reaction to system failures and security attacks is strongly influenced by its infrastructural, procedural and organisational settings. Analysis of reaction procedures and practices from different domains (Air Traffic Management, Response to Computer Security Incident, Response to emergencies, recovery in Chemical Process Industry) highlight three key requirements for this activity: smooth collaboration and coordination among responders, accurate monitoring and management of resources and ability to adapt pre-established reaction plans to the actual context. The SERENITY Reaction Mechanisms (SRM) is the subsystem of the SERENITY Run-time Framework aimed to provide SERENITY aware AmI settings (i.e. socio-technical systems with highly distributed dynamic services) with functionalities to implement applications specific reaction strategies. The SRM uses SERENITY Organisational S&D Patterns as run-time models to drive these three key functionalities.

A thematic analysis of the role of the organisation in building allied health research capacity: a senior managers' perspective.

PubMed

Golenko, Xanthe; Pager, Susan; Holden, Libby

2012-08-27

Evidence-based practice aims to achieve better health outcomes in the community. It relies on high quality research to inform policy and practice; however research in primary health care continues to lag behind that of other medical professions. The literature suggests that research capacity building (RCB) functions across four levels; individual, team, organisation and external environment. Many RCB interventions are aimed at an individual or team level, yet evidence indicates that many barriers to RCB occur at an organisational or external environment level. This study asks senior managers from a large healthcare organisation to identify the barriers and enablers to RCB. The paper then describes strategies for building allied health (AH) research capacity at an organisational level from a senior managers' perspective. This qualitative study is part of a larger collaborative RCB project. Semi-structured in-depth interviews were conducted with nine allied health senior managers. Recorded interviews were transcribed and NVivo was used to analyse findings and emergent themes were defined. The dominant themes indicate that the organisation plays an integral role in building AH research capacity and is the critical link in creating synergy across the four levels of RCB. The organisation can achieve this by incorporating research into its core business with a whole of organisation approach including its mission, vision and strategic planning. Critical success factors include: developing a co-ordinated and multidisciplinary approach to attain critical mass of research-active AH and enhance learning and development; support from senior managers demonstrated through structures, processes and systems designed to facilitate research; forming partnerships to increase collaboration and sharing of resources and knowledge; and establishing in internal framework to promote recognition for research and career path opportunities. This study identifies four key themes: whole of organisation approach; structures, processes and systems; partnerships and collaboration; and dedicated research centres, units and positions. These themes form the foundation of a model which can be applied to assist in achieving synergy across the four levels of RCB, overcome barriers and create an environment that supports and facilitates research development in AH.

Making sense of evidence in management decisions: the role of research-based knowledge on innovation adoption and implementation in healthcare. study protocol.

PubMed

Kyratsis, Yiannis; Ahmad, Raheelah; Holmes, Alison

2012-03-21

We know that patient care can be improved by implementing evidence-based innovations and applying research findings linked to good practice. Successfully implementing innovations in complex organisations, such as the UK's National Health Service (NHS), is often challenging as multiple contextual dynamics mediate the process. Research studies have explored the challenges of introducing innovations into healthcare settings and have contributed to a better understanding of why potentially useful innovations are not always implemented in practice, even if backed by strong evidence. Mediating factors include health policy and health system influences, organisational factors, and individual and professional attitudes, including decision makers' perceptions of innovation evidence. There has been limited research on how different forms of evidence are accessed and utilised by organisational decision makers during innovation adoption. We also know little about how diverse healthcare professionals (clinicians, administrators) make sense of evidence and how this collective sensemaking mediates the uptake of innovations. The study will involve nine comparative case study sites of acute care organisations grouped into three regional clusters across England. Each of the purposefully selected sites represents a variety of trust types and organisational contexts. We will use qualitative methods, in-depth interviews, observation of key meetings, and systematic analysis of relevant secondary data to understand the rationale and challenges involved in sourcing and utilising innovation evidence in the empirical setting of infection prevention and control. We will use theories of innovation adoption and sensemaking in organisations to interpret the data. The research will provide lessons for the uptake and continuous use of innovations in the English and international health systems. Unlike most innovation studies, which involve single-level analysis, our study will explore the innovation-adoption process at multiple embedded levels: micro (individual), meso (organisational), and macro (interorganisational). By comparing and contrasting across the nine sites, each with different organisational contexts, local networks, leadership styles, and different innovations considered for adoption, the findings of the study will have wide relevance. The research will produce actionable findings responding to the political and economic need for healthcare organisations to be innovation-ready.

Making sense of evidence in management decisions: the role of research-based knowledge on innovation adoption and implementation in healthcare. study protocol

PubMed Central

2012-01-01

Background We know that patient care can be improved by implementing evidence-based innovations and applying research findings linked to good practice. Successfully implementing innovations in complex organisations, such as the UK's National Health Service (NHS), is often challenging as multiple contextual dynamics mediate the process. Research studies have explored the challenges of introducing innovations into healthcare settings and have contributed to a better understanding of why potentially useful innovations are not always implemented in practice, even if backed by strong evidence. Mediating factors include health policy and health system influences, organisational factors, and individual and professional attitudes, including decision makers' perceptions of innovation evidence. There has been limited research on how different forms of evidence are accessed and utilised by organisational decision makers during innovation adoption. We also know little about how diverse healthcare professionals (clinicians, administrators) make sense of evidence and how this collective sensemaking mediates the uptake of innovations. Methods The study will involve nine comparative case study sites of acute care organisations grouped into three regional clusters across England. Each of the purposefully selected sites represents a variety of trust types and organisational contexts. We will use qualitative methods, in-depth interviews, observation of key meetings, and systematic analysis of relevant secondary data to understand the rationale and challenges involved in sourcing and utilising innovation evidence in the empirical setting of infection prevention and control. We will use theories of innovation adoption and sensemaking in organisations to interpret the data. The research will provide lessons for the uptake and continuous use of innovations in the English and international health systems. Discussion Unlike most innovation studies, which involve single-level analysis, our study will explore the innovation-adoption process at multiple embedded levels: micro (individual), meso (organisational), and macro (interorganisational). By comparing and contrasting across the nine sites, each with different organisational contexts, local networks, leadership styles, and different innovations considered for adoption, the findings of the study will have wide relevance. The research will produce actionable findings responding to the political and economic need for healthcare organisations to be innovation-ready. PMID:22436094

Organisational downsizing and increased use of psychotropic drugs among employees who remain in employment.

PubMed

Kivimäki, Mika; Honkonen, Teija; Wahlbeck, Kristian; Elovainio, Marko; Pentti, Jaana; Klaukka, Timo; Virtanen, Marianna; Vahtera, Jussi

2007-02-01

Organisational downsizing is common in modern work life, but its effect on employees' mental health is not known. The authors examined whether working in downsizing organisations predicts use of psychotropic drugs among employees who remain in employment. Prospective cohort study of municipal employees in Finland. 4783 employees worked in downsized units but kept their jobs after downsizing in 1993, 4271 employees lost their jobs during the downsizing, and 17 599 employees did not experience downsizing. The outcome was psychotropic drug prescriptions (antidepressants, anxiolytics and hypnotics) during 1994-2000 extracted from nationwide registers and linked to the data by means of each participant's personal identification number. After adjustment for predownsizing characteristics, employees who were exposed to downsizing but kept their jobs were at a higher risk of being prescribed psychotropic drugs (rate ratio 1.49, 95% CI 1.10 to 2.02 in men and 1.12, 95% CI 1.00 to 1.27 in women) than those not exposed to downsizing. The association of downsizing was strongest with hypnotics among the men and with anxiolytics among the women. An increased rate of psychotropic prescriptions after downsizing was also seen in male workers who lost their job (rate ratio 1.64, 95% CI 1.19 to 2.25). The association between organisational downsizing and increased use of psychotropic drugs suggests that this managerial strategy may pose mental health risks among employees.

Systems and processes that ensure high quality care.

PubMed

Bassett, Sally; Westmore, Kathryn

2012-10-01

This is the second in a series of articles examining the components of good corporate governance. It considers how the structures and processes for quality governance can affect an organisation's ability to be assured about the quality of care. Complex information systems and procedures can lead to poor quality care, but sound structures and processes alone are insufficient to ensure good governance, and behavioural factors play a significant part in making sure that staff are enabled to provide good quality care. The next article in this series looks at how the information reporting of an organisation can affect its governance.

Managing boundaries in primary care service improvement: A developmental approach to communities of practice

PubMed Central

2012-01-01

Background Effective implementation of change in healthcare organisations involves multiple professional and organisational groups and is often impeded by professional and organisational boundaries that present relatively impermeable barriers to sharing knowledge and spreading work practices. Informed by the theory of communities of practice (CoPs), this study explored the effects of intra-organisational and inter-organisational boundaries on the implementation of service improvement within and across primary healthcare settings and on the development of multiprofessional and multi-organisational CoPs during this process. Methods The study was conducted within the Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester—a collaborative partnership between the University of Manchester and local National Health Service organisations aiming to undertake applied health research and enhance its implementation in clinical practice. It deployed a qualitative embedded case study design, encompassing semistructured interviews, direct observation and documentary analysis, conducted in 2010–2011. The sample included practice doctors, nurses, managers and members of the CLAHRC implementation team. Findings The study showed that in spite of epistemic and status differences, professional boundaries between general practitioners, practice nurses and practice managers co-located in the same practice over a relatively long period of time could be successfully bridged, leading to the formation of multiprofessional CoPs. While knowledge circulated relatively easily within these CoPs, barriers to knowledge sharing emerged at the boundary separating them from other groups existing in the same primary care setting. The strongest boundaries, however, lay between individual general practices, with inter-organisational knowledge sharing and collaboration between them remaining unequally developed across different areas due to historical factors, competition and strong organisational identification. Manipulated emergence of multi-organisational CoPs in the context of primary care may thus be problematic. Conclusions In cases when manipulated emergence of new CoPs is problematic, boundary issues could be addressed by adopting a developmental perspective on CoPs, which provides an alternative to the analytical and instrumental perspectives previously described in the CoP literature. This perspective implies a pragmatic, situational approach to mapping existing CoPs and their characteristics and potentially modifying them in the process of service improvement through the combination of internal and external facilitation. PMID:23068016

Organisation of workplace learning: a case study of paediatric residents' and consultants' beliefs and practices.

PubMed

Skipper, Mads; Nøhr, Susanne Backman; Jacobsen, Tine Klitgaard; Musaeus, Peter

2016-08-01

Several studies have examined how doctors learn in the workplace, but research is needed linking workplace learning with the organisation of doctors' daily work. This study examined residents' and consultants' attitudes and beliefs regarding workplace learning and contextual and organisational factors influencing the organisation and planning of medical specialist training. An explorative case study in three paediatric departments in Denmark including 9 days of field observations and focus group interviews with 9 consultants responsible for medical education and 16 residents. The study aimed to identify factors in work organisation facilitating and hindering residents' learning. Data were coded through an iterative process guided by thematic analysis. Findings illustrate three main themes: (1) Learning beliefs about patient care and apprenticeship learning as inseparable in medical practice. Beliefs about training and patient care expressed in terms of training versus production caused a potential conflict. (2) Learning context. Continuity over time in tasks and care for patients is important, but continuity is challenged by the organisation of daily work routines. (3) Organisational culture and regulations were found to be encouraging as well inhibiting to a successful organisation of the work in regards to learning. Our findings stress the importance of consultants' and residents' beliefs about workplace learning as these agents handle the potential conflict between patient care and training of health professionals. The structuring of daily work tasks is a key factor in workplace learning as is an understanding of underlying relations and organisational culture in the clinical departments.

Using a Malcolm Baldrige framework to understand high-performing clinical microsystems.

PubMed

Foster, Tina C; Johnson, Julie K; Nelson, Eugene C; Batalden, Paul B

2007-10-01

BACKGROUND, OBJECTIVES AND METHOD: The Malcolm Baldrige National Quality Award (MBNQA) provides a set of criteria for organisational quality assessment and improvement that has been used by thousands of business, healthcare and educational organisations for more than a decade. The criteria can be used as a tool for self-evaluation, and are widely recognised as a robust framework for design and evaluation of healthcare systems. The clinical microsystem, as an organisational construct, is a systems approach for providing clinical care based on theories from organisational development, leadership and improvement. This study compared the MBNQA criteria for healthcare and the success factors of high-performing clinical microsystems to (1) determine whether microsystem success characteristics cover the same range of issues addressed by the Baldrige criteria and (2) examine whether this comparison might better inform our understanding of either framework. Both Baldrige criteria and microsystem success characteristics cover a wide range of areas crucial to high performance. Those particularly called out by this analysis are organisational leadership, work systems and service processes from a Baldrige standpoint, and leadership, performance results, process improvement, and information and information technology from the microsystem success characteristics view. Although in many cases the relationship between Baldrige criteria and microsystem success characteristics are obvious, in others the analysis points to ways in which the Baldrige criteria might be better understood and worked with by a microsystem through the design of work systems and a deep understanding of processes. Several tools are available for those who wish to engage in self-assessment based on MBNQA criteria and microsystem characteristics.

Using a Malcolm Baldrige framework to understand high‐performing clinical microsystems

PubMed Central

Foster, Tina C; Johnson, Julie K; Nelson, Eugene C; Batalden, Paul B

2007-01-01

Background, objectives and method The Malcolm Baldrige National Quality Award (MBNQA) provides a set of criteria for organisational quality assessment and improvement that has been used by thousands of business, healthcare and educational organisations for more than a decade. The criteria can be used as a tool for self‐evaluation, and are widely recognised as a robust framework for design and evaluation of healthcare systems. The clinical microsystem, as an organisational construct, is a systems approach for providing clinical care based on theories from organisational development, leadership and improvement. This study compared the MBNQA criteria for healthcare and the success factors of high‐performing clinical microsystems to (1) determine whether microsystem success characteristics cover the same range of issues addressed by the Baldrige criteria and (2) examine whether this comparison might better inform our understanding of either framework. Results and conclusions Both Baldrige criteria and microsystem success characteristics cover a wide range of areas crucial to high performance. Those particularly called out by this analysis are organisational leadership, work systems and service processes from a Baldrige standpoint, and leadership, performance results, process improvement, and information and information technology from the microsystem success characteristics view. Although in many cases the relationship between Baldrige criteria and microsystem success characteristics are obvious, in others the analysis points to ways in which the Baldrige criteria might be better understood and worked with by a microsystem through the design of work systems and a deep understanding of processes. Several tools are available for those who wish to engage in self‐assessment based on MBNQA criteria and microsystem characteristics. PMID:17913773

A Study in Difference: Structures and Cultures in Registered Training Organisations. Support Document 3

ERIC Educational Resources Information Center

Clayton, Berwyn; Fisher, Thea; Harris, Roger; Bateman, Andrea; Brown, Mike

2008-01-01

This document supports the report "A Study in Difference: Structures and Cultures in Registered Training Organisations." The first section outlines the methodology used to undertake the research and covers the design of the research, sample details, the data collection process and the strategy for data analysis and reporting. The…

Bridging the Gap between Academic Research and Regional Development in the Basque Country

ERIC Educational Resources Information Center

Karlsen, James; Larrea, Miren; Wilson, James R.; Aranguren, Mari Jose

2012-01-01

The discussion in this article focuses on how the gap between academic knowledge and regional development can be bridged, creating conditions for change processes between researchers and regional agents. Institutional entrepreneurs can create regional development organisations and research organisations, but in order to fulfil regional needs it is…

The Co-Creation-Wheel: A Four-Dimensional Model of Collaborative Interorganistional Innovation

ERIC Educational Resources Information Center

Ehlen, Corry; van der Klink, Marcel; Stoffers, Jol; Boshuizen, Henny

2017-01-01

Purpose: This study aims to design and validate a conceptual and practical model of co-creation. Co-creation, to design collaborative new products, services and processes in contact with users, has become more and more important because organisations increasingly require multidisciplinary collaboration inside and outside the organisation to…

The Contribution of VET Student Placement to Innovation in Host Organisations--Support Document

ERIC Educational Resources Information Center

Hodge, Steven; Smith, Raymond; Field, Jenny; Flynn, Matthew

2017-01-01

This document gathers material used in the research project entitled: "The Contribution of VET Student Placement to Innovation in Host Organisations" that was not presented in the main report. The project sought to explore the question, "What is the contribution of the VET student placement process to innovation in host…

School Organisational Efforts in Search for Alternatives to Ability Grouping

ERIC Educational Resources Information Center

Alpert, Bracha; Bechar, Shlomit

2008-01-01

The paper presents a case study of a secondary school in Israel and its efforts at attending to students' needs without resorting to tracking and ability grouping. It explores an organisational process the school has established, called "Opening triads", which involves periodical regrouping of three classrooms of students of the same age…

Schooling, Organisation of the Constitutional Monarchy and the Education of Citizens (Brazil, 1822-1889)

ERIC Educational Resources Information Center

Veiga, Cynthia Greive

2013-01-01

The objective of this article is to analyse the process of institutionalisation of public elementary schooling associated with the political organisation of the constitutional monarchy and the legislation regarding citizen rights and prerogatives in Brazil, especially in the province of Minas Gerais, during the nineteenth century. During this…

Feelings over Facts--A University Merger Brings Organisational Identity to the Forefront

ERIC Educational Resources Information Center

Puusa, Anu; Kekäle, Jouni

2015-01-01

This article presents a qualitative case study based on an analysis of the outcomes and meanings attributed by university academics to an institutional merger, from the perspective of organisational identity. The change process may have broadened the "us and them" gap that exists between those responsible for university leadership and…

Political and institutional influences on the use of evidence in public health policy. A systematic review.

PubMed

Liverani, Marco; Hawkins, Benjamin; Parkhurst, Justin O

2013-01-01

There is increasing recognition that the development of evidence-informed health policy is not only a technical problem of knowledge exchange or translation, but also a political challenge. Yet, while political scientists have long considered the nature of political systems, the role of institutional structures, and the political contestation of policy issues as central to understanding policy decisions, these issues remain largely unexplored by scholars of evidence-informed policy making. We conducted a systematic review of empirical studies that examined the influence of key features of political systems and institutional mechanisms on evidence use, and contextual factors that may contribute to the politicisation of health evidence. Eligible studies were identified through searches of seven health and social sciences databases, websites of relevant organisations, the British Library database, and manual searches of academic journals. Relevant findings were extracted using a uniform data extraction tool and synthesised by narrative review. 56 studies were selected for inclusion. Relevant political and institutional aspects affecting the use of health evidence included the level of state centralisation and democratisation, the influence of external donors and organisations, the organisation and function of bureaucracies, and the framing of evidence in relation to social norms and values. However, our understanding of such influences remains piecemeal given the limited number of empirical analyses on this subject, the paucity of comparative works, and the limited consideration of political and institutional theory in these studies. This review highlights the need for a more explicit engagement with the political and institutional factors affecting the use of health evidence in decision-making. A more nuanced understanding of evidence use in health policy making requires both additional empirical studies of evidence use, and an engagement with theories and approaches beyond the current remit of public health or knowledge utilisation studies.

The cell proliferation antigen Ki-67 organises heterochromatin

PubMed Central

Sobecki, Michal; Mrouj, Karim; Camasses, Alain; Parisis, Nikolaos; Nicolas, Emilien; Llères, David; Gerbe, François; Prieto, Susana; Krasinska, Liliana; David, Alexandre; Eguren, Manuel; Birling, Marie-Christine; Urbach, Serge; Hem, Sonia; Déjardin, Jérôme; Malumbres, Marcos; Jay, Philippe; Dulic, Vjekoslav; Lafontaine, Denis LJ; Feil, Robert; Fisher, Daniel

2016-01-01

Antigen Ki-67 is a nuclear protein expressed in proliferating mammalian cells. It is widely used in cancer histopathology but its functions remain unclear. Here, we show that Ki-67 controls heterochromatin organisation. Altering Ki-67 expression levels did not significantly affect cell proliferation in vivo. Ki-67 mutant mice developed normally and cells lacking Ki-67 proliferated efficiently. Conversely, upregulation of Ki-67 expression in differentiated tissues did not prevent cell cycle arrest. Ki-67 interactors included proteins involved in nucleolar processes and chromatin regulators. Ki-67 depletion disrupted nucleologenesis but did not inhibit pre-rRNA processing. In contrast, it altered gene expression. Ki-67 silencing also had wide-ranging effects on chromatin organisation, disrupting heterochromatin compaction and long-range genomic interactions. Trimethylation of histone H3K9 and H4K20 was relocalised within the nucleus. Finally, overexpression of human or Xenopus Ki-67 induced ectopic heterochromatin formation. Altogether, our results suggest that Ki-67 expression in proliferating cells spatially organises heterochromatin, thereby controlling gene expression. DOI: http://dx.doi.org/10.7554/eLife.13722.001 PMID:26949251

New forms of development: branding innovative ideas and bidding for foreign aid in the maternal and child health service in Nepal.

PubMed

Adhikari, Radha; Smith, Pam; Sharma, Jeevan Raj; Chand, Obindra Bahadur

2018-03-27

Nepal has been receiving foreign aid since the early 1950s. Currently, the country's health care system is heavily dependent on aid, even for the provision of basic health services to its people. Globally, the mechanism for the dispersal of foreign aid is becoming increasingly complex. Numerous stakeholders are involved at various levels: donors, intermediary organisations, project-implementing partners and the beneficiaries, engaging not only in Nepal but also globally. To illustrate how branding and bidding occurs, and to discuss how this process has become increasingly vital in securing foreign aid to run MCH activities in Nepal. This paper is based on a qualitative study. The data collection method includes Key Informant Interviews, the review of relevant policy documents and secondary data, and finally field observation visits to four maternal and child health (MCH) projects, currently funded by foreign aid. Through these methods we planned to gain a comprehensive understanding of the aid dispersing mechanism, and the aid-securing strategies, used by organisations seeking funds to provide MCH services in Nepal. Study findings suggest that foreign aid for the provision of MCH services in Nepal is channeled increasingly to its beneficiaries, not through the Government system, but rather via various intermediary organisations, employing branding and bidding processes. These organisations adapt commercial models, seeking to justify their 'cost-effectiveness'. They argue that they are 'yielding good value for money', with short-term target oriented projects. This ethos is evident throughout the aid dispersing chain. Organisations use innovative ideas and intervention packages, branded internationally and nationally, and employ the appropriate language of commerce in their bid to secure funds. The paper raises an important question as to whether the current mechanisms of channeling foreign aid in the MCH sector, via intermediary organisations, can actually be cost-effective, given the complex bureaucratic processes involved. The study findings are very important, for Nepal's development in particular, and for international development in general. The paper concludes by recommending strongly that foreign aid should concentrate on supporting and strengthening the national government system. Complex bureaucratic process must be minimised and streamlined in order to provide quality care to the beneficiaries.

What methods are used to apply positive deviance within healthcare organisations? A systematic review

PubMed Central

Baxter, Ruth; Taylor, Natalie; Kellar, Ian; Lawton, Rebecca

2016-01-01

Background The positive deviance approach focuses on those who demonstrate exceptional performance, despite facing the same constraints as others. ‘Positive deviants’ are identified and hypotheses about how they succeed are generated. These hypotheses are tested and then disseminated within the wider community. The positive deviance approach is being increasingly applied within healthcare organisations, although limited guidance exists and different methods, of varying quality, are used. This paper systematically reviews healthcare applications of the positive deviance approach to explore how positive deviance is defined, the quality of existing applications and the methods used within them, including the extent to which staff and patients are involved. Methods Peer-reviewed articles, published prior to September 2014, reporting empirical research on the use of the positive deviance approach within healthcare, were identified from seven electronic databases. A previously defined four-stage process for positive deviance in healthcare was used as the basis for data extraction. Quality assessments were conducted using a validated tool, and a narrative synthesis approach was followed. Results 37 of 818 articles met the inclusion criteria. The positive deviance approach was most frequently applied within North America, in secondary care, and to address healthcare-associated infections. Research predominantly identified positive deviants and generated hypotheses about how they succeeded. The approach and processes followed were poorly defined. Research quality was low, articles lacked detail and comparison groups were rarely included. Applications of positive deviance typically lacked staff and/or patient involvement, and the methods used often required extensive resources. Conclusion Further research is required to develop high quality yet practical methods which involve staff and patients in all stages of the positive deviance approach. The efficacy and efficiency of positive deviance must be assessed and compared with other quality improvement approaches. PROSPERO registration number CRD42014009365. PMID:26590198

Developing anti-tobacco messages for Australian Aboriginal and Torres Strait Islander peoples: evidence from a national cross-sectional survey.

PubMed

Gould, Gillian S; Watt, Kerrianne; Stevenson, Leah; McEwen, Andy; Cadet-James, Yvonne; Clough, Alan R

2014-03-13

Smoking rates in Australian Aboriginal and Torres Strait Islander peoples remain high, with limited impact of government measures for many subgroups. The aim of this cross-sectional study was to investigate differences in organisational practice for developing anti-tobacco messages for these target populations. Telephone interviews were conducted with 47 organisation representatives using a structured questionnaire based on health communication and health promotion frameworks. Responses were coded into phases of message development, message types (educational, threat, positive or advocacy), target groups, message recommendations, and evaluations undertaken. Cultural sensitivity for message development was divided into surface structure (use of images, language, demographics) and deep structure (use of socio-cultural values). A categorical principal component analysis explored the key dimensions of the findings and their component relationships. Among organisations interviewed, a community-orientated, bottom-up approach for developing anti-tobacco messages was reported by 47% (n=24); 55% based message development on a theoretical framework; 87% used a positive benefit appeal; 38% used threat messages. More Aboriginal Medical Services (AMSs) targeted youth (p<0.005) and advised smokers to quit (p<0.05) than other types of organisations. AMSs were significantly more likely to report using deep structure in tailoring messages compared with non-government (p<0.05) and government organisations (p<0.05). Organisations that were oriented to the general population were more likely to evaluate their programs (p<0.05). A two-dimensional non-linear principal component analysis extracted components interpreted as "cultural understanding" (bottom-up, community-based approaches, deep structures) and "rigour" (theoretical frameworks, and planned/completed evaluations), and accounted for 53% of the variability in the data. Message features, associated with successful campaigns in other populations, are starting to be used for Aboriginal and Torres Strait Islander peoples. A model is proposed to facilitate the development of targeted anti-tobacco messages for Aboriginal and Torres Strait Islander peoples. Organisations could consider incorporating both components of cultural understanding-rigour to enable the growth of evidence-based practice.

Developing anti-tobacco messages for Australian Aboriginal and Torres Strait Islander peoples: evidence from a national cross-sectional survey

PubMed Central

2014-01-01

Background Smoking rates in Australian Aboriginal and Torres Strait Islander peoples remain high, with limited impact of government measures for many subgroups. The aim of this cross-sectional study was to investigate differences in organisational practice for developing anti-tobacco messages for these target populations. Methods Telephone interviews were conducted with 47 organisation representatives using a structured questionnaire based on health communication and health promotion frameworks. Responses were coded into phases of message development, message types (educational, threat, positive or advocacy), target groups, message recommendations, and evaluations undertaken. Cultural sensitivity for message development was divided into surface structure (use of images, language, demographics) and deep structure (use of socio-cultural values). A categorical principal component analysis explored the key dimensions of the findings and their component relationships. Results Among organisations interviewed, a community-orientated, bottom-up approach for developing anti-tobacco messages was reported by 47% (n = 24); 55% based message development on a theoretical framework; 87% used a positive benefit appeal; 38% used threat messages. More Aboriginal Medical Services (AMSs) targeted youth (p < 0.005) and advised smokers to quit (p < 0.05) than other types of organisations. AMSs were significantly more likely to report using deep structure in tailoring messages compared with non-government (p < 0.05) and government organisations (p < 0.05). Organisations that were oriented to the general population were more likely to evaluate their programs (p < 0.05). A two-dimensional non-linear principal component analysis extracted components interpreted as “cultural understanding” (bottom-up, community-based approaches, deep structures) and “rigour” (theoretical frameworks, and planned/completed evaluations), and accounted for 53% of the variability in the data. Conclusion Message features, associated with successful campaigns in other populations, are starting to be used for Aboriginal and Torres Strait Islander peoples. A model is proposed to facilitate the development of targeted anti-tobacco messages for Aboriginal and Torres Strait Islander peoples. Organisations could consider incorporating both components of cultural understanding-rigour to enable the growth of evidence-based practice. PMID:24625235

The influence of personal and organisational factors on entrepreneurship intention: An application in the health care sector.

PubMed

Marques, Carla S; Valente, Sandra; Lages, Marisa

2018-03-05

This study sought to contribute to research on entrepreneurial intention by identifying which constructs of the entrepreneurial profile and internal conditions of health care organisations support entrepreneurship and contribute to the entrepreneurial intention of these organisations' employees. In addition to psychological attributes, cognitive processes, motivations, sociodemographic and professional characteristics, and entrepreneurial skills, the literature indicates that internal conditions of organisations also contribute to explaining entrepreneurial intention. To evaluate this model empirically, the primary data were collected with questionnaires distributed to nurses in two public hospitals-the Trás-os-Montes and Alto Douro Hospital Center and the Local Health Unit of the Northeast. A total of 638 nurses filled out the questionnaire. The data were analysed using inferential and regression analyses. The results suggest that the dimensions related to personal attributes, namely, motivation and entrepreneurial skills, are the constructs that best explain the entrepreneurial intention of these professionals within their organisations. A broad discussion is needed about how to implement internal conditions that promote an intrapreneurial and innovative culture in health care organisations. Health care organisation administrators need to prioritise intrapreneurship while structuring their management strategies, thereby creating favourable internal conditions (e.g., support, autonomy, rewards, time availability and appropriate organisational procedures) that enhance their nurses' entrepreneurial intention. © 2018 John Wiley & Sons Ltd.

A practical and systematic approach to organisational capacity strengthening for research in the health sector in Africa.

PubMed

Bates, Imelda; Boyd, Alan; Smith, Helen; Cole, Donald C

2014-03-03

Despite increasing investment in health research capacity strengthening efforts in low and middle income countries, published evidence to guide the systematic design and monitoring of such interventions is very limited. Systematic processes are important to underpin capacity strengthening interventions because they provide stepwise guidance and allow for continual improvement. Our objective here was to use evidence to inform the design of a replicable but flexible process to guide health research capacity strengthening that could be customized for different contexts, and to provide a framework for planning, collecting information, making decisions, and improving performance. We used peer-reviewed and grey literature to develop a five-step pathway for designing and evaluating health research capacity strengthening programmes, tested in a variety of contexts in Africa. The five steps are: i) defining the goal of the capacity strengthening effort, ii) describing the optimal capacity needed to achieve the goal, iii) determining the existing capacity gaps compared to the optimum, iv) devising an action plan to fill the gaps and associated indicators of change, and v) adapting the plan and indicators as the programme matures. Our paper describes three contrasting case studies of organisational research capacity strengthening to illustrate how our five-step approach works in practice. Our five-step pathway starts with a clear goal and objectives, making explicit the capacity required to achieve the goal. Strategies for promoting sustainability are agreed with partners and incorporated from the outset. Our pathway for designing capacity strengthening programmes focuses not only on technical, managerial, and financial processes within organisations, but also on the individuals within organisations and the wider system within which organisations are coordinated, financed, and managed. Our five-step approach is flexible enough to generate and utilise ongoing learning. We have tested and critiqued our approach in a variety of organisational settings in the health sector in sub-Saharan Africa, but it needs to be applied and evaluated in other sectors and continents to determine the extent of transferability.

Controlled information destruction: the final frontier in preserving information security for every organisation

NASA Astrophysics Data System (ADS)

Curiac, Daniel-Ioan; Pachia, Mihai

2015-05-01

Information security represents the cornerstone of every data processing system that resides in an organisation's trusted network, implementing all necessary protocols, mechanisms and policies to be one step ahead of possible threats. Starting from the need to strengthen the set of security services, in this article we introduce a new and innovative process named controlled information destruction (CID) that is meant to secure sensitive data that are no longer needed for the organisation's future purposes but would be very damaging if revealed. The disposal of this type of data has to be controlled carefully in order to delete not only the information itself but also all its splinters spread throughout the network, thus denying any possibility of recovering the information after its alleged destruction. This process leads to a modified model of information assurance and also reconfigures the architecture of any information security management system. The scheme we envisioned relies on a reshaped information lifecycle, which reveals the impact of the CID procedure directly upon the information states.

Quicker, slicker, and better? An evaluation of a web-based human resource management system

NASA Astrophysics Data System (ADS)

Gibb, Stephen; McBride, Andrew

2001-10-01

This paper reviews the design and development of a web based Human Resource Management (HRM) system which has as its foundation a 'capability profiler' tool for analysing individual or team roles in organisations. This provides a foundation for managing a set of integrated activities in recruitment and selection, performance and career management, and training and development for individuals, teams, and whole organisations. The challenges of representing and processing information about the human side of organisation encountered in the design and implementation of such systems are evident. There is a combination of legal, practical, technical and philosophical issues to be faced in the processes of defining roles, selecting staff, monitoring and managing the performance of employees in the design and implementation of such systems. The strengths and weaknesses of web based systems in this context are evaluated. This evaluation highlights both the potential, given the evolution of broader Enterprise Resource Planning (ERP) systems and strategies in manufacturing, and concerns about the migration of HRM processes to such systems.

A proto-architecture for innate directionally selective visual maps.

PubMed

Adams, Samantha V; Harris, Chris M

2014-01-01

Self-organizing artificial neural networks are a popular tool for studying visual system development, in particular the cortical feature maps present in real systems that represent properties such as ocular dominance (OD), orientation-selectivity (OR) and direction selectivity (DS). They are also potentially useful in artificial systems, for example robotics, where the ability to extract and learn features from the environment in an unsupervised way is important. In this computational study we explore a DS map that is already latent in a simple artificial network. This latent selectivity arises purely from the cortical architecture without any explicit coding for DS and prior to any self-organising process facilitated by spontaneous activity or training. We find DS maps with local patchy regions that exhibit features similar to maps derived experimentally and from previous modeling studies. We explore the consequences of changes to the afferent and lateral connectivity to establish the key features of this proto-architecture that support DS.

Institutions of care, moral proximity and demoralisation: The case of the emergency department

PubMed Central

Hillman, Alexandra

2016-01-01

This article draws on concepts of morality and demoralisation to understand the problematic nature of relationships between staff and patients in public health services. The article uses data from a case study of a UK hospital Emergency Department to show how staff are tasked with the responsibility of treating and caring for patients, while at the same time their actions are shaped by the institutional concerns of accountability and resource management. The data extracts illustrate how such competing agendas create a tension for staff to manage and suggests that, as a consequence of this tension, staff participate in processes of ‘effacement' that limit the presence of patients and families as a moral demand. The analysis from the Emergency Department case study suggests that demoralisation is an increasingly important lens through which to understand health-care institutions, where contemporary organisational cultures challenge the ethical quality of human interaction. PMID:26823656

An attention-gating recurrent working memory architecture for emergent speech representation

NASA Astrophysics Data System (ADS)

Elshaw, Mark; Moore, Roger K.; Klein, Michael

2010-06-01

This paper describes an attention-gating recurrent self-organising map approach for emergent speech representation. Inspired by evidence from human cognitive processing, the architecture combines two main neural components. The first component, the attention-gating mechanism, uses actor-critic learning to perform selective attention towards speech. Through this selective attention approach, the attention-gating mechanism controls access to working memory processing. The second component, the recurrent self-organising map memory, develops a temporal-distributed representation of speech using phone-like structures. Representing speech in terms of phonetic features in an emergent self-organised fashion, according to research on child cognitive development, recreates the approach found in infants. Using this representational approach, in a fashion similar to infants, should improve the performance of automatic recognition systems through aiding speech segmentation and fast word learning.

Towards a typology of business process management professionals: identifying patterns of competences through latent semantic analysis

NASA Astrophysics Data System (ADS)

Müller, Oliver; Schmiedel, Theresa; Gorbacheva, Elena; vom Brocke, Jan

2016-01-01

While researchers have analysed the organisational competences that are required for successful Business Process Management (BPM) initiatives, individual BPM competences have not yet been studied in detail. In this study, latent semantic analysis is used to examine a collection of 1507 BPM-related job advertisements in order to develop a typology of BPM professionals. This empirical analysis reveals distinct ideal types and profiles of BPM professionals on several levels of abstraction. A closer look at these ideal types and profiles confirms that BPM is a boundary-spanning field that requires interdisciplinary sets of competence that range from technical competences to business and systems competences. Based on the study's findings, it is posited that individual and organisational alignment with the identified ideal types and profiles is likely to result in high employability and organisational BPM success.

Work environments for employee creativity.

PubMed

Dul, Jan; Ceylan, Canan

2011-01-01

Innovative organisations need creative employees who generate new ideas for product or process innovation. This paper presents a conceptual framework for the effect of personal, social-organisational and physical factors on employee creativity. Based on this framework, an instrument to analyse the extent to which the work environment enhances creativity is developed. This instrument was applied to a sample of 409 employees and support was found for the hypothesis that a creative work environment enhances creative performance. This paper illustrates how the instrument can be used in companies to select and implement improvements. STATEMENT OF RELEVANCE: The ergonomics discipline addresses the work environment mainly for improving health and safety and sometimes productivity and quality. This paper opens a new area for ergonomics: designing work environments for enhancing employee creativity in order to strengthen an organisation's capability for product and process innovation and, consequently, its competitiveness.

Analysing organisational context: case studies on the contribution of absorptive capacity theory to understanding inter-organisational variation in performance improvement.

PubMed

Harvey, Gill; Jas, Pauline; Walshe, Kieran

2015-01-01

Organisational context is frequently cited as an important consideration when implementing and evaluating quality improvement interventions in healthcare, but limited guidance is available on which aspects of context are most influential or modifiable. This paper examines how internal and external contextual factors mediate organisational-level performance improvement through applying the knowledge-based theory of absorptive capacity (AC). Three healthcare case studies are presented. Each case is a UK National Health Service organisation that had been identified as having performance problems. Qualitative data were collected through semi-structured interviews with general and clinical managers within the organisation and members of external teams supporting or overseeing performance improvement (n=22). Interview data were analysed using an existing AC framework from the literature. The organisation with the highest AC showed the quickest and most comprehensive performance improvement. Internal characteristics including strategic priorities, processes for managing information, communication and orientation to learning and development impacted on the organisation's ability to engage successfully with external stakeholders and make use of available knowledge. This enabled the organisation to thrive despite the challenging external environment. Lower levels of AC appeared to delay or limit the improvement trajectory. Developing a more detailed and nuanced understanding of how context influences improvement is an important step towards achieving more effective and sustainable quality improvement programmes in healthcare. AC, with its focus on knowledge and organisational learning, provides a useful way to explore the relationship between context and quality improvement and represents a potentially valuable area for future research and development. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Working towards integrated community care for older people: empowering organisational features from a professional perspective.

PubMed

Janssen, Bienke M; Snoeren, Miranda W C; Van Regenmortel, Tine; Abma, Tineke A

2015-01-01

Although multi-disciplinary cooperation between professionals is a prerequisite to provide integrated care in the community, this seems hard to realise in practice. Yet, little is known about the experiences of professionals who implement it nor about the organisational features professionals identify as empowering during this cooperation process. Therefore, a case study of a multi-disciplinary geriatric team was performed. The data-collection included observations of meetings, in-depth interviews and focus groups with professionals (N = 12). Data were analysed inductively and related to the three organisational levels within the model of organisational empowerment of Peterson and Zimmerman. Signs of empowering organisational features on the intraorganisational level were mutual trust and clear working routines. On the interorganisational level important features included improved linkages between participating organisations and increased insight into each other's tasks. Tensions occurred relating to the inter- and the extraorganisational level. Professionals felt that the commitment of the management of involved organisations should be improved just as the capacity of the team to influence (local) policy. It is recommended that policymakers should not determine the nature of professional cooperation in advance, but to leave that to the local context as well as to the judgement of involved professionals. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Symmetry breaking, germ layer specification and axial organisation in aggregates of mouse embryonic stem cells

PubMed Central

van den Brink, Susanne C.; Baillie-Johnson, Peter; Balayo, Tina; Hadjantonakis, Anna-Katerina; Nowotschin, Sonja; Turner, David A.; Martinez Arias, Alfonso

2014-01-01

Mouse embryonic stem cells (mESCs) are clonal populations derived from preimplantation mouse embryos that can be propagated in vitro and, when placed into blastocysts, contribute to all tissues of the embryo and integrate into the normal morphogenetic processes, i.e. they are pluripotent. However, although they can be steered to differentiate in vitro into all cell types of the organism, they cannot organise themselves into structures that resemble embryos. When aggregated into embryoid bodies they develop disorganised masses of different cell types with little spatial coherence. An exception to this rule is the emergence of retinas and anterior cortex-like structures under minimal culture conditions. These structures emerge from the cultures without any axial organisation. Here, we report that small aggregates of mESCs, of about 300 cells, self-organise into polarised structures that exhibit collective behaviours reminiscent of those that cells exhibit in early mouse embryos, including symmetry breaking, axial organisation, germ layer specification and cell behaviour, as well as axis elongation. The responses are signal specific and uncouple processes that in the embryo are tightly associated, such as specification of the anteroposterior axis and anterior neural development, or endoderm specification and axial elongation. We discuss the meaning and implications of these observations and the potential uses of these structures which, because of their behaviour, we suggest to call ‘gastruloids’. PMID:25371360

Symmetry breaking, germ layer specification and axial organisation in aggregates of mouse embryonic stem cells.

PubMed

van den Brink, Susanne C; Baillie-Johnson, Peter; Balayo, Tina; Hadjantonakis, Anna-Katerina; Nowotschin, Sonja; Turner, David A; Martinez Arias, Alfonso

2014-11-01

Mouse embryonic stem cells (mESCs) are clonal populations derived from preimplantation mouse embryos that can be propagated in vitro and, when placed into blastocysts, contribute to all tissues of the embryo and integrate into the normal morphogenetic processes, i.e. they are pluripotent. However, although they can be steered to differentiate in vitro into all cell types of the organism, they cannot organise themselves into structures that resemble embryos. When aggregated into embryoid bodies they develop disorganised masses of different cell types with little spatial coherence. An exception to this rule is the emergence of retinas and anterior cortex-like structures under minimal culture conditions. These structures emerge from the cultures without any axial organisation. Here, we report that small aggregates of mESCs, of about 300 cells, self-organise into polarised structures that exhibit collective behaviours reminiscent of those that cells exhibit in early mouse embryos, including symmetry breaking, axial organisation, germ layer specification and cell behaviour, as well as axis elongation. The responses are signal specific and uncouple processes that in the embryo are tightly associated, such as specification of the anteroposterior axis and anterior neural development, or endoderm specification and axial elongation. We discuss the meaning and implications of these observations and the potential uses of these structures which, because of their behaviour, we suggest to call 'gastruloids'. © 2014. Published by The Company of Biologists Ltd.

EarthServer2 : The Marine Data Service - Web based and Programmatic Access to Ocean Colour Open Data

NASA Astrophysics Data System (ADS)

Clements, Oliver; Walker, Peter

2017-04-01

The ESA Ocean Colour - Climate Change Initiative (ESA OC-CCI) has produced a long-term high quality global dataset with associated per-pixel uncertainty data. This dataset has now grown to several hundred terabytes (uncompressed) and is freely available to download. However, the sheer size of the dataset can act as a barrier to many users; large network bandwidth, local storage and processing requirements can prevent researchers without the backing of a large organisation from taking advantage of this raw data. The EC H2020 project, EarthServer2, aims to create a federated data service providing access to more than 1 petabyte of earth science data. Within this federation the Marine Data Service already provides an innovative on-line tool-kit for filtering, analysing and visualising OC-CCI data. Data are made available, filtered and processed at source through a standards-based interface, the Open Geospatial Consortium Web Coverage Service and Web Coverage Processing Service. This work was initiated in the EC FP7 EarthServer project where it was found that the unfamiliarity and complexity of these interfaces itself created a barrier to wider uptake. The continuation project, EarthServer2, addresses these issues by providing higher level tools for working with these data. We will present some examples of these tools. Many researchers wish to extract time series data from discrete points of interest. We will present a web based interface, based on NASA/ESA WebWorldWind, for selecting points of interest and plotting time series from a chosen dataset. In addition, a CSV file of locations and times, such as a ship's track, can be uploaded and these points extracted and returned in a CSV file allowing researchers to work with the extract locally, such as a spreadsheet. We will also present a set of Python and JavaScript APIs that have been created to complement and extend the web based GUI. These APIs allow the selection of single points and areas for extraction. The extracted data is returned as structured data (for instance a Python array) which can then be passed directly to local processing code. We will highlight how the libraries can be used by the community and integrated into existing systems, for instance by the use of Jupyter notebooks to share Python code examples which can then be used by other researchers as a basis for their own work.

The Advocacy of an Appraisal System for Teachers: A Case Study

ERIC Educational Resources Information Center

Bisschoff, Tom; Mathye, Annah

2009-01-01

Education systems all over the world, like all other organisations, have certain organisational goals that they set and wish to achieve. It is argued that for increased pupil performance, in the case of education systems, teachers must work harder and smarter. A performance system is regarded as part of the process to achieve this organisational…

Using the Research and Development in Organisations Model to Improve Transition to High School

ERIC Educational Resources Information Center

Ashton, Rebecca

2009-01-01

This article describes the application of the Research and Development in Organisations (RADIO) model to five action research projects carried out in schools around transition processes. The RADIO model is mapped onto all five studies, and adapting the model in order to include greater stakeholder participation is suggested. Reflections are made…

Intervening with Care--Varying Outcomes of a Training and Development Programme in Elderly Care in Sweden

ERIC Educational Resources Information Center

Hauer, Esther; Westerberg, Kristina; Nordlund, Annika M.

2017-01-01

Awareness of the mechanisms underlying training and development (T&D) programmes is crucial in creating sustainable learning conditions in organisations. The organisational and psychosocial aspects of the work environment in Swedish elderly care is the focus of this longitudinal study, and the relation between process and results of a T&D…

The Challenges of Adopting the Learning Organisation Philosophy in a Singapore School

ERIC Educational Resources Information Center

Retna, Kala S.; Tee, Ng Pak

2006-01-01

Purpose: To report on a case study that examines how the Learning Organisation (LO) concept can be applied in a Singapore school and the challenges that the school faces in the process. Design/methodology/approach: A qualitative research inquiry was adopted using ethnographic methods. Data includes in-depth face-to-face interviews, observation of…

Knowledge Creation and Deployment in the Small, but Growing, Enterprise and the Psychological Contract

ERIC Educational Resources Information Center

Leach, Tony

2010-01-01

This paper contains an account of a small scale investigation into the usefulness of the concepts of the learning organisation and organisational learning when seeking to describe the processes of knowledge creation and deployment within the small, but growing, enterprise (SME). A review of the literature reveals a concern that the relationship…

Holding a Sustainability Bearing through Cutty-Grass and Clearings: Implementing Sustainability during Disruptive Organisational Changes

ERIC Educational Resources Information Center

North, Chris; Jansen, Chris

2013-01-01

This article explores our experiences as faculty implementing a five year sustainability strategic plan within the Outdoor and Environmental Education (OEE) curriculum centre during a time of organisational restructuring. This paper builds on the work of Jansen and Boardman (2011) who describe the process of developing the strategic plan and some…

Fight the Power: Situated Learning and Conscientisation in a Gendered Community of Practice

ERIC Educational Resources Information Center

Curnow, Joe

2013-01-01

In this paper, I employ situated learning theory to explore gendered processes of marginalisation and conscientisation in a social movement organisation. Using a student activist organisation as a case study, I explain women's awareness of and resistance to masculine performances of leadership and decision-making through the concept of…

Outcomes of Quality Assurance: A Discussion of Knowledge, Methodology and Validity

ERIC Educational Resources Information Center

Stensaker, Bjorn

2008-01-01

A common characteristic in many quality assurance schemes around the world is their implicit and often narrowly formulated understanding of how organisational change is to take place as a result of the process. By identifying some of the underlying assumptions related to organisational change in current quality assurance schemes, the aim of this…

A case study of organisational Cultural Competence in mental healthcare.

PubMed

Adamson, Jean; Warfa, Nasir; Bhui, Kamaldeep

2011-09-15

Ensuring Cultural Competence (CC) in health care is a mechanism to deliver culturally appropriate care and optimise recovery. In policies that promote cultural competence, the training of mental health practitioners is a key component of a culturally competent organisation. This study examines staff perceptions of CC and the integration of CC principles in a mental healthcare organisation. The purpose is to show interactions between organisational and individual processes that help or hinder recovery orientated services. We carried out a case study of a large mental health provider using a cultural competence needs analysis. We used structured and semi-structured questionnaires to explore the perceptions of healthcare professionals located in one of the most ethnically and culturally diverse areas of England, its capital city London. There was some evidence that clinical staff were engaged in culturally competent activities. We found a growing awareness of cultural competence amongst staff in general, and many had attended training. However, strategic plans and procedures that promote cultural competence tended to not be well communicated to all frontline staff; whilst there was little understanding at corporate level of culturally competent clinical practices. The provider organisation had commenced a targeted recruitment campaign to recruit staff from under-represented ethnic groups and it developed collaborative working patterns with service users. There is evidence to show tentative steps towards building cultural competence in the organisation. However, further work is needed to embed cultural competence principles and practices at all levels of the organisation, for example, by introducing monitoring systems that enable organisations to benchmark their performance as a culturally capable organisation.

A case study of organisational cultural competence in mental healthcare

PubMed Central

2011-01-01

Background Ensuring Cultural Competence (CC) in health care is a mechanism to deliver culturally appropriate care and optimise recovery. In policies that promote cultural competence, the training of mental health practitioners is a key component of a culturally competent organisation. This study examines staff perceptions of CC and the integration of CC principles in a mental healthcare organisation. The purpose is to show interactions between organisational and individual processes that help or hinder recovery orientated services. Methods We carried out a case study of a large mental health provider using a cultural competence needs analysis. We used structured and semi-structured questionnaires to explore the perceptions of healthcare professionals located in one of the most ethnically and culturally diverse areas of England, its capital city London. Results There was some evidence that clinical staff were engaged in culturally competent activities. We found a growing awareness of cultural competence amongst staff in general, and many had attended training. However, strategic plans and procedures that promote cultural competence tended to not be well communicated to all frontline staff; whilst there was little understanding at corporate level of culturally competent clinical practices. The provider organisation had commenced a targeted recruitment campaign to recruit staff from under-represented ethnic groups and it developed collaborative working patterns with service users. Conclusion There is evidence to show tentative steps towards building cultural competence in the organisation. However, further work is needed to embed cultural competence principles and practices at all levels of the organisation, for example, by introducing monitoring systems that enable organisations to benchmark their performance as a culturally capable organisation. PMID:21920044

Whistleblowing Need not Occur if Internal Voices Are Heard: From Deaf Effect to Hearer Courage: Comment on "Cultures of Silence and Cultures of Voice: The Role of Whistleblowing in Healthcare Organisations".

PubMed

Cleary, Sonja R; Doyle, Kerrie E

2015-09-29

Whistleblowing by health professionals is an infrequent and extraordinary event and need not occur if internal voices are heard. Mannion and Davies' editorial on "Cultures of Silence and Cultures of Voice: The Role of Whistleblowing in Healthcare Organisations" asks the question whether whistleblowing ameliorates or exacerbates the 'deaf effect' prevalent in healthcare organisations. This commentary argues that the focus should remain on internal processes and hearer courage . © 2016 by Kerman University of Medical Sciences.

Revisiting Organisational Learning in Integrated Care.

PubMed

Nuño-Solinís, Roberto

2017-08-11

Progress in health care integration is largely linked to changes in processes and ways of doing. These changes have knowledge management and learning implications. For this reason, the use of the concept of organisational learning is explored in the field of integrated care. There are very limited contributions that have connected the fields of organisational learning and care integration in a systematic way, both at the theoretical and empirical level. For this reason, hybridization of both perspectives still provides opportunities for understanding care integration initiatives from a research perspective as well as potential applications in health care management and planning.

Revisiting Organisational Learning in Integrated Care

PubMed Central

2017-01-01

Progress in health care integration is largely linked to changes in processes and ways of doing. These changes have knowledge management and learning implications. For this reason, the use of the concept of organisational learning is explored in the field of integrated care. There are very limited contributions that have connected the fields of organisational learning and care integration in a systematic way, both at the theoretical and empirical level. For this reason, hybridization of both perspectives still provides opportunities for understanding care integration initiatives from a research perspective as well as potential applications in health care management and planning. PMID:28970762

A real-time programming system.

PubMed

Townsend, H R

1979-03-01

The paper describes a Basic Operating and Scheduling System (BOSS) designed for a small computer. User programs are organised as self-contained modular 'processes' and the way in which the scheduler divides the time of the computer equally between them, while arranging for any process which has to respond to an interrupt from a peripheral device to be given the necessary priority, is described in detail. Next the procedures provided by the operating system to organise communication between processes are described, and how they are used to construct dynamically self-modifying real-time systems. Finally, the general philosophy of BOSS and applications to a multi-processor assembly are discussed.

Achieving change in primary care—effectiveness of strategies for improving implementation of complex interventions: systematic review of reviews

PubMed Central

Lau, Rosa; Stevenson, Fiona; Ong, Bie Nio; Dziedzic, Krysia; Treweek, Shaun; Eldridge, Sandra; Everitt, Hazel; Kennedy, Anne; Qureshi, Nadeem; Rogers, Anne; Peacock, Richard; Murray, Elizabeth

2015-01-01

Objective To identify, summarise and synthesise available literature on the effectiveness of implementation strategies for optimising implementation of complex interventions in primary care. Design Systematic review of reviews. Data sources MEDLINE, EMBASE, CINAHL, Cochrane Library and PsychINFO were searched, from first publication until December 2013; the bibliographies of relevant articles were screened for additional reports. Eligibility criteria for selecting studies Eligible reviews had to (1) examine effectiveness of single or multifaceted implementation strategies, (2) measure health professional practice or process outcomes and (3) include studies from predominantly primary care in developed countries. Two reviewers independently screened titles/abstracts and full-text articles of potentially eligible reviews for inclusion. Data synthesis Extracted data were synthesised using a narrative approach. Results 91 reviews were included. The most commonly evaluated strategies were those targeted at the level of individual professionals, rather than those targeting organisations or context. These strategies (eg, audit and feedback, educational meetings, educational outreach, reminders) on their own demonstrated a small to modest improvement (2–9%) in professional practice or behaviour with considerable variability in the observed effects. The effects of multifaceted strategies targeted at professionals were mixed and not necessarily more effective than single strategies alone. There was relatively little review evidence on implementation strategies at the levels of organisation and wider context. Evidence on cost-effectiveness was limited and data on costs of different strategies were scarce and/or of low quality. Conclusions There is a substantial literature on implementation strategies aimed at changing professional practices or behaviour. It remains unclear which implementation strategies are more likely to be effective than others and under what conditions. Future research should focus on identifying and assessing the effectiveness of strategies targeted at the wider context and organisational levels and examining the costs and cost-effectiveness of implementation strategies. PROSPERO registration number CRD42014009410. PMID:26700290

Achieving change in primary care--causes of the evidence to practice gap: systematic reviews of reviews.

PubMed

Lau, Rosa; Stevenson, Fiona; Ong, Bie Nio; Dziedzic, Krysia; Treweek, Shaun; Eldridge, Sandra; Everitt, Hazel; Kennedy, Anne; Qureshi, Nadeem; Rogers, Anne; Peacock, Richard; Murray, Elizabeth

2016-03-22

This study is to identify, summarise and synthesise literature on the causes of the evidence to practice gap for complex interventions in primary care. This study is a systematic review of reviews. MEDLINE, EMBASE, CINAHL, Cochrane Library and PsychINFO were searched, from inception to December 2013. Eligible reviews addressed causes of the evidence to practice gap in primary care in developed countries. Data from included reviews were extracted and synthesised using guidelines for meta-synthesis. Seventy reviews fulfilled the inclusion criteria and encompassed a wide range of topics, e.g. guideline implementation, integration of new roles, technology implementation, public health and preventative medicine. None of the included papers used the term "cause" or stated an intention to investigate causes at all. A descriptive approach was often used, and the included papers expressed "causes" in terms of "barriers and facilitators" to implementation. We developed a four-level framework covering external context, organisation, professionals and intervention. External contextual factors included policies, incentivisation structures, dominant paradigms, stakeholders' buy-in, infrastructure and advances in technology. Organisation-related factors included culture, available resources, integration with existing processes, relationships, skill mix and staff involvement. At the level of individual professionals, professional role, underlying philosophy of care and competencies were important. Characteristics of the intervention that impacted on implementation included evidence of benefit, ease of use and adaptability to local circumstances. We postulate that the "fit" between the intervention and the context is critical in determining the success of implementation. This comprehensive review of reviews summarises current knowledge on the barriers and facilitators to implementation of diverse complex interventions in primary care. To maximise the uptake of complex interventions in primary care, health care professionals and commissioning organisations should consider the range of contextual factors, remaining aware of the dynamic nature of context. Future studies should place an emphasis on describing context and articulating the relationships between the factors identified here. PROSPERO CRD42014009410.

Learning robot actions based on self-organising language memory.

PubMed

Wermter, Stefan; Elshaw, Mark

2003-01-01

In the MirrorBot project we examine perceptual processes using models of cortical assemblies and mirror neurons to explore the emergence of semantic representations of actions, percepts and concepts in a neural robot. The hypothesis under investigation is whether a neural model will produce a life-like perception system for actions. In this context we focus in this paper on how instructions for actions can be modeled in a self-organising memory. Current approaches for robot control often do not use language and ignore neural learning. However, our approach uses language instruction and draws from the concepts of regional distributed modularity, self-organisation and neural assemblies. We describe a self-organising model that clusters actions into different locations depending on the body part they are associated with. In particular, we use actual sensor readings from the MIRA robot to represent semantic features of the action verbs. Furthermore, we outline a hierarchical computational model for a self-organising robot action control system using language for instruction.

Learning from failure in health care: frequent opportunities, pervasive barriers.

PubMed

Edmondson, A C

2004-12-01

The notion that hospitals and medical practices should learn from failures, both their own and others', has obvious appeal. Yet, healthcare organisations that systematically and effectively learn from the failures that occur in the care delivery process, especially from small mistakes and problems rather than from consequential adverse events, are rare. This article explores pervasive barriers embedded in healthcare's organisational systems that make shared or organisational learning from failure difficult and then recommends strategies for overcoming these barriers to learning from failure, emphasising the critical role of leadership. Firstly, leaders must create a compelling vision that motivates and communicates urgency for change; secondly, leaders must work to create an environment of psychological safety that fosters open reporting, active questioning, and frequent sharing of insights and concerns; and thirdly, case study research on one hospital's organisational learning initiative suggests that leaders can empower and support team learning throughout their organisations as a way of identifying, analysing, and removing hazards that threaten patient safety.

Learning from failure in health care: frequent opportunities, pervasive barriers

PubMed Central

Edmondson, A

2004-01-01

The notion that hospitals and medical practices should learn from failures, both their own and others', has obvious appeal. Yet, healthcare organisations that systematically and effectively learn from the failures that occur in the care delivery process, especially from small mistakes and problems rather than from consequential adverse events, are rare. This article explores pervasive barriers embedded in healthcare's organisational systems that make shared or organisational learning from failure difficult and then recommends strategies for overcoming these barriers to learning from failure, emphasising the critical role of leadership. Firstly, leaders must create a compelling vision that motivates and communicates urgency for change; secondly, leaders must work to create an environment of psychological safety that fosters open reporting, active questioning, and frequent sharing of insights and concerns; and thirdly, case study research on one hospital's organisational learning initiative suggests that leaders can empower and support team learning throughout their organisations as a way of identifying, analysing, and removing hazards that threaten patient safety. PMID:15576689

Managing Evaluation: A Community Arts Organisation Perspective.

PubMed

Swan, Peter; Atkinson, Sarah

2012-09-01

Arts and health organisations must increasingly provide measurable evidence of impact to stakeholders, which can pose both logistical and ideological challenges. This paper examines the relationship between the ethos of an arts and health organisation with external demands for evaluation. Research involved an ethnographic engagement where the first author worked closely with the organisation for a year. In addition to informal discussions, twenty semi-structured interviews were conducted with core staff and participants. Transcribed interviews were coded and emerging themes were identified. Staff considered evaluation to be necessary and useful, yet also to be time consuming and a potential threat to their ethos. Nevertheless, they were able to negotiate the terms of evaluation to enable them to meet their own needs as well as those of funders and other stakeholders. While not completely resisting outside demands for evaluation, the organisation was seen to intentionally rework demands for evidence into processes they felt they could work with, thus enabling their ethos to be maintained.

Managing Evaluation: A Community Arts Organisation Perspective

PubMed Central

Swan, Peter; Atkinson, Sarah

2014-01-01

Background Arts and health organisations must increasingly provide measurable evidence of impact to stakeholders, which can pose both logistical and ideological challenges. This paper examines the relationship between the ethos of an arts and health organisation with external demands for evaluation. Methods Research involved an ethnographic engagement where the first author worked closely with the organisation for a year. In addition to informal discussions, twenty semi-structured interviews were conducted with core staff and participants. Transcribed interviews were coded and emerging themes were identified. Results Staff considered evaluation to be necessary and useful, yet also to be time consuming and a potential threat to their ethos. Nevertheless, they were able to negotiate the terms of evaluation to enable them to meet their own needs as well as those of funders and other stakeholders. Conclusions While not completely resisting outside demands for evaluation, the organisation was seen to intentionally rework demands for evidence into processes they felt they could work with, thus enabling their ethos to be maintained. PMID:25429306

'Ethos' Enabling Organisational Knowledge Creation

NASA Astrophysics Data System (ADS)

Matsudaira, Yoshito

This paper examines knowledge creation in relation to improvements on the production line in the manufacturing department of Nissan Motor Company and aims to clarify embodied knowledge observed in the actions of organisational members who enable knowledge creation will be clarified. For that purpose, this study adopts an approach that adds a first, second, and third-person's viewpoint to the theory of knowledge creation. Embodied knowledge, observed in the actions of organisational members who enable knowledge creation, is the continued practice of 'ethos' (in Greek) founded in Nissan Production Way as an ethical basis. Ethos is knowledge (intangible) assets for knowledge creating companies. Substantiated analysis classifies ethos into three categories: the individual, team and organisation. This indicates the precise actions of the organisational members in each category during the knowledge creation process. This research will be successful in its role of showing the indispensability of ethos - the new concept of knowledge assets, which enables knowledge creation -for future knowledge-based management in the knowledge society.

Using a Co-Creational Approach to Develop, Implement and Evaluate an Intervention to Promote Physical Activity in Adolescent Girls from Vocational and Technical Schools: A Case Control Study

PubMed Central

Verloigne, Maïté; Altenburg, Teatske Maria; Chinapaw, Mai Jeanette Maidy; Chastin, Sebastien; Cardon, Greet

2017-01-01

Background: As physical inactivity is particularly prevalent amongst lower-educated adolescent girls, interventions are needed. Using a co-creational approach increases their engagement and might be effective. This study aimed to: (1) describe the co-creation process, (2) evaluate how girls experienced co-creation, and (3) evaluate the effect of the co-creational interventions on physical activity, individual, sociocultural and school-based factors. Methods: Three intervention schools (n = 91) and three control schools (n = 105) across Flanders participated. A questionnaire was completed pre (September–October 2014) and post (April–May 2015). In between, sessions with a co-creation group were organised to develop and implement the intervention in each intervention school. Focus groups were conducted to evaluate the co-creational process. Results: School 1 organised sport sessions for girls, school 2 organised a fitness activity and set up a Facebook page, school 3 organised a lunch walk. Girls were positive about having a voice in developing an intervention. No significant effects were found, except for small effects on extracurricular sports participation and self-efficacy. Conclusions: Using a co-creational approach amongst adolescent girls might be a feasible approach. However, as interventions were minimal, effects were limited or undetectable. Future co-creation projects could consider the most optimal co-creation process, evaluation design and intensively test this approach. PMID:28763041

Implementing an organised cervical screening programme in the Republic of Moldova-Stakeholder identification and engagement.

PubMed

Davies, Philip; Valuta, Diana; Cojohari, Natalia; Sancho-Garnier, Helene

2017-10-01

Successfully implementing cervical screening programmes requires them to be adapted to the local context and have broad stakeholder support. This can be achieved by actively engaging local stakeholders in planning as well as implementing the programmes. The Moldovan government started implementing an organised cervical screening programme in 2010 with the first step being stakeholder identification and engagement. This process started by contacting easily identified stakeholders with each asked to recommend others and the process continued until no new ones were identified. Stakeholders were then involved in a series of individual and group meetings over a 2-year period to build confidence and encourage progressively greater engagement. In total, 87 individuals from 46 organisations were identified. Over the 2-year process, the individual and group meetings facilitated a change in stakeholder attitudes from disinterest, to acceptance and finally to active cooperation in designing the screening programme and preparing an implementation plan that were both well adapted to the Moldovan context. Developing the broad support needed to implement cervical screening programmes required ongoing interaction with stakeholders over an extended period. This interaction allowed stakeholder concerns to be identified and addressed, progress to be demonstrated, and stakeholders to be educated about organised screening programmes so they had the knowledge to progressively take greater responsibility and ownership. Copyright © 2017 Elsevier Ltd. All rights reserved.

Using a Co-Creational Approach to Develop, Implement and Evaluate an Intervention to Promote Physical Activity in Adolescent Girls from Vocational and Technical Schools: A Case Control Study.

PubMed

Verloigne, Maïté; Altenburg, Teatske Maria; Chinapaw, Mai Jeanette Maidy; Chastin, Sebastien; Cardon, Greet; De Bourdeaudhuij, Ilse

2017-08-01

Background: As physical inactivity is particularly prevalent amongst lower-educated adolescent girls, interventions are needed. Using a co-creational approach increases their engagement and might be effective. This study aimed to: (1) describe the co-creation process, (2) evaluate how girls experienced co-creation, and (3) evaluate the effect of the co-creational interventions on physical activity, individual, sociocultural and school-based factors. Methods: Three intervention schools (n = 91) and three control schools (n = 105) across Flanders participated. A questionnaire was completed pre (September-October 2014) and post (April-May 2015). In between, sessions with a co-creation group were organised to develop and implement the intervention in each intervention school. Focus groups were conducted to evaluate the co-creational process. Results: School 1 organised sport sessions for girls, school 2 organised a fitness activity and set up a Facebook page, school 3 organised a lunch walk. Girls were positive about having a voice in developing an intervention. No significant effects were found, except for small effects on extracurricular sports participation and self-efficacy. Conclusions: Using a co-creational approach amongst adolescent girls might be a feasible approach. However, as interventions were minimal, effects were limited or undetectable. Future co-creation projects could consider the most optimal co-creation process, evaluation design and intensively test this approach.

The perceived quality of interprofessional teamwork in an intensive care unit: A single centre intervention study.

PubMed

Van den Bulcke, Bo; Vyt, Andre; Vanheule, Stijn; Hoste, Eric; Decruyenaere, Johan; Benoit, Dominique

2016-05-01

This article describes a study that evaluated the quality of teamwork in a surgical intensive care unit and assessed whether teamwork could be improved significantly through a tailor-made intervention. The quality of teamwork prior to and after the intervention was assessed using the Interprofessional Practice and Education Quality Scales (IPEQS) using the PROSE online diagnostics and documenting system, which assesses three domains of teamwork: organisational factors, care processes, and team members' attitudes and beliefs. Furthermore, team members evaluated strengths and weaknesses of the teamwork through open-ended questions. Information gathered by means of the open questions was used to design a tailor-made 12-week intervention consisting of (1) optimising the existing weekly interdisciplinary meetings with collaborative decision-making and clear communication of goal-oriented actions, including the psychosocial aspects of care; and (2) organising and supporting the effective exchange of information over time between all professions involved. It was found that the intervention had a significant impact on organisational factors and care processes related to interprofessional teamwork for the total group and within all subgroups, despite baseline differences between the subgroups in interprofessional teamwork. In conclusion, teamwork, and more particularly the organisational aspects of interprofessional collaboration and processes of care, can be improved by a tailor-made intervention that takes into account the professional needs of healthcare workers.

Improving the Representation of Human Factors in Operational Analysis

DTIC Science & Technology

2010-10-01

Defence Equipment and Support (DE&S) via Human Factors Integration Defence Technology Centre ( HFI DTC) activities. In particular this study’s Theme...Framework has been exploited in the HFI DTC Social Organisational Framework study, and the study team has provided a short extract for contribution to...the HFI DTC Handbook. The study has also been explicitly referenced in support to future MOD OA research studies. 8 SUMMARY AND CONCLUSIONS This

Organisational downsizing and increased use of psychotropic drugs among employees who remain in employment

PubMed Central

Kivimäki, Mika; Honkonen, Teija; Wahlbeck, Kristian; Elovainio, Marko; Pentti, Jaana; Klaukka, Timo; Virtanen, Marianna; Vahtera, Jussi

2007-01-01

Objective Organisational downsizing is common in modern work life, but its effect on employees' mental health is not known. The authors examined whether working in downsizing organisations predicts use of psychotropic drugs among employees who remain in employment. Design, setting and participants Prospective cohort study of municipal employees in Finland. 4783 employees worked in downsized units but kept their jobs after downsizing in 1993, 4271 employees lost their jobs during the downsizing, and 17 599 employees did not experience downsizing. The outcome was psychotropic drug prescriptions (antidepressants, anxiolytics and hypnotics) during 1994–2000 extracted from nationwide registers and linked to the data by means of each participant's personal identification number. Main results After adjustment for predownsizing characteristics, employees who were exposed to downsizing but kept their jobs were at a higher risk of being prescribed psychotropic drugs (rate ratio 1.49, 95% CI 1.10 to 2.02 in men and 1.12, 95% CI 1.00 to 1.27 in women) than those not exposed to downsizing. The association of downsizing was strongest with hypnotics among the men and with anxiolytics among the women. An increased rate of psychotropic prescriptions after downsizing was also seen in male workers who lost their job (rate ratio 1.64, 95% CI 1.19 to 2.25). Conclusions The association between organisational downsizing and increased use of psychotropic drugs suggests that this managerial strategy may pose mental health risks among employees. PMID:17234876

Animal welfare: the role of non-governmental organisations.

PubMed

Wilkins, D B; Houseman, C; Allan, R; Appleby, M C; Peeling, D; Stevenson, P

2005-08-01

The welfare of animals is of interest to many people in most parts of the world. Concern about the way that animals are treated will depend on many factors, including socio-economic conditions, culture, religion and tradition. The World Organisation for Animal Health (OIE) is committed to ensuring that all animal welfare standards are science-based, but recognises that these other factors must also be taken into account. The International Coalition for Farm Animal Welfare (ICFAW) was formed to represent the interests of non-governmental animal welfare organisations from most corners of the globe and opinions, comment and information from these animal welfare organisations will play a part in the OIE decision-making process. In coming together for this purpose it was recognised that the views of the various member organisations of ICFAW vary depending on which part of the world they come from. The authors provide information about the situation in three continents: Africa, North America and Europe. This information includes details of relevant legislation, farming practices, and educational and campaign programmes developed by both animal welfare non-governmental organisations and governments. The authors also look to the future to see what issues may influence the way that farm animals are reared, transported and slaughtered.

Deficient crisis-probing practices and taken-for-granted assumptions in health organisations.

PubMed

Canyon, Deon V; Adhikari, Ashmita; Cordery, Thomas; Giguère-Simmonds, Philippe; Huang, Jessica; Nguyen, Helen; Watson, Michael; Yang, Daniel

2011-04-18

The practice of crisis-probing in proactive organisations involves meticulous and sustained investigation into operational processes and management structures for potential weaknesses and flaws before they become difficult to resolve. In health organisations, crisis probing is a necessary part of preparing to manage emerging health threats. This study examined the degree of pre-emptive probing in health organisations and the type of crisis training provided to determine whether or not they are prepared in this area. This evidence-based study draws on cross-sectional responses provided by executives from chiropractic, physiotherapy, and podiatry practices; dental and medical clinics; pharmacies; aged care facilities; and hospitals. The data show a marked lack of mandatory probing and a generalised failure to reward crisis reporting. Crisis prevention training is poor in all organisations except hospitals and aged care facilities where it occurs at an adequate frequency. However this training focuses primarily on natural disasters, fails to address most other crisis types, is mostly reactive and not designed to probe for and uncover key taken-for-granted assumptions. Crisis-probing in health organisations is inadequate, and improvements in this area may well translate into measurable improvements in preparedness and response outcomes.

Organisational reporting and learning systems: Innovating inside and outside of the box.

PubMed

Sujan, Mark; Furniss, Dominic

2015-01-01

Reporting and learning systems are key organisational tools for the management and prevention of clinical risk. However, current approaches, such as incident reporting, are struggling to meet expectations of turning health systems like the UK National Health Service (NHS) into learning organisations. This article aims to open up debate on the potential for novel reporting and learning systems in healthcare, by reflecting on experiences from two recent projects: Proactive Risk Monitoring in Healthcare (PRIMO) and Errordiary in Healthcare. These two approaches demonstrate how paying attention to ordinary, everyday clinical work can derive useful learning and active discussion about clinical risk. We argue that innovations in reporting and learning systems might come from both inside and outside of the box. 'Inside' being along traditional paths of controlled organisational innovation. 'Outside' in the sense that inspiration comes outside of the healthcare domain, or more extremely, outside official channels through external websites and social media (e.g. patient forums, public review sites, whistleblower blogs and Twitter streams). Reporting routes that bypass official channels could empower staff and patient activism, and turn out to be a driver to challenge organisational processes, assumptions and priorities where the organisation is failing and has become unresponsive.

Self-organisation after embryonic kidney dissociation is driven via selective adhesion of ureteric epithelial cells.

PubMed

Lefevre, James G; Chiu, Han S; Combes, Alexander N; Vanslambrouck, Jessica M; Ju, Ali; Hamilton, Nicholas A; Little, Melissa H

2017-03-15

Human pluripotent stem cells, after directed differentiation in vitro , can spontaneously generate complex tissues via self-organisation of the component cells. Self-organisation can also reform embryonic organ structure after tissue disruption. It has previously been demonstrated that dissociated embryonic kidneys can recreate component epithelial and mesenchymal relationships sufficient to allow continued kidney morphogenesis. Here, we investigate the timing and underlying mechanisms driving self-organisation after dissociation of the embryonic kidney using time-lapse imaging, high-resolution confocal analyses and mathematical modelling. Organotypic self-organisation sufficient for nephron initiation was observed within a 24 h period. This involved cell movement, with structure emerging after the clustering of ureteric epithelial cells, a process consistent with models of random cell movement with preferential cell adhesion. Ureteric epithelialisation rapidly followed the formation of ureteric cell clusters with the reformation of nephron-forming niches representing a later event. Disruption of P-cadherin interactions was seen to impair this ureteric epithelial cell clustering without affecting epithelial maturation. This understanding could facilitate improved regulation of patterning within organoids and facilitate kidney engineering approaches guided by cell-cell self-organisation. © 2017. Published by The Company of Biologists Ltd.

Deficient crisis-probing practices and taken-for-granted assumptions in health organisations

PubMed Central

Canyon, Deon V.; Adhikari, Ashmita; Cordery, Thomas; Giguère-Simmonds, Philippe; Huang, Jessica; Nguyen, Helen; Watson, Michael; Yang, Daniel

2011-01-01

The practice of crisis-probing in proactive organisations involves meticulous and sustained investigation into operational processes and management structures for potential weaknesses and flaws before they become difficult to resolve. In health organisations, crisis probing is a necessary part of preparing to manage emerging health threats. This study examined the degree of pre-emptive probing in health organisations and the type of crisis training provided to determine whether or not they are prepared in this area. This evidence-based study draws on cross-sectional responses provided by executives from chiropractic, physiotherapy, and podiatry practices; dental and medical clinics; pharmacies; aged care facilities; and hospitals. The data show a marked lack of mandatory probing and a generalised failure to reward crisis reporting. Crisis prevention training is poor in all organisations except hospitals and aged care facilities where it occurs at an adequate frequency. However this training focuses primarily on natural disasters, fails to address most other crisis types, is mostly reactive and not designed to probe for and uncover key taken-for-granted assumptions. Crisis-probing in health organisations is inadequate, and improvements in this area may well translate into measurable improvements in preparedness and response outcomes. PMID:24149030

Organisational effectiveness within National Health Service (NHS) Trusts.

PubMed

Jackson, S

1998-01-01

In view of the dearth of information relating to organisational effectiveness of NHS Trusts in comparison with clinical effectiveness, a complex study was undertaken to determine whether overall effectiveness was a result of management processes, people, or a combination of both. The study incorporated two phases involving the distribution of a comprehensive questionnaire to identify the "whats" of organisational effectiveness, and a bench-marking exercise aimed at identifying the "hows". In the main, the better performing trusts were found to be subscribing to the concepts of "keeping it simple", innovation and attainment of highly efficient processes. A number of examples of better/best practices were observed which included visible leadership, a commitment towards stakeholder involvement and the practice of teamworking. Given the complexity of the study area, the findings were deemed valuable to managers practising within all areas of healthcare. However, a need for further research was identified in order to substantiate the results.

Tight Junction Protein 1a regulates pigment cell organisation during zebrafish colour patterning.

PubMed

Fadeev, Andrey; Krauss, Jana; Frohnhöfer, Hans Georg; Irion, Uwe; Nüsslein-Volhard, Christiane

2015-04-27

Zebrafish display a prominent pattern of alternating dark and light stripes generated by the precise positioning of pigment cells in the skin. This arrangement is the result of coordinated cell movements, cell shape changes, and the organisation of pigment cells during metamorphosis. Iridophores play a crucial part in this process by switching between the dense form of the light stripes and the loose form of the dark stripes. Adult schachbrett (sbr) mutants exhibit delayed changes in iridophore shape and organisation caused by truncations in Tight Junction Protein 1a (ZO-1a). In sbr mutants, the dark stripes are interrupted by dense iridophores invading as coherent sheets. Immuno-labelling and chimeric analyses indicate that Tjp1a is expressed in dense iridophores but down-regulated in the loose form. Tjp1a is a novel regulator of cell shape changes during colour pattern formation and the first cytoplasmic protein implicated in this process.

Process and implementation of participatory ergonomic interventions: a systematic review.

PubMed

van Eerd, Dwayne; Cole, Donald; Irvin, Emma; Mahood, Quenby; Keown, Kiera; Theberge, Nancy; Village, Judy; St Vincent, Marie; Cullen, Kim

2010-10-01

Participatory ergonomic (PE) interventions may vary in implementation. A systematic review was done to determine the evidence regarding context, barriers and facilitators to the implementation of participatory ergonomic interventions in workplaces. In total, 17 electronic databases were searched. Data on PE process and implementation were extracted from documents meeting content and quality criteria and synthesised. The search yielded 2151 references. Of these, 190 documents were relevant and 52 met content and quality criteria. Different ergonomic teams were described in the documents as were the type, duration and content of ergonomic training. PE interventions tended to focus on physical and work process changes and report positive impacts. Resources, programme support, ergonomic training, organisational training and communication were the most often noted facilitators or barriers. Successful PE interventions require the right people to be involved, appropriate ergonomic training and clear responsibilities. Addressing key facilitators and barriers such as programme support, resources, and communication is paramount. STATEMENT OF RELEVANCE: A recent systematic review has suggested that PE has some effect on reducing symptoms, lost days of work and claims. Systematic reviews of effectiveness provide practitioners with the desire to implement but do not provide clear information about how. This article reviews the literature on process and implementation of PE.

The logic of relations and the logic of management.

PubMed

Buntinx, W

2008-07-01

Increasing emphasis on financial and administrative control processes is affecting service culture in support organisations for persons with intellectual disability. This phenomenon is currently obvious in Dutch service organisations that find themselves in transition towards more community care and at the same time under pressure from new administrative and funding managerial bureaucracy. As a result, the logic of management is becoming more dominant in direct support settings and risk to overshadow the logic of relationships between staff and clients. The article presents a reflection on this phenomenon, starting from a description of service team characteristics as found in the literature. Next, findings about direct support staff (DSS) continuity are summarised from four Dutch studies. Following up these findings, the concept of 'microsystems' is explored as a possible answer to the organisational challenges demonstrated in the studies. Team characteristics, especially team size and membership continuity for DSS, appear relevant factors for assuring supportive relationships and service quality in direct support teams. The structure of the primary support team shows to be of special interest. The organisational concept of 'microsystems' is explored with respect to transcending the present conflict between bureaucratic managerial pressure and the need for supportive relationships. Service organisations need to create structural conditions for the efficacy of direct support teams in terms of client relationships and relevant client outcomes. At the same time, the need for administrative and control processes can not be denied. The concept of 'microsystems', application of a Quality of Life framework and the use of new instruments, such as the Supports Intensity Scale, can contribute to an organisational solution for the present conflicting logic of relations and management.

Self-Assessment of Schools and Teachers as a Road to Transforming Schools from Teaching to Learning Organisations

ERIC Educational Resources Information Center

Franz, Hans-Werner

2012-01-01

This article explores the manner in which self-assessment in schools can play an integral role in the transformation of schools into learning organisations. The perspective adopted is based upon European experiences and describes and analyses the sociological constructs and bases supporting the process of transformation. (Contains 6 notes and 2…

Practice of Organisational Strategies of Improving Computer Rooms for Promoting Smart Education Using ICT Equipment

ERIC Educational Resources Information Center

Ogawa, Nobuyuki; Shimizu, Akira

2017-01-01

This paper describes our concrete efforts to improve the functions of the computer rooms in the Information Processing Center from among several organisational strategies which can assume a large role in the next-generation education, while examining the practice of active learning by the faculty in all classes using ICT equipment. We implemented…

Patient Education as an Information System, Healthcare Tool and Interaction

ERIC Educational Resources Information Center

Pirhonen, Antti; Silvennoinen, Minna; Sillence, Elizabeth

2014-01-01

Patient education (PE) has a crucial role in the function of a healthcare organisation. For the care process of a patient, it is essential to get the right information at the right moment and in the right form. This paper analyses PE as the primary mode of interaction between a patient and a healthcare organisation. The approach is illustrated…

A Knowledge Management Technology Architecture for Educational Research Organisations: Scaffolding Research Projects and Workflow Processing

ERIC Educational Resources Information Center

Muthukumar; Hedberg, John G.

2005-01-01

There is growing recognition that the economic climate of the world is shifting towards a knowledge-based economy where knowledge will be cherished as the most prized asset. In this regard, technology can be leveraged as a useful tool in effectually managing the knowledge capital of an organisation. Although several research studies have advanced…

A knowledge Management Technology Architecture for Educational Research Organisations: Scaffolding Research Projects and Workflow Processing

ERIC Educational Resources Information Center

Muthukumar; Hedberg, John G.

2005-01-01

There is growing recognition that the economic climate of the world is shifting towards a knowledge-based economy where knowledge will be cherished as the most prized asset. In this regard, technology can be leveraged as a useful tool in effectually managing the knowledge capital of an organisation. Although several research studies have advanced…

The Impact of Organisational Structure and Practices on Learning in the Workplace

ERIC Educational Resources Information Center

Ashton, David N.

2004-01-01

The main thrust of the research effort into workplace learning has been to identify the characteristics of workplace learning as experienced by the learner. The impact of the wider organisational process in which that learning is embedded have been played down. This paper, building on the work of Koike and Darrah, uses research conducted in a…

Maximising the Effectiveness of a Scenario Planning Process: Tips for Scenario Planners in Higher Education

ERIC Educational Resources Information Center

Sayers, Nicola

2011-01-01

Scenario planning is a tool which can help organisations and people to think about, and plan for, the long-term future. In basic terms, it involves creating a number of in-depth scenarios (stories), each of which tells of a different possible future for an organisation or issue, and considering how each different future might influence…

Service innovation management practices in the telecommunications industry: what does cross country analysis reveal?

PubMed

Rahman, Syed Abidur; Taghizadeh, Seyedeh Khadijeh; Ramayah, T; Ahmad, Noor Hazlina

2015-01-01

Service innovation management practice is currently being widely scrutinized mainly in the developed countries, where it has been initiated. The current study attempts to propose a framework and empirically validate and explain the service innovation practices for successful performance in the telecommunications industry of two developing countries, Malaysia and Bangladesh. The research framework proposes relationships among organisational culture, operating core (innovation process, cross-functional organisation, and implementation of tools/technology), competition-informed pricing, and performance. A total of 176 usable data from both countries are analysed for the purpose of the research. The findings show that organisational culture tends to be more influential on innovation process and cross-functional organisation in Malaysian telecommunication industry. In contrast, implementation of tools/technology plays a more instrumental role in competition-informed pricing practices in Bangladesh. This study revealed few differences in the innovation management practices between two developing countries. The findings have strategic implications for the service sectors in both the developing countries regarding implementation of innovative enterprises, especially in Bangladesh where innovation is the basis for survival. Testing the innovation management practices in the developing countries perhaps contains uniqueness in the field of innovation management.

A systematic review of integrated use of disease-management interventions in asthma and COPD.

PubMed

Lemmens, Karin M M; Nieboer, Anna P; Huijsman, Robbert

2009-05-01

The effectiveness of multiple interventions in asthma and chronic obstructive pulmonary disease (COPD) is unclear. To examine the effectiveness of multiple interventions as compared to single interventions or usual care on health outcomes and health care utilisation within the context of integrated disease management in asthma and COPD. MEDLINE and the Cochrane Library (1995-May 2008) were searched for controlled trials. Two reviewers independently extracted data and assessed study quality. Meta-analyses were performed on quality of life and health care utilisation data. Furthermore, the effects of multiple interventions versus single interventions and usual care were assessed qualitatively. Of the 36 studies included, 17 targeted double interventions (patient-related and organisational interventions); 19 studies performed triple interventions (patient-related, professional-directed and organisational interventions). They were heterogeneous in terms of (combinations of) interventions, outcomes measured, study design and setting. Pooled data showed that studied disease management programmes significantly improved quality of life on several domains. Patients within triple intervention programmes had less chance of at least one hospital admission compared with usual care. No significant effects were found in number of emergency department visits. Qualitative analyses revealed positive trends on process improvements and satisfaction. Inconclusive results were reported on symptoms; no effects were found in lung function. In spite of the heterogeneity of disease management studies in asthma and COPD care, this review showed promising improvements in quality of life and reductions in hospitalisations, especially for triple intervention programmes.

Making large amounts of meteorological plots easily accessible to users

NASA Astrophysics Data System (ADS)

Lamy-Thepaut, Sylvie; Siemen, Stephan; Sahin, Cihan; Raoult, Baudouin

2015-04-01

The European Centre for Medium-Range Weather Forecasts (ECMWF) is an international organisation providing its member organisations with forecasts in the medium time range of 3 to 15 days, and some longer-range forecasts for up to a year ahead, with varying degrees of detail. As part of its mission, ECMWF generates an increasing number of forecast data products for its users. To support the work of forecasters and researchers and to let them make best use of ECMWF forecasts, the Centre also provides tools and interfaces to visualise their products. This allows users to make use of and explore forecasts without having to transfer large amounts of raw data. This is especially true for products based on ECMWF's 50 member ensemble forecast, where some specific processing and visualisation are applied to extract information. Every day, thousands of raw data are being pushed to the ECMWF's interactive web charts application called ecCharts, and thousands of products are processed and pushed to ECMWF's institutional web site ecCharts provides a highly interactive application to display and manipulate recent numerical forecasts to forecasters in national weather services and ECMWF's commercial customers. With ecCharts forecasters are able to explore ECMWF's medium-range forecasts in far greater detail than has previously been possible on the web, and this as soon as the forecast becomes available. All ecCharts's products are also available through a machine-to-machine web map service based on the OGC Web Map Service (WMS) standard. ECMWF institutional web site provides access to a large number of graphical products. It was entirely redesigned last year. It now shares the same infrastructure as ECMWF's ecCharts, and can benefit of some ecCharts functionalities, for example the dashboard. The dashboard initially developed for ecCharts allows users to organise their own collection of products depending on their work flow, and is being further developed. In its first implementation, It presents the user's products in a single interface with fast access to the original product, and possibilities of synchronous animations between them. But its functionalities are being extended to give users the freedom to collect not only ecCharts's 2D maps and graphs, but also other ECMWF Web products such as monthly and seasonal products, scores, and observation monitoring. The dashboard will play a key role to help the user to interpret the large amount of information that ECMWF is providing. This talk will present examples of how the new user interface can organise complex meteorological maps and graphs and show the new possibilities users have gained by using the web as a medium.

Building human resources capability in health care: a global analysis of best practice--Part III.

PubMed

Zairi, M

1998-01-01

This is the last part of a series of three papers which discussed very comprehensively best practice applications in human resource management by drawing special inferences to the healthcare context. It emerged from parts I and II that high performing organisations plan and intend to build sustainable capability through a systematic consideration of the human element as the key asset and through a continuous process of training, developing, empowering and engaging people in all aspects of organisational excellence. Part III brings this debate to a close by demonstrating what brings about organisational excellence and proposes a road map for effective human resource development and management, based on world class standards. Healthcare human resource professionals can now rise to the challenge and plan ahead for building organisational capability and sustainable performance.

Implementing Information and Communication Technology to Support Community Aged Care Service Integration: Lessons from an Australian Aged Care Provider.

PubMed

Douglas, Heather E; Georgiou, Andrew; Tariq, Amina; Prgomet, Mirela; Warland, Andrew; Armour, Pauline; Westbrook, Johanna I

2017-04-10

There is limited evidence of the benefits of information and communication technology (ICT) to support integrated aged care services. We undertook a case study to describe carelink+, a centralised client service management ICT system implemented by a large aged and community care service provider, Uniting. We sought to explicate the care-related information exchange processes associated with carelink+ and identify lessons for organisations attempting to use ICT to support service integration. Our case study included seventeen interviews and eleven observation sessions with a purposive sample of staff within the organisation. Inductive analysis was used to develop a model of ICT-supported information exchange. Management staff described the integrated care model designed to underpin carelink+. Frontline staff described complex information exchange processes supporting coordination of client services. Mismatches between the data quality and the functions carelink+ was designed to support necessitated the evolution of new work processes associated with the system. There is value in explicitly modelling the work processes that emerge as a consequence of ICT. Continuous evaluation of the match between ICT and work processes will help aged care organisations to achieve higher levels of ICT maturity that support their efforts to provide integrated care to clients.

Implementing Information and Communication Technology to Support Community Aged Care Service Integration: Lessons from an Australian Aged Care Provider

PubMed Central

Georgiou, Andrew; Tariq, Amina; Prgomet, Mirela; Warland, Andrew; Armour, Pauline; Westbrook, Johanna I

2017-01-01

Introduction: There is limited evidence of the benefits of information and communication technology (ICT) to support integrated aged care services. Objectives: We undertook a case study to describe carelink+, a centralised client service management ICT system implemented by a large aged and community care service provider, Uniting. We sought to explicate the care-related information exchange processes associated with carelink+ and identify lessons for organisations attempting to use ICT to support service integration. Methods: Our case study included seventeen interviews and eleven observation sessions with a purposive sample of staff within the organisation. Inductive analysis was used to develop a model of ICT-supported information exchange. Results: Management staff described the integrated care model designed to underpin carelink+. Frontline staff described complex information exchange processes supporting coordination of client services. Mismatches between the data quality and the functions carelink+ was designed to support necessitated the evolution of new work processes associated with the system. Conclusions: There is value in explicitly modelling the work processes that emerge as a consequence of ICT. Continuous evaluation of the match between ICT and work processes will help aged care organisations to achieve higher levels of ICT maturity that support their efforts to provide integrated care to clients. PMID:29042851

How do NHS organisations plan research capacity development? Strategies, strengths, and opportunities for improvement.

PubMed

Gee, Melanie; Cooke, Jo

2018-03-22

Research that is integral into a 'learning healthcare system' can promote cost effective services and knowledge creation. As such, research is defined as a 'core function' in UK health service organisations, and is often planned through research and development (R&D) strategies that aim to promote research activity and research capacity development (RCD). The discussion focuses around the content of ten R&D strategies for healthcare organisations in England and Scotland, with respect to RCD. These organisations were engaged with a research interest network called ACORN (Addressing Organisational Capacity to do Research Network) that included two Scottish Health Boards, four community and mental health trusts, two provincial district hospitals, and two teaching hospitals. We undertook a thematic documentary analysis of the R&D strategies which identified 11 'core activities' of RCD. The potential for building research capacity in these 'core activities' was established by reviewing them through the lens of a RCD framework. Core activities aimed to 'hard wire' RCD into health organisations. They demonstrated a complex interplay between developing a strong internal organisational infrastructure, and supporting individual career planning and skills development, in turn enabled by organisational processes. They also included activities to build stronger inter-organisational relationships and networks. Practitioner, manager and patient involvement was a cross cutting theme. The potential to demonstrate progress was included in plans through monitoring activity across all RCD principles. Strategies were primarily aimed at research production rather than research use. Developing 'actionable dissemination' was poorly addressed in the strategies, and represents an area for improvement. We describe strengths of RCD planning activities, and opportunities for improvement. We explore how national policy and research funders can influence health systems' engagement in research.

An implementation evaluation of a qualitative culture assessment tool.

PubMed

Tappin, D C; Bentley, T A; Ashby, L E

2015-03-01

Safety culture has been identified as a critical element of healthy and safe workplaces and as such warrants the attention of ergonomists involved in occupational health and safety (OHS). This study sought to evaluate a tool for assessing organisational safety culture as it impacts a common OHS problem: musculoskeletal disorders (MSD). The level of advancement across nine cultural aspects was assessed in two implementation site organisations. These organisations, in residential healthcare and timber processing, enabled evaluation of the tool in contrasting settings, with reported MSD rates also high in both sectors. Interviews were conducted with 39 managers and workers across the two organisations. Interview responses and company documentation were compared by two researchers to the descriptor items for each MSD culture aspect. An assignment of the level of advancement, using a five stage framework, was made for each aspect. The tool was readily adapted to each implementation site context and provided sufficient evidence to assess their levels of advancement. Assessments for most MSD culture aspects were in the mid to upper levels of advancement, although the levels differed within each organisation, indicating that different aspects of MSD culture, as with safety culture, develop at a different pace within organisations. Areas for MSD culture improvement were identified for each organisation. Reflections are made on the use and merits of the tool by ergonomists for addressing MSD risk. Copyright © 2014 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Nursing staff connect libraries with improving patient care but not with achieving organisational objectives: a grounded theory approach.

PubMed

Chamberlain, David; Brook, Richard

2014-03-01

Health organisations are often driven by specific targets defined by mission statements, aims and objectives to improve patient care. Health libraries need to demonstrate that they contribute to organisational objectives, but it is not clear how nurses view that contribution. To investigate ward nursing staff motivations, their awareness of ward and organisational objectives; and their attitudes towards the contribution of health library services to improving patient care. Qualitative research using focus group data was combined with content analysis of literature evidence and library statistics (quantitative data). Data were analysed using thematic coding, divided into five group themes: understanding of Trust, Ward and Personal objectives, use of Library, use of other information sources, quality and Issues. Four basic social-psychological processes were then developed. Behaviour indicates low awareness of organisational objectives despite patient-centric motivation. High awareness of library services is shown with some connection made by ward staff between improved knowledge and improved patient care. There was a two-tiered understanding of ward objectives and library services, based on level of seniority. However, evidence-based culture needs to be intrinsic in the organisation before all staff benefit. Libraries can actively engage in this at ward and board level and improve patient care by supporting organisational objectives. © 2014 The author. Health Information and Libraries Journal © 2014 Health Libraries Group.

Solid-Phase Extraction of Sulfur Mustard Metabolites Using an Activated Carbon Fiber Sorbent.

PubMed

Lee, Jin Young; Lee, Yong Han

2016-01-01

A novel solid-phase extraction method using activated carbon fiber (ACF) was developed and validated. ACF has a vast network of pores of varying sizes and microporous structures that result in rapid adsorption and selective extraction of sulfur mustard metabolites according to the pH of eluting solvents. ACF could not only selectively extract thiodiglycol and 1-methylsulfinyl-2-[2-(methylthio)-ethylsulfonyl]ethane eluting a 9:1 ratio of dichloromethane to acetone, and 1,1'-sulfonylbis[2-(methylsulfinyl)ethane] and 1,1'-sulfonylbis- [2-S-(N-acetylcysteinyl)ethane] eluting 3% hydrogen chloride in methanol, but could also eliminate most interference without loss of analytes during the loading and washing steps. A sample preparation method has been optimized for the extraction of sulfur mustard metabolites from human urine using an ACF sorbent. The newly developed extraction method was applied to the trace analysis of metabolites of sulfur mustard in human urine matrices in a confidence-building exercise for the analysis of biomedical samples provided by the Organisation for the Prohibition of Chemical Weapons. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Best practices for community-engaged participatory research with Pacific Islander communities in the USA and USAPI: protocol for a scoping review

PubMed Central

McElfish, Pearl Anna; Ayers, Britni L; Purvis, Rachel S; Sinclair, Ka’imi; Esquivel, Monica; Steelman, Susan C

2018-01-01

Introduction Community-based participatory research is a partnership approach to research that seeks to equally involve community members, organisational representatives and academic partners throughout the research process in a coequal and mutually beneficial partnership. To date, no published article has synthesised the best practices for community-based participatory research practices with Pacific Islanders. Methods and analysis The reviewers will examine studies’ titles, abstracts and full text, comparing eligibility to address discrepancies. For each eligible study, data extraction will be executed by two reviewers and one confirmation coder, comparing extracted data to address any discrepancies. Eligible data will be synthesised and reported in a narrative review assessing coverage and gaps in existing literature related to community-based participatory research with Pacific Islanders. Discussion and dissemination The purpose of this review is to identify best practices used when conducting community-based participatory research with Pacific Islanders; it will also extrapolate where the gaps are in the existing literature. This will be the first scoping review on community-based participatory research with Pacific Islanders. To facilitate dissemination, the results of this scoping review will be submitted for publication to a peer-reviewed journal, presented at conferences and shared with community-based participatory research stakeholders. PMID:29371285

Clinical audit: shining a light on good practice.

PubMed

Grainger, Angela

2010-07-01

Healthcare organisations undertake quality assurance to produce safe and effective patient care systems. Statutory quality assurance requirements are met through external reviews, monitoring and inspection processes, and each NHS trust must produce a corporate annual quality account. However, this can result in approaching audits as if they are 'tick-box activities'. This article discusses how organisations can avoid this trap by applying audit results to practice.

A practical and systematic approach to organisational capacity strengthening for research in the health sector in Africa

PubMed Central

2014-01-01

Background Despite increasing investment in health research capacity strengthening efforts in low and middle income countries, published evidence to guide the systematic design and monitoring of such interventions is very limited. Systematic processes are important to underpin capacity strengthening interventions because they provide stepwise guidance and allow for continual improvement. Our objective here was to use evidence to inform the design of a replicable but flexible process to guide health research capacity strengthening that could be customized for different contexts, and to provide a framework for planning, collecting information, making decisions, and improving performance. Methods We used peer-reviewed and grey literature to develop a five-step pathway for designing and evaluating health research capacity strengthening programmes, tested in a variety of contexts in Africa. The five steps are: i) defining the goal of the capacity strengthening effort, ii) describing the optimal capacity needed to achieve the goal, iii) determining the existing capacity gaps compared to the optimum, iv) devising an action plan to fill the gaps and associated indicators of change, and v) adapting the plan and indicators as the programme matures. Our paper describes three contrasting case studies of organisational research capacity strengthening to illustrate how our five-step approach works in practice. Results Our five-step pathway starts with a clear goal and objectives, making explicit the capacity required to achieve the goal. Strategies for promoting sustainability are agreed with partners and incorporated from the outset. Our pathway for designing capacity strengthening programmes focuses not only on technical, managerial, and financial processes within organisations, but also on the individuals within organisations and the wider system within which organisations are coordinated, financed, and managed. Conclusions Our five-step approach is flexible enough to generate and utilise ongoing learning. We have tested and critiqued our approach in a variety of organisational settings in the health sector in sub-Saharan Africa, but it needs to be applied and evaluated in other sectors and continents to determine the extent of transferability. PMID:24581148

A longitudinal, multi-level comparative study of quality and safety in European hospitals: the QUASER study protocol.

PubMed

Robert, Glenn B; Anderson, Janet E; Burnett, Susan J; Aase, Karina; Andersson-Gare, Boel; Bal, Roland; Calltorp, Johan; Nunes, Francisco; Weggelaar, Anne-Marie; Vincent, Charles A; Fulop, Naomi J

2011-10-26

although there is a wealth of information available about quality improvement tools and techniques in healthcare there is little understanding about overcoming the challenges of day-to-day implementation in complex organisations like hospitals. The 'Quality and Safety in Europe by Research' (QUASER) study will investigate how hospitals implement, spread and sustain quality improvement, including the difficulties they face and how they overcome them. The overall aim of the study is to explore relationships between the organisational and cultural characteristics of hospitals and how these impact on the quality of health care; the findings will be designed to help policy makers, payers and hospital managers understand the factors and processes that enable hospitals in Europe to achieve-and sustain-high quality services for their patients. in-depth multi-level (macro, meso and micro-system) analysis of healthcare quality policies and practices in 5 European countries, including longitudinal case studies in a purposive sample of 10 hospitals. The project design has three major features: • a working definition of quality comprising three components: clinical effectiveness, patient safety and patient experience • a conceptualisation of quality as a human, social, technical and organisational accomplishment • an emphasis on translational research that is evidence-based and seeks to provide strategic and practical guidance for hospital practitioners and health care policy makers in the European Union. Throughout the study we will adopt a mixed methods approach, including qualitative (in-depth, narrative-based, ethnographic case studies using interviews, and direct non-participant observation of organisational processes) and quantitative research (secondary analysis of safety and quality data, for example: adverse incident reporting; patient complaints and claims). the protocol is based on the premise that future research, policy and practice need to address the sociology of improvement in equal measure to the science and technique of improvement, or at least expand the discipline of improvement to include these critical organisational and cultural processes. We define the 'organisational and cultural characteristics associated with better quality of care' in a broad sense that encompasses all the features of a hospital that might be hypothesised to impact upon clinical effectiveness, patient safety and/or patient experience.

Advancing the application of systems thinking in health: a realist evaluation of a capacity building programme for district managers in Tumkur, India.

PubMed

Prashanth, Nuggehalli Srinivas; Marchal, Bruno; Devadasan, Narayanan; Kegels, Guy; Criel, Bart

2014-08-26

Health systems interventions, such as capacity-building of health workers, are implemented across districts in order to improve performance of healthcare organisations. However, such interventions often work in some settings and not in others. Local health systems could be visualised as complex adaptive systems that respond variously to inputs of capacity building interventions, depending on their local conditions and several individual, institutional, and environmental factors. We aim at demonstrating how the realist evaluation approach advances complex systems thinking in healthcare evaluation by applying the approach to understand organisational change within local health systems in the Tumkur district of southern India. We collected data on several input, process, and outcome measures of performance of the talukas (administrative sub-units of the district) and explore the interplay between the individual, institutional, and contextual factors in contributing to the outcomes using qualitative data (interview transcripts and observation notes) and quantitative measures of commitment, self-efficacy, and supervision style. The talukas of Tumkur district responded differently to the intervention. Their responses can be explained by the interactions between several individual, institutional, and environmental factors. In a taluka with committed staff and a positive intention to make changes, the intervention worked through aligning with existing opportunities from the decentralisation process to improve performance. However, commitment towards the organisation was neither crucial nor sufficient. Committed staff in two other talukas were unable to actualise their intentions to improve organisational performance. In yet another taluka, the leadership was able to compensate for the lack of commitment. Capacity building of local health systems could work through aligning or countering existing relationships between internal (individual and organisational) and external (policy and socio-political environment) attributes of the organisation. At the design and implementation stage, intervention planners need to identify opportunities for such triggering alignments. Local health systems may differ in their internal configuration and hence capacity building programmes need to accommodate possibilities for change through different pathways. By a process of formulating and testing hypotheses, making critical comparisons, discovering empirical patterns, and monitoring their scope and extent, a realist evaluation enables a comprehensive assessment of system-wide change in health systems.

Modelling elderly cardiac patients decision making using Cognitive Work Analysis: identifying requirements for patient decision aids.

PubMed

Dhukaram, Anandhi Vivekanandan; Baber, Chris

2015-06-01

Patients make various healthcare decisions on a daily basis. Such day-to-day decision making can have significant consequences on their own health, treatment, care, and costs. While decision aids (DAs) provide effective support in enhancing patient's decision making, to date there have been few studies examining patient's decision making process or exploring how the understanding of such decision processes can aid in extracting requirements for the design of DAs. This paper applies Cognitive Work Analysis (CWA) to analyse patient's decision making in order to inform requirements for supporting self-care decision making. This study uses focus groups to elicit information from elderly cardiovascular disease (CVD) patients concerning a range of decision situations they face on a daily basis. Specifically, the focus groups addressed issues related to the decision making of CVD in terms of medication compliance, pain, diet and exercise. The results of these focus groups are used to develop high level views using CWA. CWA framework decomposes the complex decision making problem to inform three approaches to DA design: one design based on high level requirements; one based on a normative model of decision-making for patients; and the third based on a range of heuristics that patients seem to use. CWA helps in extracting and synthesising decision making from different perspectives: decision processes, work organisation, patient competencies and strategies used in decision making. As decision making can be influenced by human behaviour like skills, rules and knowledge, it is argued that patients require support to different types of decision making. This paper also provides insights for designers in using CWA framework for the design of effective DAs to support patients in self-management. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

An empirically-derived approach for investigating Health Information Technology: the Elementally Entangled Organisational Communication (EEOC) framework.

PubMed

Georgiou, Andrew; Westbrook, Johanna I; Braithwaite, Jeffrey

2012-07-12

The purpose of this paper is to illustrate the Elementally Entangled Organisational Communication (EEOC) framework by drawing on a set of three case studies which assessed the impact of new Health Information Technology (HIT) on a pathology service. The EEOC framework was empirically developed as a tool to tackle organisational communication challenges in the implementation and evaluation of health information systems. The framework was synthesised from multiple research studies undertaken across a major metropolitan hospital pathology service during the period 2005 to 2008. These studies evaluated the impact of new HIT systems in pathology departments (Laboratory Information System) and an Emergency Department (Computerised Provider Order Entry) located in Sydney, Australia. Key dimensions of EEOC are illustrated by the following case studies: 1) the communication infrastructure between the Blood Bank and the ward for the coordination and distribution of blood products; 2) the organisational environment in the Clinical Chemistry and Haematology departments and their attempts to organise, plan and control the processing of laboratory specimens; and 3) the temporal make up of the organisation as revealed in changes to the way the Central Specimen Reception allocated, sequenced and synchronised work tasks. The case studies not only highlight the pre-existing communication architecture within the organisation but also the constitutive role communication plays in the way organisations go about addressing their requirements. HIT implementation involves a mutual transformation of the organisation and the technology. This is a vital consideration because of the dangers associated with poor organisational planning and implementation of HIT, and the potential for unintended adverse consequences, workarounds and risks to the quality and safety of patient care. The EEOC framework aims to account for the complex range of contextual factors and triggers that play a role in the success or otherwise of new HITs, and in the realisation of their innovation potential.

An empirically-derived approach for investigating Health Information Technology: the Elementally Entangled Organisational Communication (EEOC) framework

PubMed Central

2012-01-01

Background The purpose of this paper is to illustrate the Elementally Entangled Organisational Communication (EEOC) framework by drawing on a set of three case studies which assessed the impact of new Health Information Technology (HIT) on a pathology service. The EEOC framework was empirically developed as a tool to tackle organisational communication challenges in the implementation and evaluation of health information systems. Methods The framework was synthesised from multiple research studies undertaken across a major metropolitan hospital pathology service during the period 2005 to 2008. These studies evaluated the impact of new HIT systems in pathology departments (Laboratory Information System) and an Emergency Department (Computerised Provider Order Entry) located in Sydney, Australia. Results Key dimensions of EEOC are illustrated by the following case studies: 1) the communication infrastructure between the Blood Bank and the ward for the coordination and distribution of blood products; 2) the organisational environment in the Clinical Chemistry and Haematology departments and their attempts to organise, plan and control the processing of laboratory specimens; and 3) the temporal make up of the organisation as revealed in changes to the way the Central Specimen Reception allocated, sequenced and synchronised work tasks. Conclusions The case studies not only highlight the pre-existing communication architecture within the organisation but also the constitutive role communication plays in the way organisations go about addressing their requirements. HIT implementation involves a mutual transformation of the organisation and the technology. This is a vital consideration because of the dangers associated with poor organisational planning and implementation of HIT, and the potential for unintended adverse consequences, workarounds and risks to the quality and safety of patient care. The EEOC framework aims to account for the complex range of contextual factors and triggers that play a role in the success or otherwise of new HITs, and in the realisation of their innovation potential. PMID:22788698

Improving health professionals' management and the organisation of care for overweight and obese people.

PubMed

Harvey, E L; Glenny, A; Kirk, S F; Summerbell, C D

2001-01-01

Obesity is increasing throughout the industrialised world. If left unchecked it will have major implications for both population health and costs to health services. To assess whether health professionals' management or the organisation of care for overweight and obese people could be improved. We searched the specialised registers of the Cochrane Effective Practice and Organisation of Care Group (April 2000), the Cochrane Depression, Anxiety and Neurosis Group (August 1997), the Cochrane Diabetes Group (August 1997), the Cochrane Controlled Trials Register (September 1997), MEDLINE to April 2000, EMBASE to February 2000, Cinahl (1982 to February 2000), PsycLit (1974 to May 2000), Sigle (1980 to April 2000), Sociofile (1974 to October 1997), Dissertation Abstracts (1861 to January 1998), Conference Papers Index (1973 to January 1998), Resource Database in Continuing Medical Education. We also hand searched seven key journals and contacted experts in the field. Randomised trials, controlled before-and-after studies and interrupted time series analyses of providers' management of obesity or the organisation of care to improve provider practice or patient outcomes. We addressed three a priori comparisons and a fourth post hoc comparison. 1. Interventions aimed at improving health professionals' management or the delivery of health care for overweight/obese patients are more effective than usual care. 2. Interventions aimed at redressing negative attitudes and related practices towards overweight/obese patients are more effective than usual care. 3. Organisational interventions designed to change the structure of services for overweight/obese people are more effective than educational or behavioural interventions for health professionals. 4. Comparisons of different organisational interventions. Two reviewers independently extracted data and assessed study quality. Eighteen studies were included involving more than 447 providers and 4104 patients. Six studies were identified for comparison 1. Five were professional-oriented interventions (the use of reminders and training) and the sixth was a study of professional and organisational interventions of shared care. No studies were identified for comparisons 2 or 3. Twelve studies were identified for post hoc comparison 4. These compared either the deliverer of weight loss interventions or the setting of interventions. The included studies were heterogeneous and of generally poor quality. At present, decisions about improving provision of services must be based on the evidence of patient interventions and good clinical judgement. Further research is needed to identify cost effective strategies for improving the management of obesity.

A methodology proposal for collaborative business process elaboration using a model-driven approach

NASA Astrophysics Data System (ADS)

Mu, Wenxin; Bénaben, Frédérick; Pingaud, Hervé

2015-05-01

Business process management (BPM) principles are commonly used to improve processes within an organisation. But they can equally be applied to supporting the design of an Information System (IS). In a collaborative situation involving several partners, this type of BPM approach may be useful to support the design of a Mediation Information System (MIS), which would ensure interoperability between the partners' ISs (which are assumed to be service oriented). To achieve this objective, the first main task is to build a collaborative business process cartography. The aim of this article is to present a method for bringing together collaborative information and elaborating collaborative business processes from the information gathered (by using a collaborative situation framework, an organisational model, an informational model, a functional model and a metamodel and by using model transformation rules).

A Multi-organisational Approach to Service Delivery

NASA Astrophysics Data System (ADS)

Purchase, Valerie; Mills, John; Parry, Glenn

Who is involved in delivering a service? There has been growing recognition in a wide variety of contexts that service is increasingly being delivered by multi-rather than single-organisational entities. Such recognition is evident not only in our experience but in a number of areas of literature including strategy development, core competence analysis, operations and supply chain management, and is reflected in and further facilitated by ICT developments. Customers have always been involved in some degree in the process of value delivery and such involvement is increasing to include complex co-creation of value. Such interactions are challenging when they involve individual customers, however, this becomes ever more challenging when the 'customer' is another organisation or when there are multiple 'customers'. Within this chapter we will consider some of the key drivers for a multi-organisational approach to service delivery; examine the ways in which the parties involved in service co-creation have expanded to include multiple service providers and customers; and finally, identify some of the challenges created by a multi-organisational approach to service delivery.

[Planning by service organisation priorities. The process of preparing strategic service-organisation plans].

PubMed

Sampietro-Colom, Laura; Costa, Dolors; Busqué, Anna; Lacasa, Carme

2008-12-01

Strategic planning designs the general setting and the strategic principles of a healthcare system, as well as the general guidelines that govern the development of a health system. Strategic service-organisation plans deal with translating healthcare policies into service policies and respond, principally, to the need for services; these give rise to problems that require a solution. They are developed in line with advances in scientific knowledge, the implementation and current characteristics of the healthcare services and the evolution in the competences of professional teams. There are five stages for their development: identification of health/service requirements; prioritisation of needs in health/services; definition of and agreement on service organisation models (care model and service portfolio); the preparation of and agreement on territorial action plans; introduction and evaluation. A conceptual framework is presented along with practical applications carried out in Catalonia.

Playing the role of a 'boundary organisation': getting smarter with networking.

PubMed

Drimie, Scott; Quinlan, Tim

2011-06-16

This paper discusses the practices of organisations that cross the boundary between research and politics, to promote evidence-based policies and programmes. It uses the experience of a network of organisations in Africa to describe the methodology, challenges and successes of efforts to promote utilisation of research on the inter-connections between HIV/AIDS, food security and nutrition in South Africa. It emphasises that crossing the boundary between science and politics can be done systematically and is inevitable for any attempt that seeks influence policy making. The paper reveals the complexity of the research-policy making interface and identifies key lessons for the practice of networking and engaging policy and decision-makers. The concept of boundary organisation is a helpful means to understand the methodological underpinnings of efforts to get research into policy and practice and to understand the 'messy' process of doing so.

Random behaviour, amplification processes and number of participants: How they contribute to the foraging properties of ants

NASA Astrophysics Data System (ADS)

Deneubourg, J. L.; Aron, S.; Goss, S.; Pasteels, J. M.; Duerinck, G.

1986-10-01

Two major types of foraging organisation in ants are described and compared, being illustrated with experimental data and mathematical models. The first concerns large colonies of identical, unspecialised foragers. The communication and interaction between foragers and their randomness generates collective and efficient structures. The second concerns small societies of deterministic and specialised foragers, rarely communicating together. The first organisation is discussed in relation to the different recruitment mechanisms, trail-following error, quality and degree of aggregation of food-sources, and territorial marking, and is the key to many types of collective behaviour in social insects. The second is discussed in relation to spatial specialisation, foraging density, individual learning and genetic programming. The two organisations may be associated in the same colony. The choice of organisation is discussed in relation to colony size and size and predictability of food sources.

Modeling stroke rehabilitation processes using the Unified Modeling Language (UML).

PubMed

Ferrante, Simona; Bonacina, Stefano; Pinciroli, Francesco

2013-10-01

In organising and providing rehabilitation procedures for stroke patients, the usual need for many refinements makes it inappropriate to attempt rigid standardisation, but greater detail is required concerning workflow. The aim of this study was to build a model of the post-stroke rehabilitation process. The model, implemented in the Unified Modeling Language, was grounded on international guidelines and refined following the clinical pathway adopted at local level by a specialized rehabilitation centre. The model describes the organisation of the rehabilitation delivery and it facilitates the monitoring of recovery during the process. Indeed, a system software was developed and tested to support clinicians in the digital administration of clinical scales. The model flexibility assures easy updating after process evolution. Copyright © 2013 Elsevier Ltd. All rights reserved.

Use cases and DEMO: aligning functional features of ICT-infrastructure to business processes.

PubMed

Maij, E; Toussaint, P J; Kalshoven, M; Poerschke, M; Zwetsloot-Schonk, J H M

2002-11-12

The proper alignment of functional features of the ICT-infrastructure to business processes is a major challenge in health care organisations. This alignment takes into account that the organisational structure not only shapes the ICT-infrastructure, but that the inverse also holds. To solve the alignment problem, relevant features of the ICT-infrastructure should be derived from the organisational structure and the influence of this envisaged ICT to the work practices should be pointed out. The objective of our study was to develop a method to solve this alignment problem. In a previous study we demonstrated the appropriateness of the business process modelling methodology Dynamic Essential Modelling of Organizations (DEMO). A proven and widely used modelling language for expressing functional features is Unified Modelling Language (UML). In the context of a specific case study at the University Medical Centre Utrecht in the Netherlands we investigated if the combined use of DEMO and UML could solve the alignment problem. The study demonstrated that the DEMO models were suited as a starting point in deriving system functionality by using the use case concept of UML. Further, the case study demonstrated that in using this approach for the alignment problem, insight is gained into the mutual influence of ICT-infrastructure and organisation structure: (a) specification of independent, re-usable components-as a set of related functionalities-is realised, and (b) a helpful representation of the current and future work practice is provided for in relation to the envisaged ICT support.

Organisational identity and alcohol use among young employees: a case study of a professional services firm.

PubMed

Walker, Benjamin; Bridgman, Todd

2013-11-01

Cultural influences on young people's drinking have been the focus of much research and policy practice. Young people's drinking is influenced by a range of institutions, including the workplace, yet this has received comparatively little attention by researchers and policymakers. This study examines the workplace influences on young people's drinking through the conceptual lens of organisational identification. Data was collected through 16 semi-structured interviews with mainly young employees of a professional services firm in New Zealand. The interviews were coded and analysed thematically, generating five themes of alcohol use at work. Alcohol was used in a number of ways by the respondents in relation to their work, from acting as a means of relieving stress or anxiety induced by work, to providing a means for bonding with work colleagues. Their work also impacted on their alcohol use in more 'positive' ways (e.g. respondents limiting their intake to prevent damage to their career prospects). The study highlights how processes of organisational identification both encourage and inhibit alcohol use. The consumption of alcohol at work provides young professionals with a medium to engage in a variety of organisational identification processes. An understanding of these processes can assist policymakers in focusing on the workplace, an area largely ignored to date, as a target for their campaigns aimed at reducing the harmful effects of young people's heavy alcohol use. Copyright © 2013 Elsevier B.V. All rights reserved.

Using social network analysis to evaluate health-related adaptation decision-making in Cambodia.

PubMed

Bowen, Kathryn J; Alexander, Damon; Miller, Fiona; Dany, Va

2014-01-30

Climate change adaptation in the health sector requires decisions across sectors, levels of government, and organisations. The networks that link these different institutions, and the relationships among people within these networks, are therefore critical influences on the nature of adaptive responses to climate change in the health sector. This study uses social network research to identify key organisational players engaged in developing health-related adaptation activities in Cambodia. It finds that strong partnerships are reported as developing across sectors and different types of organisations in relation to the health risks from climate change. Government ministries are influential organisations, whereas donors, development banks and non-government organisations do not appear to be as influential in the development of adaptation policy in the health sector. Finally, the study highlights the importance of informal partnerships (or 'shadow networks') in the context of climate change adaptation policy and activities. The health governance 'map' in relation to health and climate change adaptation that is developed in this paper is a novel way of identifying organisations that are perceived as key agents in the decision-making process, and it holds substantial benefits for both understanding and intervening in a broad range of climate change-related policy problems where collaboration is paramount for successful outcomes.

Ergonomics in the development and implementation of organisational strategy for sustainability.

PubMed

Ryan, Brendan; Wilson, John R

2013-01-01

This is the first phase of an ergonomics study of sustainability in a rail organisation, particularly environmental sustainability. The main emphasis has been on the use of a qualitative approach to carry out in-depth consultation with those in influential and policy setting roles in the organisation, collecting and analysing perceptions on sustainability policy and related business processes. The study identified factors affecting implementation of policy on sustainability and these have been developed to produce a list of requirements for implementing the policy. The findings are valuable in understanding the range of attitudes, aspirations and perceived constraints, from the perspective of those in senior roles in the company, and development of a sustainability strategy for a rail infrastructure owner. There is need for wider consultation, both within the organisation and externally, to validate and refine the understanding of barriers to the implementation of the policy. The role of ergonomics in supporting the work on sustainability is discussed. The study collects in-depth views from senior managers on the challenges of implementing a policy on sustainability in a rail organisation. Outputs include a list of factors affecting implementation of policy and requirements for better implementation of policy in this area. Potential contributions of ergonomics to sustainability in organisational contexts are discussed.

Learning to listen to the organisational rhetoric of primary health and social care integration.

PubMed

Warne, T; McAndrew, S; King, M; Holland, K

2007-11-01

The sustained modernisation of the UK primary health care service has resulted in individuals and organisations having to develop more integrated ways of working. This has resulted in changes to the structure and functioning of primary care organisations, changes to the traditional workforce, and an increase in scope of primary care practice. These changes have contributed to what for many staff has become a constantly turbulent organisational and practice environment. Data from a three-year project, commissioned by the North West Development Agency is used to explore how staff involved in these changes dealt with this turbulence. Three hundred and fifty staff working within primary care participated in the study. A multimethods approach was used which facilitated an iterative analysis and data collection process. Thematic analysis revealed a high degree of congruence between the perceptions of all staff groups with evidence of a generally well-articulated, but often rhetorical view of the organisational and professional factors involved in how these changes were experienced. This rhetoric was used by individuals as a way of containing both the good and bad elements of their experience. This paper discusses how these defense mechanisms need to be recognised and understood by managers so that a more supportive organisational culture is developed.

The organisational stressors encountered by athletes with a disability.

PubMed

Arnold, Rachel; Wagstaff, Christopher R D; Steadman, Lauren; Pratt, Yasmin

2017-06-01

Organisational stressors have been found to be prevalent and problematic for sport performers, with research identifying demographic differences in the stressors encountered. Nevertheless, extant sport psychology research on the topic of stress has generally focused on able-bodied athletes; whilst that which has been conducted on performers with a disability has typically recruited relatively small samples to explore a narrow selection of organisational stressors, or examined other components of the stress process. The purpose of the present study was to explore the various organisational stressors that athletes with a disability encounter. The sample comprised 18 elite athletes with a disability (10 male, 8 female) who had a classified disability and experience of competing at a major championships in their sport (e.g., Paralympic Games, World Championships). Participants took part in a semi-structured interview which was analysed by drawing from grounded theory procedures. A total of 316 organisational stressors were identified, which were abstracted into 31 concepts and four, previously conceptualised, exploratory schemes: leadership and personnel issues, cultural and team issues, logistical and environmental issues, and performance and personal issues. This study not only provides the first illustration of the prevalence of organisational stressors for athletes with a disability, but also significantly points to salient similarities and distinct differences between the stress experiences of performers with and without a disability.

Using Social Network Analysis to Evaluate Health-Related Adaptation Decision-Making in Cambodia

PubMed Central

Bowen, Kathryn J.; Alexander, Damon; Miller, Fiona; Dany, Va

2014-01-01

Climate change adaptation in the health sector requires decisions across sectors, levels of government, and organisations. The networks that link these different institutions, and the relationships among people within these networks, are therefore critical influences on the nature of adaptive responses to climate change in the health sector. This study uses social network research to identify key organisational players engaged in developing health-related adaptation activities in Cambodia. It finds that strong partnerships are reported as developing across sectors and different types of organisations in relation to the health risks from climate change. Government ministries are influential organisations, whereas donors, development banks and non-government organisations do not appear to be as influential in the development of adaptation policy in the health sector. Finally, the study highlights the importance of informal partnerships (or ‘shadow networks’) in the context of climate change adaptation policy and activities. The health governance ‘map’ in relation to health and climate change adaptation that is developed in this paper is a novel way of identifying organisations that are perceived as key agents in the decision-making process, and it holds substantial benefits for both understanding and intervening in a broad range of climate change-related policy problems where collaboration is paramount for successful outcomes. PMID:24487452

Effect of organisational change type and frequency on long-term sickness absence in hospitals.

PubMed

Bernstrøm, Vilde H; Kjekshus, Lars Erik

2015-09-01

The present study was conducted to investigate how the frequency of structural change and patient care-related change is related to employees' long-term sickness absence. Although a growing body of research is investigating the potentially harmful effects of organisational change on employee health, most studies have focused on single episodes of organisational change and do not differentiate among the types and frequencies of change. National registry data were collected from 2005 and 2007. A total of 34 712 health professionals from 56 hospitals were included (76% nurses, 18% physicians and 6% other health professionals) and the data were analysed using multilevel logistic regression. The research findings reveal a significantly higher probability of long-term sickness absence among employees who experienced more frequent structural changes (OR = 1.03; CI: 1.00-1.06; P < 0.05), but not among employees who experienced more frequent patient care-related changes. A higher frequency of organisational change may lead to more sickness-related absence among employees, with the effect depending on the type of change. These findings highlight the need for managers who are contemplating or are in the process of implementing organisational change to become more aware of the potentially harmful effects of frequent organisational change on employee health. © 2014 John Wiley & Sons Ltd.

Connecting local support: A qualitative study exploring the role of voluntary organisations in long-term condition management.

PubMed

Morris, Rebecca; Kirk, Susan; Kennedy, Anne; Vassilev, Ivaylo; Mathieson, Amy; Jeffries, Mark; Blickem, Christian; Brooks, Helen; Sanders, Caroline; Rogers, Anne

2015-06-01

To examine the role of community groups to support people living with long-term conditions and the organisational factors that influence this role. Thirty-three semi-structured interviews were conducted with voluntary group organisers purposefully sampled in Greater Manchester from a local database of community groups. Interviews explored the organisations role in supporting people living with a long-term condition, their social networks and the origins of the groups. Respondents' construed their role in supporting individual capacity for management either explicitly (e.g. providing exercise) or implicitly (e.g. emotional support). This role was influenced by a combination of group ideology, funding and social networks. Analysis highlights the role of the non-clinical setting, the social support provided within the group, as well as organisational processes that influenced their capacity to support people living with long-term conditions. By examining the organisation of voluntary groups, this study highlights the way in which they may support or constrain access to an extended range of support for people with long-term conditions. This paper has implications for commissioning of services by the health service from the third sector because of the differing ideological perspectives and limited operational capacity. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Effectiveness of external inspection of compliance with standards in improving healthcare organisation behaviour, healthcare professional behaviour or patient outcomes

PubMed Central

Flodgren, Gerd; Pomey, Marie-Pascale; Taber, Sarah A; Eccles, Martin P

2014-01-01

Background Inspection systems are used in health care to promote quality improvements, i.e. to achieve changes in organisational structures or processes, healthcare provider behaviour and patient outcomes. These systems are based on the assumption that externally promoted adherence to evidence-based standards (through inspection/assessment) will result in higher quality of health care. However, the benefits of external inspection in terms of organisational, provider and patient level outcomes are not clear. Objectives To evaluate the effectiveness of external inspection of compliance with standards in improving healthcare organisation behaviour, healthcare professional behaviour and patient outcomes. Search methods We searched the following electronic databases for studies: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effectiveness, Scopus, HMIC, Index to Theses and Intute from their inception dates up to May 2011. There was no language restriction and studies were included regardless of publication status. We searched the reference lists of included studies and contacted authors of relevant papers, accreditation bodies and the International Organization for Standardisation (ISO), regarding any further published or unpublished work. Selection criteria We included randomised controlled trials (RCTs), controlled clinical trials (CCTs), interrupted time-series (ITSs) and controlled before and after studies (CBAs) evaluating the effect of external inspection against external standards on healthcare organisation change, healthcare professional behaviour or patient outcomes in hospitals, primary healthcare organisations and other community-based healthcare organisations. Data collection and analysis Two review authors independently applied eligibility criteria, extracted data and assessed the risk of bias of each included study. Since meta-analysis was not possible, we produced a narrative results summary. Main results We identified one cluster-RCT involving 20 South African public hospitals (Salmon 2003) and one ITS involving all acute trusts in England (OPM 2009) for inclusion in this review. Salmon and colleagues (Salmon 2003) showed mixed effects of a hospital accreditation system on the compliance with COHSASA (the Council for Health Services Accreditation for South Africa) accreditation standards and eight indicators of hospital quality. Significantly improved total mean compliance score with COHSASA accreditation standards was found for 21/28 service elements: mean intervention effect (95% confidence interval (CI)) was 30% (23% to 57%) (P < 0.001). The score increased from 48% to 78% in intervention hospitals, while remaining the same in control hospitals (43%). A sub-analysis of 424 a priori identified critical criteria (19 service elements) showed significantly improved compliance with the critical standards (P < 0.001). The score increased from 41% (21% to 46%) to 75% (55% to 96%) in intervention hospitals, but was unchanged in control hospitals (37%). Only one of the nine intervention hospitals gained full accreditation status at the end of the study period, with two others reached pre-accreditation status.The median intervention effect (range) for the indicators of hospital quality of care was 2.4 (−1.9 to +11.8) and only one of the eight indicators: ‘nurses perception of clinical quality, participation and teamwork’ was significantly improved (mean intervention effect 5.7, P = 0.03). Re-analysis of the MRSA (methicillin-resistant Staphylococcus aureus) data showed statistically non-significant effects of the Healthcare Commissions Infection Inspection programme. Authors’ conclusions We only identified two studies for inclusion in this review, which highlights the paucity of high-quality controlled evaluations of the effectiveness of external inspection systems. No firm conclusions could therefore be drawn about the effectiveness of external inspection on compliance with standards. PMID:22071861

[Work organisation improvement methods applied to activities of Blood Transfusion Establishments (BTE): Lean Manufacturing, VSM, 5S].

PubMed

Bertholey, F; Bourniquel, P; Rivery, E; Coudurier, N; Follea, G

2009-05-01

Continuous improvement of efficiency as well as new expectations from customers (quality and safety of blood products) and employees (working conditions) imply constant efforts in Blood Transfusion Establishments (BTE) to improve work organisations. The Lean method (from "Lean" meaning "thin") aims at identifying wastages in the process (overproduction, waiting, over-processing, inventory, transport, motion) and then reducing them in establishing a mapping of value chain (Value Stream Mapping). It consists in determining the added value of each step of the process from a customer perspective. Lean also consists in standardizing operations while implicating and responsabilizing all collaborators. The name 5S comes from the first letter of five operations of a Japanese management technique: to clear, rank, keep clean, standardize, make durable. The 5S method leads to develop the team working inducing an evolution of the way in the management is performed. The Lean VSM method has been applied to blood processing (component laboratory) in the Pays de la Loire BTE. The Lean 5S method has been applied to blood processing, quality control, purchasing, warehouse, human resources and quality assurance in the Rhône-Alpes BTE. The experience returns from both BTE shows that these methods allowed improving: (1) the processes and working conditions from a quality perspective, (2) the staff satisfaction, (3) the efficiency. These experiences, implemented in two BTE for different processes, confirm the applicability and usefulness of these methods to improve working organisations in BTE.

Measuring organisational readiness for patient engagement (MORE): an international online Delphi consensus study.

PubMed

Oostendorp, Linda J M; Durand, Marie-Anne; Lloyd, Amy; Elwyn, Glyn

2015-02-14

Widespread implementation of patient engagement by organisations and clinical teams is not a reality yet. The aim of this study is to develop a measure of organisational readiness for patient engagement designed to monitor and facilitate a healthcare organisation's willingness and ability to effectively implement patient engagement in healthcare. The development of the MORE (Measuring Organisational Readiness for patient Engagement) scale was guided by Weiner's theory of organisational readiness for change. Weiner postulates that an organisation's readiness is determined by both the willingness and ability to implement the change (i.e. in this context: patient engagement). A first version of the scale was developed based on a literature search and evaluation of pre-existing tools. We invited multi-disciplinary stakeholders to participate in a two-round online Delphi survey. Respondents were asked to rate the importance of each proposed item, and to comment on the proposed domains and items. Second round participants received feedback from the first round and were asked to re-rate the importance of the revised, new and unchanged items, and to provide comments. The first version of the scale contained 51 items divided into three domains: (1) Respondents' characteristics; (2) the organisation's willingness to implement patient engagement; and (3) the organisation's ability to implement patient engagement. 131 respondents from 16 countries (health care managers, policy makers, clinicians, patients and patient representatives, researchers, and other stakeholders) completed the first survey, and 72 of them also completed the second survey. During the Delphi process, 34 items were reworded, 8 new items were added, 5 items were removed, and 18 were combined. The scale's instructions were revised. The final version of MORE totalled 38 items; 5 on stakeholders, 13 on an organisation's willingness to implement, and 20 on an organisation's ability to implement patient engagement in healthcare. The Delphi technique was successfully used to refine the scale's instructions, domains and items, using input from a broad range of international stakeholders, hoping that MORE can be applied in a variety of healthcare contexts worldwide. Further assessment is needed to determine the psychometric properties of the scale.

Facilitating organisational development using a group-based formative assessment and benchmarking method: design and implementation of the International Family Practice Maturity Matrix.

PubMed

Elwyn, Glyn; Bekkers, Marie-Jet; Tapp, Laura; Edwards, Adrian; Newcombe, Robert; Eriksson, Tina; Braspenning, Jozé; Kuch, Christine; Adzic, Zlata Ozvacic; Ayankogbe, Olayinka; Cvetko, Tatjana; In 't Veld, Kees; Karotsis, Antonis; Kersnik, Janko; Lefebvre, Luc; Mecini, Ilir; Petricek, Goranka; Pisco, Luis; Thesen, Janecke; Turón, José María; van Rossen, Edward; Grol, Richard

2010-12-01

Well-organised practices deliver higher-quality care. Yet there has been very little effort so far to help primary care organisations achieve higher levels of team performance and to help them identify and prioritise areas where quality improvement efforts should be concentrated. No attempt at all has been made to achieve a method which would be capable of providing comparisons--and the stimulus for further improvement--at an international level. The development of the International Family Practice Maturity Matrix took place in three phases: (1) selection and refinement of organisational dimensions; (2) development of incremental scales based on a recognised theoretical framework; and (3) testing the feasibility of the approach on an international basis, including generation of an automated web-based benchmarking system. This work has demonstrated the feasibility of developing an organisational assessment tool for primary care organisations that is sufficiently generic to cross international borders and is applicable across a diverse range of health settings, from state-organised systems to insurer-based health economies. It proved possible to introduce this assessment method in 11 countries in Europe and one in Africa, and to generate comparison benchmarks based on the data collected. The evaluation of the assessment process was uniformly positive with the view that the approach efficiently enables the identification of priorities for organisational development and quality improvement at the same time as motivating change by virtue of the group dynamics. We are not aware of any other organisational assessment method for primary care which has been 'born international,' and that has involved attention to theory, dimension selection and item refinement. The principal aims were to achieve an organisational assessment which gains added value by using interaction, engagement comparative benchmarks: aims which have been achieved. The next step is to achieve wider implementation and to ensure that those who undertake the assessment method ensure linkages are made to planned investment in organisational development and quality improvement. Knowing the problems is only half the story.

The role of organisational and cultural factors in the implementation of system-wide interventions in acute hospitals to improve patient outcomes: protocol for a systematic literature review.

PubMed

Nosrati, Hadis; Clay-Williams, Robyn; Cunningham, Frances; Hillman, Ken; Braithwaite, Jeffrey

2013-03-09

Little is known about the role of the organisational culture in the success and sustainability of the hospital-wide interventions, and how local culture affects patient outcomes in acute hospitals. A systematic literature review will be conducted to identify organisational factors influencing hospital-wide interventions and patient outcomes. A search of English language articles will be performed in MEDLINE, CINAHL, EMBASE, Web of Science, PsychInfo and Global Health databases using Medical Subject Headings and keywords. Randomised controlled trials, quasi-randomised trials, controlled before and after design studies and interrupted time-series analysis studies will be included. 'Grey literature' will be excluded, however peer-reviewed journals that are likely to publish relevant studies (JAMA, BMJ, BMJ Quality and Safety, Lancet and New England Journal of Medicine and Implementation Science) will be hand searched for the last 5 years. Two reviewers will independently undertake a title and abstract review using inclusion and exclusion criteria. Studies will be excluded only after discussion between at least two reviewers, who will assess and agree on the inclusion, risk of bias and quality rating of the studies. One author will extract summary descriptive data from these studies; the other author will review this documentation for accuracy and completeness. It is likely that the studies will be heterogeneous in nature, therefore a narrative synthesis of the findings will be conducted. We will discuss characteristics of the studies and stratify the results according to the type of hospital-wide interventions, organisational factors associated with them and outcomes measured.

Collaborating with nurse leaders to develop patient safety practices.

PubMed

Kanerva, Anne; Kivinen, Tuula; Lammintakanen, Johanna

2017-07-03

Purpose The organisational level and leadership development are crucial elements in advancing patient safety, because patient safety weaknesses are often caused by system failures. However, little is known about how frontline leader and director teams can be supported to develop patient safety practices. The purpose of this study is to describe the patient safety development process carried out by nursing leaders and directors. The research questions were: how the chosen development areas progressed in six months' time and how nursing leaders view the participatory development process. Design/methodology/approach Participatory action research was used to engage frontline nursing leaders and directors into developing patient safety practices. Semi-structured group interviews ( N = 10) were used in data collection at the end of a six-month action cycle, and data were analysed using content analysis. Findings The participatory development process enhanced collaboration and gave leaders insights into patient safety as a part of the hospital system and their role in advancing it. The chosen development areas advanced to different extents, with the greatest improvements in those areas with simple guidelines to follow and in which the leaders were most participative. The features of high-reliability organisation were moderately identified in the nursing leaders' actions and views. For example, acting as a change agent to implement patient safety practices was challenging. Participatory methods can be used to support leaders into advancing patient safety. However, it is important that the participants are familiar with the method, and there are enough facilitators to steer development processes. Originality/value Research brings more knowledge of how leaders can increase their effectiveness in advancing patient safety and promoting high-reliability organisation features in the healthcare organisation.

A prospective, multi-method, multi-disciplinary, multi-level, collaborative, social-organisational design for researching health sector accreditation [LP0560737

PubMed Central

Braithwaite, Jeffrey; Westbrook, Johanna; Pawsey, Marjorie; Greenfield, David; Naylor, Justine; Iedema, Rick; Runciman, Bill; Redman, Sally; Jorm, Christine; Robinson, Maureen; Nathan, Sally; Gibberd, Robert

2006-01-01

Background Accreditation has become ubiquitous across the international health care landscape. Award of full accreditation status in health care is viewed, as it is in other sectors, as a valid indicator of high quality organisational performance. However, few studies have empirically demonstrated this assertion. The value of accreditation, therefore, remains uncertain, and this persists as a central legitimacy problem for accreditation providers, policymakers and researchers. The question arises as to how best to research the validity, impact and value of accreditation processes in health care. Most health care organisations participate in some sort of accreditation process and thus it is not possible to study its merits using a randomised controlled strategy. Further, tools and processes for accreditation and organisational performance are multifaceted. Methods/design To understand the relationship between them a multi-method research approach is required which incorporates both quantitative and qualitative data. The generic nature of accreditation standard development and inspection within different sectors enhances the extent to which the findings of in-depth study of accreditation process in one industry can be generalised to other industries. This paper presents a research design which comprises a prospective, multi-method, multi-level, multi-disciplinary approach to assess the validity, impact and value of accreditation. Discussion The accreditation program which assesses over 1,000 health services in Australia is used as an exemplar for testing this design. The paper proposes this design as a framework suitable for application to future international research into accreditation. Our aim is to stimulate debate on the role of accreditation and how to research it. PMID:16968552

A simple, semi-prescriptive self-assessment model for TQM.

PubMed

Warwood, Stephen; Antony, Jiju

2003-01-01

This article presents a simple, semi-prescriptive self-assessment model for use in industry as part of a continuous improvement program such as Total Quality Management (TQM). The process by which the model was constructed started with a review of the available literature in order to research TQM success factors. Next, postal surveys were conducted by sending questionnaires to the winning organisations of the Baldrige and European Quality Awards and to a preselected group of enterprising UK organisations. From the analysis of this data, the self-assessment model was constructed to help organisations in their quest for excellence. This work confirmed the findings from the literature, that there are key factors that contribute to the successful implementation of TQM and these have different levels of importance. These key factors, in order of importance, are: effective leadership, the impact of other quality-related programs, measurement systems, organisational culture, education and training, the use of teams, efficient communications, active empowerment of the workforce, and a systems infrastructure to support the business and customer-focused processes. This analysis, in turn, enabled the design of a self-assessment model that can be applied within any business setting. Further work should include the testing and review of this model to ascertain its suitability and effectiveness within industry today.

Using corporate governance to enhance 'long-term situation awareness' and assist in the avoidance of organisation-induced disasters.

PubMed

Siemieniuch, C E; Sinclair, M A

2008-03-01

This paper considers the issue of how corporate governance can and should deal with the long-term understanding of systems health-what we may call 'long-term situation awareness' (i.e. which evolves and is coherent over time) for organisational systems (and their component sub systems) in the engineering domain. Many characteristics affect long-term situation awareness-the rate of change to processes, pressures for greater efficiency from existing resources, changes in personnel, cultural changes and changes to the operational environment of the organisational systems. Many disasters (e.g. Chernobyl, Flixborough, Piper Alpha) have a causal path that indicates a loss of group situation awareness, over a long period of time. The problem of the gradual, slow drift over many years towards unsafe conduct of company operations is discussed and examples of possible consequences provided. A 'parable' from the world of manufacturing is used to exemplify the problem. The paper goes on to discuss some ways by which this problem could be addressed and longer-term system situational awareness increased; essentially by good corporate governance, knowledge management and ownership of processes. Links are made to the literature on these topics, and a route map to help organisations to gain the benefits is offered.

Decision-making in crisis: Applying a healthcare triage methodology to business continuity management.

PubMed

Moore, Bethany; Bone, Eric A

2017-01-01

The concept of triage in healthcare has been around for centuries and continues to be applied today so that scarce resources are allocated according to need. A business impact analysis (BIA) is a form of triage in that it identifies which processes are most critical, which to address first and how to allocate limited resources. On its own, however, the BIA provides only a roadmap of the impacts and interdependencies of an event. When disaster strikes, organisational decision-makers often face difficult decisions with regard to allocating limited resources between multiple 'mission-critical' functions. Applying the concept of triage to business continuity provides those decision-makers navigating a rapidly evolving and unpredictable event with a path that protects the fundamental priorities of the organisation. A business triage methodology aids decision-makers in times of crisis by providing a simplified framework for decision-making based on objective, evidence-based criteria, which is universally accepted and understood. When disaster strikes, the survival of the organisation depends on critical decision-making and quick actions to stabilise the incident. This paper argues that organisations need to supplement BIA processes with a decision-making triage methodology that can be quickly applied during the chaos of an actual event.

Having a yarn about smoking: using action research to develop a 'no smoking' policy within an Aboriginal Health Organisation.

PubMed

Fletcher, Gillian; Fredericks, Bronwyn; Adams, Karen; Finlay, Summer; Andy, Simone; Briggs, Lyn; Hall, Robert

2011-11-01

This article reports on a culturally appropriate process of development of a smoke-free workplace policy within the peak Aboriginal Controlled Community Health Organisation in Victoria, Australia. Smoking is acknowledged as being responsible for at least 20% of all deaths in Aboriginal communities in Australia, and many Aboriginal health workers smoke. The smoke-free workplace policy was developed using the iterative, discursive and experience-based methodology of Participatory Action Research, combined with the culturally embedded concept of 'having a yarn'. Staff members initially identified smoking as a topic to be avoided within workplace discussions. This was due, in part, to grief (everyone had suffered a smoking-related bereavement). Further, there was anxiety that discussing smoking would result in culturally difficult conflict. The use of yarning opened up a safe space for discussion and debate, enabling development of a policy that was accepted across the organisation. Within Aboriginal organisations, it is not sufficient to focus on the outcomes of policy development. Rather, due attention must be paid to the process employed in development of policy, particularly when that policy is directly related to an emotionally and communally weighted topic such as smoking. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Preclinical Toxicological Evaluation of IDM01: The Botanical Composition of 4-Hydroxyisoleucine- and Trigonelline-based Standardized Fenugreek Seed Extract.

PubMed

Deshpande, Pallavi O; Mohan, Vishwaraman; Thakurdesai, Prasad Arvind

2017-01-01

To evaluate acute oral toxicity (AOT), subchronic (90-day repeated dose) toxicity, mutagenicity, and genotoxicity potential of IDM01, the botanical composition of 4-hydroxyisoleucine- and trigonelline-based standardized fenugreek ( Trigonella foenum-graecum L) seed extract in laboratory rats. The AOT and subchronic (90-day repeated dose) toxicity were evaluated using Sprague-Dawley rats as per the Organisation for Economic Co-operation and Development (OECD) guidelines No. 423 and No. 408, respectively. During the subchronic study, the effects on body weight, food and water consumption, organ weights with hematology, clinical biochemistry, and histology were studied. The mutagenicity and genotoxicity of IDM01 were evaluated by reverse mutation assay (Ames test, OECD guideline No. 471) and chromosome aberration test (OECD guideline No. 473), respectively. The IDM01 did not show mortality or treatment-related adverse signs during acute (limit dose of 2000 mg/kg) and subchronic (90-day repeated dose of 250, 500, and 1000 mg/kg with 28 days of recovery period) administration. The IDM01 showed oral median lethal dose (LD50) >2000 mg/kg during AOT study. The no-observed adverse effect level (NOAEL) of IDM01 was 500 mg/kg. IDM01 did not show mutagenicity up to a concentration of 5000 μg/plate during Ames test and did not induce structural chromosomal aberrations up to 50 mg/culture. IDM01 was found safe during preclinical acute and subchronic (90-day repeated dose) toxicity in rats without mutagenicity or genotoxicity. Acute oral toxicity, subchronic (90-day) oral toxicity, mutagenicity and genotoxicity of IDM01 (4-hydroxyisoleucine- and trigonelline-based standardized fenugreek seed extract) was evaluated.The median lethal dose, LD50, of IDM01 was more than 2000 mg/kg of body weight in rats.No observed adverse effect level (NOAEL) of IDM01 was 500 mg/kg of body weight in rats.IDM01 was found safe during acute and subchronic oral toxicity studies in rats without mutagenicity or genotoxicity potetial. Abbreviations Used: 2-AA: 2-aminoanthracene; 2-AF: 2-aminofluorene; 4 NQNO: 4-nitroquinolene-N-oxide; 4HI: 4-hydroxyisoleucine; ANOVA: Analysis of variance; AOT: Acute oral toxicity; DM: Diabetes mellitus; IDM01: The Botanical composition of 4-hydroxyisoleucine- and trigonelline-based standardized fenugreek seed extract; LD50: Median lethal dose; MMS: Methyl methanesulfonate; NAD: No abnormality detected; OECD: Organisation for Economic Co-operation and Development; SD: Standard deviation; UV: Ultraviolet; VC: Vehicle control. 2-AA: 2-aminoanthracene; 2-AF: 2-aminofluorene; 4 NQNO: 4-nitroquinolene-N-oxide; 4HI: 4-hydroxyisoleucine; ANOVA: Analysis of variance; AOT: Acute oral toxicity; DM: Diabetes mellitus; IDM01: The Botanical composition of 4-hydroxyisoleucine- and trigonelline-based standardized fenugreek seed extract; LD50: Median lethal dose; MMS: Methyl methanesulfonate; NAD: No abnormality detected; OECD: Organisation for Economic Co-operation and Development; SD: Standard deviation; UV: Ultraviolet; VC: Vehicle control.

Preclinical Toxicological Evaluation of IDM01: The Botanical Composition of 4-Hydroxyisoleucine- and Trigonelline-based Standardized Fenugreek Seed Extract

PubMed Central

Deshpande, Pallavi O.; Mohan, Vishwaraman; Thakurdesai, Prasad Arvind

2017-01-01

Objective: To evaluate acute oral toxicity (AOT), subchronic (90-day repeated dose) toxicity, mutagenicity, and genotoxicity potential of IDM01, the botanical composition of 4-hydroxyisoleucine- and trigonelline-based standardized fenugreek (Trigonella foenum-graecum L) seed extract in laboratory rats. Materials and Methods: The AOT and subchronic (90-day repeated dose) toxicity were evaluated using Sprague-Dawley rats as per the Organisation for Economic Co-operation and Development (OECD) guidelines No. 423 and No. 408, respectively. During the subchronic study, the effects on body weight, food and water consumption, organ weights with hematology, clinical biochemistry, and histology were studied. The mutagenicity and genotoxicity of IDM01 were evaluated by reverse mutation assay (Ames test, OECD guideline No. 471) and chromosome aberration test (OECD guideline No. 473), respectively. Results: The IDM01 did not show mortality or treatment-related adverse signs during acute (limit dose of 2000 mg/kg) and subchronic (90-day repeated dose of 250, 500, and 1000 mg/kg with 28 days of recovery period) administration. The IDM01 showed oral median lethal dose (LD50) >2000 mg/kg during AOT study. The no-observed adverse effect level (NOAEL) of IDM01 was 500 mg/kg. IDM01 did not show mutagenicity up to a concentration of 5000 μg/plate during Ames test and did not induce structural chromosomal aberrations up to 50 mg/culture. Conclusions: IDM01 was found safe during preclinical acute and subchronic (90-day repeated dose) toxicity in rats without mutagenicity or genotoxicity. SUMMARY Acute oral toxicity, subchronic (90-day) oral toxicity, mutagenicity and genotoxicity of IDM01 (4-hydroxyisoleucine- and trigonelline-based standardized fenugreek seed extract) was evaluated.The median lethal dose, LD50, of IDM01 was more than 2000 mg/kg of body weight in rats.No observed adverse effect level (NOAEL) of IDM01 was 500 mg/kg of body weight in rats.IDM01 was found safe during acute and subchronic oral toxicity studies in rats without mutagenicity or genotoxicity potetial. Abbreviations Used: 2-AA: 2-aminoanthracene; 2-AF: 2-aminofluorene; 4 NQNO: 4-nitroquinolene-N-oxide; 4HI: 4-hydroxyisoleucine; ANOVA: Analysis of variance; AOT: Acute oral toxicity; DM: Diabetes mellitus; IDM01: The Botanical composition of 4-hydroxyisoleucine- and trigonelline-based standardized fenugreek seed extract; LD50: Median lethal dose; MMS: Methyl methanesulfonate; NAD: No abnormality detected; OECD: Organisation for Economic Co-operation and Development; SD: Standard deviation; UV: Ultraviolet; VC: Vehicle control. 2-AA: 2-aminoanthracene; 2-AF: 2-aminofluorene; 4 NQNO: 4-nitroquinolene-N-oxide; 4HI: 4-hydroxyisoleucine; ANOVA: Analysis of variance; AOT: Acute oral toxicity; DM: Diabetes mellitus; IDM01: The Botanical composition of 4-hydroxyisoleucine- and trigonelline-based standardized fenugreek seed extract; LD50: Median lethal dose; MMS: Methyl methanesulfonate; NAD: No abnormality detected; OECD: Organisation for Economic Co-operation and Development; SD: Standard deviation; UV: Ultraviolet; VC: Vehicle control PMID:28539737

Political and Institutional Influences on the Use of Evidence in Public Health Policy. A Systematic Review

PubMed Central

Liverani, Marco; Hawkins, Benjamin; Parkhurst, Justin O.

2013-01-01

Background There is increasing recognition that the development of evidence-informed health policy is not only a technical problem of knowledge exchange or translation, but also a political challenge. Yet, while political scientists have long considered the nature of political systems, the role of institutional structures, and the political contestation of policy issues as central to understanding policy decisions, these issues remain largely unexplored by scholars of evidence-informed policy making. Methods We conducted a systematic review of empirical studies that examined the influence of key features of political systems and institutional mechanisms on evidence use, and contextual factors that may contribute to the politicisation of health evidence. Eligible studies were identified through searches of seven health and social sciences databases, websites of relevant organisations, the British Library database, and manual searches of academic journals. Relevant findings were extracted using a uniform data extraction tool and synthesised by narrative review. Findings 56 studies were selected for inclusion. Relevant political and institutional aspects affecting the use of health evidence included the level of state centralisation and democratisation, the influence of external donors and organisations, the organisation and function of bureaucracies, and the framing of evidence in relation to social norms and values. However, our understanding of such influences remains piecemeal given the limited number of empirical analyses on this subject, the paucity of comparative works, and the limited consideration of political and institutional theory in these studies. Conclusions This review highlights the need for a more explicit engagement with the political and institutional factors affecting the use of health evidence in decision-making. A more nuanced understanding of evidence use in health policy making requires both additional empirical studies of evidence use, and an engagement with theories and approaches beyond the current remit of public health or knowledge utilisation studies. PMID:24204823

Quality tools and resources to support organisational improvement integral to high-quality primary care: a systematic review of published and grey literature.

PubMed

Janamian, Tina; Upham, Susan J; Crossland, Lisa; Jackson, Claire L

2016-04-18

To conduct a systematic review of the literature to identify existing online primary care quality improvement tools and resources to support organisational improvement related to the seven elements in the Primary Care Practice Improvement Tool (PC-PIT), with the identified tools and resources to progress to a Delphi study for further assessment of relevance and utility. Systematic review of the international published and grey literature. CINAHL, Embase and PubMed databases were searched in March 2014 for articles published between January 2004 and December 2013. GreyNet International and other relevant websites and repositories were also searched in March-April 2014 for documents dated between 1992 and 2012. All citations were imported into a bibliographic database. Published and unpublished tools and resources were included in the review if they were in English, related to primary care quality improvement and addressed any of the seven PC-PIT elements of a high-performing practice. Tools and resources that met the eligibility criteria were then evaluated for their accessibility, relevance, utility and comprehensiveness using a four-criteria appraisal framework. We used a data extraction template to systematically extract information from eligible tools and resources. A content analysis approach was used to explore the tools and resources and collate relevant information: name of the tool or resource, year and country of development, author, name of the organisation that provided access and its URL, accessibility information or problems, overview of each tool or resource and the quality improvement element(s) it addresses. If available, a copy of the tool or resource was downloaded into the bibliographic database, along with supporting evidence (published or unpublished) on its use in primary care. This systematic review identified 53 tools and resources that can potentially be provided as part of a suite of tools and resources to support primary care practices in improving the quality of their practice, to achieve improved health outcomes.

Knowledge exchange in the Pacific: The TROPIC (Translational Research into Obesity Prevention Policies for Communities) project

PubMed Central

2012-01-01

Background Policies targeting obesogenic environments and behaviours are critical to counter rising obesity rates and lifestyle-related non-communicable diseases (NCDs). Policies are likely to be most effective and enduring when they are based on the best available evidence. Evidence-informed policy making is especially challenging in countries with limited resources. The Pacific TROPIC (Translational Research for Obesity Prevention in Communities) project aims to implement and evaluate a tailored knowledge-brokering approach to evidence-informed policy making to address obesity in Fiji, a Pacific nation challenged by increasingly high rates of obesity and concomitant NCDs. Methods The TROPIC project draws on the concept of ‘knowledge exchange’ between policy developers (individuals; organisations) and researchers to deliver a knowledge broking programme that maps policy environments, conducts workshops on evidence-informed policy making, supports the development of evidence-informed policy briefs, and embeds evidence-informed policy making into organisational culture. Recruitment of government and nongovernment organisational representatives will be based on potential to: develop policies relevant to obesity, reach broad audiences, and commit to resourcing staff and building a culture that supports evidence-informed policy development. Workshops will increase awareness of both obesity and policy cycles, as well as develop participants’ skills in accessing, assessing and applying relevant evidence to policy briefs. The knowledge-broking team will then support participants to: 1) develop evidence-informed policy briefs that are both commensurate with national and organisational plans and also informed by evidence from the Pacific Obesity Prevention in Communities project and elsewhere; and 2) collaborate with participating organisations to embed evidence-informed policy making structures and processes. This knowledge broking initiative will be evaluated via data from semi-structured interviews, a validated self-assessment tool, process diaries and outputs. Discussion Public health interventions have rarely targeted evidence-informed policy making structures and processes to reduce obesity and NCDs. This study will empirically advance understanding of knowledge broking processes to extend evidence-informed policy making skills and develop a suite of national obesity-related policies that can potentially improve population health outcomes. PMID:22830984

Community and consumer participation in Australian health services--an overview of organisational commitment and participation processes.

PubMed

Johnson, A; Silburn, K

2000-01-01

This article briefly describes recent initiatives to improve consumer participation in health services that have led to the establishment of the National Resource Centre for Consumer Participation in Health. The results of a component of the needs assessment undertaken by the newly established Centre are presented. They provide a 'snapshot' of the types of feedback and participation processes mainly being utilised by Australian health services at the different levels of seeking information, information sharing and consultation, partnership, delegated power and consumer control. They also allow identification of the organisational commitment made by Australian health services to support a more coordinated approach to community and consumer feedback and participation at different levels of health services such as particular emphasis on determining the presence of community and consumer participation in key organisational statements, specific consumer policies and plans, identifiable leadership, inclusion into job descriptions, allocation of resources, and staff development and consumer training. Discussion centres around four key observations and some of the key perceived external barriers.

Certifying leaders? high-quality management practices and healthy organisations: an ISO-9000 based standardisation approach

PubMed Central

MONTANO, Diego

2016-01-01

The present study proposes a set of quality requirements to management practices by taking into account the empirical evidence on their potential effects on health, the systemic nature of social organisations, and the current conceptualisations of management functions within the framework of comprehensive quality management systems. Systematic reviews and meta-analyses focusing on the associations between leadership and/or supervision and health in occupational settings are evaluated, and the core elements of an ISO 9001 standardisation approach are presented. Six major occupational health requirements to high-quality management practices are identified pertaining to communication processes, organisational justice, role clarity, decision making, social influence processes and management support. It is concluded that the quality of management practices may be improved by developing a quality management system of management practices that ensures not only conformity to product but also to occupational safety and health requirements. Further research may evaluate the practicability of the proposed approach. PMID:26860787

Certifying leaders? high-quality management practices and healthy organisations: an ISO-9000 based standardisation approach.

PubMed

Montano, Diego

2016-08-05

The present study proposes a set of quality requirements to management practices by taking into account the empirical evidence on their potential effects on health, the systemic nature of social organisations, and the current conceptualisations of management functions within the framework of comprehensive quality management systems. Systematic reviews and meta-analyses focusing on the associations between leadership and/or supervision and health in occupational settings are evaluated, and the core elements of an ISO 9001 standardisation approach are presented. Six major occupational health requirements to high-quality management practices are identified pertaining to communication processes, organisational justice, role clarity, decision making, social influence processes and management support. It is concluded that the quality of management practices may be improved by developing a quality management system of management practices that ensures not only conformity to product but also to occupational safety and health requirements. Further research may evaluate the practicability of the proposed approach.

Of floods, sandbags and simulations: Urban resilience to natural disasters and the performance of disaster management organisations under change.

NASA Astrophysics Data System (ADS)

Dressler, Gunnar; Mueller, Birgit; Frank, Karin; Kuhlicke, Christian

2015-04-01

Natural disasters and in particular floods have become a strong threat to urban communities in the last decades. In just eleven years (2002, 2013) two centenary river floods have hit Eastern Germany, causing damages of 9.1 billion € (2002) and 6.7 billion € (2013, first estimate), making them the most costly flood events in German history. Many cities in the Free State of Saxony that were strongly hit by both floods are additionally challenged by demographic change with an ageing society and outmigration leading to population shrinkage. This also constrains the coping capacity of disaster management services, especially those of volunteer-based disaster management organisations such as fire brigades, leading to an increased vulnerability of the community at risk. On the other hand, new technologies such as social media have led to rapid information spread and self-organisation of tremendous numbers of civil volunteers willing to help. How do responsible organisations deal with the challenges associated with demographic change, as well as with expected increases in flood frequency and intensity, and what strategies could enhance their performance in the future? To explore these questions, we developed an agent-based simulation model. It is based on socio-demographic settings of the community, communication and coordination structures of disaster management as well as transportation infrastructure for resources and emergency forces. The model is developed in exchange with relevant stakeholders including experts of local disaster management organisations and authority representatives. The goal of the model is to a) assess the performance of disaster management organisations and determine performance limits with respect to forecast lead times and respective coping times of disaster management organisations and b) use it as a discussion tool with these organisations and authorities to identify weak points as well as new options and strategies to ensure protection and contribute to the communities' resilience. To achieve this goal we use different scenarios to explore the effects of change processes on the performance of disaster management organisations, e.g. rising demands posed onto disaster management organisations due to stronger floods and lower capacities caused by resource constraints. We especially focus on formal coordination structures within and between organisations, as well as informal structures such as emerging networks of volunteers or informal communication between organisations.

Scoping literature review on the Learning Organisation concept as applied to the health system.

PubMed

Akhnif, E; Macq, J; Idrissi Fakhreddine, M O; Meessen, B

2017-03-01

ᅟ: There is growing interest in the use of the management concept of a 'learning organisation'. The objective of this review is to explore work undertaken towards the application of this concept to the health sector in general and to reach the goal of universal health coverage in particular. Of interest are the exploration of evaluation frameworks and their application in health. We used a scoping literature review based on the York methodology. We conducted an online search using selected keywords on some of the main databases on health science, selected websites and main reference books on learning organisations. We restricted the focus of our search on sources in the English language only. Inclusive and exclusive criteria were applied to arrive at a final list of articles, from which information was extracted and then selected and inserted in a chart. We identified 263 articles and other documents from our search. From these, 50 articles were selected for a full analysis and 27 articles were used for the summary. The majority of the articles concerned hospital settings (15 articles, 55%). Seven articles (25%) were related to the application of the concept to the health centre setting. Four articles discussed the application of the concept to the health system (14%). Most of the applications involved high-income countries (21 articles, 78%), with only one article being related to a low-income country. We found 13 different frameworks that were applied to different health organisations. The scoping review allowed us to assess applications of the learning organisation concept to the health sector to date. Such applications are still rare, but are increasingly being used. There is no uniform framework thus far, but convergence as for the dimensions that matter is increasing. Many methodological questions remain unanswered. We also identified a gap in terms of the use of this concept in low- and middle-income countries and to the health system as a whole.

Mathematical methods to analysis of topology, functional variability and evolution of metabolic systems based on different decomposition concepts.

PubMed

Mrabet, Yassine; Semmar, Nabil

2010-05-01

Complexity of metabolic systems can be undertaken at different scales (metabolites, metabolic pathways, metabolic network map, biological population) and under different aspects (structural, functional, evolutive). To analyse such a complexity, metabolic systems need to be decomposed into different components according to different concepts. Four concepts are presented here consisting in considering metabolic systems as sets of metabolites, chemical reactions, metabolic pathways or successive processes. From a metabolomic dataset, such decompositions are performed using different mathematical methods including correlation, stiochiometric, ordination, classification, combinatorial and kinetic analyses. Correlation analysis detects and quantifies affinities/oppositions between metabolites. Stoichiometric analysis aims to identify the organisation of a metabolic network into different metabolic pathways on the hand, and to quantify/optimize the metabolic flux distribution through the different chemical reactions of the system. Ordination and classification analyses help to identify different metabolic trends and their associated metabolites in order to highlight chemical polymorphism representing different variability poles of the metabolic system. Then, metabolic processes/correlations responsible for such a polymorphism can be extracted in silico by combining metabolic profiles representative of different metabolic trends according to a weighting bootstrap approach. Finally evolution of metabolic processes in time can be analysed by different kinetic/dynamic modelling approaches.

Participatory ergonomics: co-developing interventions to reduce the risk of musculoskeletal symptoms in business drivers.

PubMed

Gyi, Diane; Sang, Katherine; Haslam, Cheryl

2013-01-01

The participatory process within four case study organisations with a target population of high mileage business drivers is described. The aim was to work with drivers and their managers to co-develop intervention activities to raise awareness of musculoskeletal health in drivers, including use of the car as a mobile office and manual handling from the car. Train-the-trainer sessions were delivered in each organisation, along with the co-production of training materials. The effectiveness of these activities were evaluated using three sources of data: post-intervention questionnaires, interviews with organisation 'champions' and observations from the research team's diaries. The approach raised management awareness of the risks to drivers and was successful in affecting change, and as such, participatory research should consider the early stages of a project as part of any intervention activities. The research team also reflect on conducting applied longitudinal research in the field. Raising awareness of the risks of musculoskeletal disorders in drivers who work from their vehicle is important. This paper reflects on research in the field and provides guidance on the participatory process and evaluating intervention activities. The participatory process was successful in affecting change at management level.

Advancing working and learning through critical action research: creativity and constraints.

PubMed

Bellman, Loretta; Bywood, Catherine; Dale, Susan

2003-12-01

Continuous professional development is an essential component within many health care 'Learning Organisations'. The paper describes the first phase of an initiative to develop a professional practice development framework for nurses in an NHS general hospital. The project was undertaken within a critical action research methodology. A tripartite arrangement between the hospital, a university and professional nursing organisation enabled clinical, educational and research support for the nurses (co-researchers) engaged in the project. Initial challenges were from some managers, educationalists and the ethics committee who did not appear to understand the action research process. A multi-method approach to data collection was undertaken to capture the change process from different stakeholders' perceptions. Triangulation of the data was undertaken. Despite organisational constraints, transformational leadership and peer support enabled the co-researchers to identify and initiate three patient-focused initiatives. The change process for the co-researchers included: enlightening personal journey, exploring the research-practice gap, enhancing personal and professional knowledge, evolving cultural change and collaborative working, empowering and disempowering messages. A hospital merger and corporate staff changes directly impacted on the project. A more flexible time-scale and longer term funding are required to enable continuity for trust-wide projects undertaken in dynamic clinical settings.

From crisis to development--analysis of air traffic control work processes.

PubMed

Teperi, Anna-Maria; Leppänen, Anneli

2011-03-01

In this study an intervention to improve work processes in air traffic control (ATC) is evaluated. The background was the Finnish air traffic controllers' strike of 1999. The old ways of thinking and acting did not support development of ATC prompting a need for a new kind of working culture in the organisation. Several actions were started. In one of these, ATC work processes were modelled by personnel and development plans concerning work were delivered to top management. Different actors (management, trade union, stakeholders) were interviewed before (n=16) and after the project (n=7). The intervention supported systematic co-operation between different actors in the organisation. However, a follow-up revealed that only a few participants had adopted the idea of continuous work development. Mastery of human factors is crucial in a high reliability work environment such as ATC. But how is the analytical and co-operative aspect kept alive in an organisation that is run by strict international regulation and has a strong technical competence, but is not that strong in collaborative and human aspects? Copyright © 2010 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Organisational participation and health among smallholder farmers: a longitudinal study in a Latin American context

PubMed Central

Orozco, Fadya; Mota, Eduardo; Cole, Donald C

2014-01-01

Objective To understand the impact of social organisation affiliation and farmers’ agricultural production practices on farmer health. Organisations facilitate the acquisition and exchange of forms of social capital which can influence the adoption of practices with potential health impacts. In countries such as Ecuador, smallholder agriculture is practised by socially vulnerable populations. Agricultural production often involves the use of extremely hazardous pesticides, while practices that reduce the use of chemicals through integrated pest management (IPM) remain uncommon. Design Longitudinal study (2007–2010). Setting 12 Ecuadorian communities, previously part of a participatory action research study. Participants 208 small-scale farmers. Inclusion criteria were: age between 18 and 65 years, literate and resident in the community for the previous 3 years. Primary outcomes The differential effects of the membership in social organisations (as an effect modifier), on the relationship between the implementation of IPM practices (main independent variable) and farmers’ health, measured by neurocognitive performance scores (better higher value; dependent variable). Results Among organisational participants, the coefficient of association between the implementation of IPM practices for the category good/very good (vs no use) and neurocognitive performance, when farmers were involved in organisations, was negative and moderate (β=−0.17, SE 0.21) though not significant (p>0.1); for the category little/moderate use, the coefficient was positive (β=0.34, SE 0.19) and significant. Among those who did not participate in organisations, both little/moderate use and good/very good use of IPM practices were associated with an increase in neurocognitive performance. Conclusions The effect of agricultural production practices on farmers’ health, transmitted through organisations, can be differentiated. Organisations as structures of social capital seem to be functional in the social reproduction process of the communities studied. Results highlight the need to redirect the analysis of social capital to a more integrated study of social determination of health. PMID:25344481

Linking hospital workers' organisational work environment to depressive symptoms: A mediating effect of effort-reward imbalance? The ORSOSA study.

PubMed

Jolivet, Anne; Caroly, Sandrine; Ehlinger, Virgine; Kelly-Irving, Michelle; Delpierre, Cyrille; Balducci, Franck; Sobaszek, Annie; De Gaudemaris, Régis; Lang, Thierry

2010-08-01

Few studies have analysed the association between the organisational work environment and depression in hospital workers and we still have little understanding of how processes in the practice environment are related to depressive disorders. However, individual perception of an imbalance between efforts made and expected rewards has been associated with incident depression. The main goal of this study was to test the hypothesis that some organisational constraints at the work-unit level may be related to depressive symptoms in hospital workers, either directly or through individual perceptions of effort-reward imbalance (ERI). In 2006, 3316 female registered nurses and nursing aids working in 190 work units in seven French university hospitals, recruited from the baseline screening of an epidemiological cohort study (the ORSOSA study), responded in 2006 to valid self-report questionnaires (CES-D, ERI). The organisational work environment was assessed with the self-rated Nursing Work Index - Extended Organisation (NWI-EO) aggregated at the work unit level. Multilevel models were used. We found that poor relations between workers within work units were associated with higher CES-D score, independently of perceived ERI. Low level of communication between workers in the unit was associated with individual perceptions of ERI and indirectly associated with depressive symptoms. Understaffing and non-respect of planned days off and vacations were associated with perceived ERI but these organisational constraints were not associated with depressive symptoms. Our study allowed us to identify and quantify organisational factors that have a direct effect on hospital workers' depressive symptoms, or an indirect effect through perceived ERI. Better understanding of the effect of organisational factors on health through perceived ERI would provide targets for successful interventions. Organisational approaches may be more effective in improving mental health at work and may also have a longer-lasting impact than individual approaches. Copyright 2010 Elsevier Ltd. All rights reserved.

Benefits of incorporating spatial organisation of catchments for a semi-distributed hydrological model

NASA Astrophysics Data System (ADS)

Schumann, Andreas; Oppel, Henning

2017-04-01

To represent the hydrological behaviour of catchments a model should reproduce/reflect the hydrologically most relevant catchment characteristics. These are heterogeneously distributed within a watershed but often interrelated and subject of a certain spatial organisation. Since common models are mostly based on fundamental assumptions about hydrological processes, the reduction of variance of catchment properties as well as the incorporation of the spatial organisation of the catchment is desirable. We have developed a method that combines the idea of the width-function used for determination of the geomorphologic unit hydrograph with information about soil or topography. With this method we are able to assess the spatial organisation of selected catchment characteristics. An algorithm was developed that structures a watershed into sub-basins and other spatial units to minimise its heterogeneity. The outcomes of this algorithm are used for the spatial setup of a semi-distributed model. Since the spatial organisation of a catchment is not bound to a single characteristic, we have to embed information of multiple catchment properties. For this purpose we applied a fuzzy-based method to combine the spatial setup for multiple single characteristics into a union, optimal spatial differentiation. Utilizing this method, we are able to propose a spatial structure for a semi-distributed hydrological model, comprising the definition of sub-basins and a zonal classification within each sub-basin. Besides the improved spatial structuring, the performed analysis ameliorates modelling in another way. The spatial variability of catchment characteristics, which is considered by a minimum of heterogeneity in the zones, can be considered in a parameter constrained calibration scheme in a case study both options were used to explore the benefits of incorporating the spatial organisation and derived parameter constraints for the parametrisation of a HBV-96 model. We use two benchmark model setups (lumped and semi-distributed by common approaches) to address the benefits for different time and spatial scales. Moreover, the benefits for calibration effort, model performance in validation periods and process extrapolation are shown.

PREFACE: 7th International Conference on Modern Practice in Stress and Vibration Analysis

NASA Astrophysics Data System (ADS)

Barton, J.

2009-07-01

The proceedings contain the papers presented at the 7th International Conference on Modern Practice in Stress and Vibration Analysis. The collection of papers represents the range of activities that are carried out to understand the functionality of engineering systems and structures through stress/strain based evaluation and dynamic response. The scope is broad and covers theoretical studies, modelling and experimental evaluations. Many of the papers cover integration techniques and approaches to better understanding of system performance and failure. All of the papers have been peer reviewed by at least two experts and represent the state of the art of research in this area. The conference is the seventh in the series, following on from previous conferences in Bath, Glasgow, Nottingham, Dublin, Sheffield and Liverpool. Although based in the British Isles the conference has a truly international flavour with offerings from 22 countries. The conference is organised by the Institute of Physics Applied Mechanics Group (formerly the Stress and Vibration Group). It incorporates activities associated with the British Society for Strain Measurement including the Measurements Lecture, the EMex Exhibition and the Young Stress Analyst Competition. The organising committee is grateful for the support of all of the authors, the scientific committee and keynote speakers who played a significant role in the review process, to John Edwards who was instrumental in managing the paper review and submission process, Dawn Stewart and Claire Garland of the Institute of Physics for organising the conference, social programme and registration and Biana Gale of the British Society for Strain Measurement for organising the Exhibition. The organising committee is also grateful to the sponsors of the conference for their kind support and to the co-sponsors for distributing information on the conference. Professor Janice Barton Professor of Experimental Mechanics University of Southampton School of Engineering Sciences Conference Chairman The PDF contains lists of the organising committee, scientific committee, sponsors and co-sponsors.

PREFACE: 7th International Conference on Modern Practice in Stress and Vibration Analysis

NASA Astrophysics Data System (ADS)

Dulieu-Barton, J. M.

2009-07-01

The proceedings contain the papers presented at the 7th International Conference on Modern Practice in Stress and Vibration Analysis. The collection of papers represents the range of activities that are carried out to understand the functionality of engineering systems and structures through stress/strain based evaluation and dynamic response. The scope is broad and covers theoretical studies, modelling and experimental evaluations. Many of the papers cover integration techniques and approaches to better understanding of system performance and failure. All of the papers have been peer reviewed by at least two experts and represent the state of the art of research in this area. The conference is the seventh in the series, following on from previous conferences in Bath, Glasgow, Nottingham, Dublin, Sheffield and Liverpool. Although based in the British Isles the conference has a truly international flavour with offerings from 22 countries. The conference is organised by the Institute of Physics Applied Mechanics Group (formerly the Stress and Vibration Group). It incorporates activities associated with the British Society for Strain Measurement including the Measurements Lecture, the EMex Exhibition and the Young Stress Analyst Competition. The organising committee is grateful for the support of all of the authors, the scientific committee and keynote speakers who played a significant role in the review process, to John Edwards who was instrumental in managing the paper review and submission process, Dawn Stewart and Claire Garland of the Institute of Physics for organising the conference, social programme and registration and Biana Gale of the British Society for Strain Measurement for organising the Exhibition. The organising committee is also grateful to the sponsors of the conference for their kind support and to the co-sponsors for distributing information on the conference. Professor Janice M Dulieu-Barton Professor of Experimental Mechanics University of Southampton School of Engineering Sciences Conference Chairman The PDF contains lists of the organising committee, scientific committee, sponsors and co-sponsors.

Enhancing the use of research in health-promoting, anti-racism policy.

PubMed

Ferdinand, Angeline S; Paradies, Yin; Kelaher, Margaret

2017-07-11

The Localities Embracing and Accepting Diversity (LEAD) programme was established to improve the health of ethnic minority communities through the reduction of racial discrimination. Local governments in the state of Victoria, Australia, were at the forefront of LEAD implementation in collaboration with leading state and national organisations. Key aims included expanding the available evidence regarding effective anti-racism interventions and facilitating the uptake of this evidence in organisational policies and practices. One rural and one metropolitan local government areas were selected to participate in LEAD. Key informant interviews and discussions were conducted with individuals who had participated in LEAD implementation and members of LEAD governance structures. Data were also collected on programme processes and implementation, partnership formation and organisational assessments. The LEAD model demonstrated both strengths and weaknesses in terms of facilitating the use of evidence in a complex, community-based health promotion initiative. Representation of implementing, funding and advisory bodies at different levels of governance enabled the input of technical advice and guidance alongside design and implementation. The representation structure assisted in ensuring the development of a programme that was acceptable to all partners and informed by the best available evidence. Simultaneous evaluation also enhanced perceived validity of the intervention, allowed for strategy correction when necessary and supported the process of double-loop organisational learning. However, due to the model's demand for simultaneous and intensive effort by various organisations, when particular elements of the intervention were not functional, there was a considerable loss of time and resources across the partner organisations. The complexity of the model also presented a challenge in ensuring clarity regarding roles, functions and the direction of the programme. The example of LEAD provides guidance on mechanisms to strengthen the entry of evidence into complex community-based health promotion programmes. The paper highlights some of the strengths and weaknesses of the LEAD model and implications for practical collaboration between policymakers, implementers and researchers.

Business plans--tips from the toolkit 6.

PubMed

Steer, Neville

2010-07-01

General practice is a business. Most practices can stay afloat by having appointments, billing patients, managing the administration processes and working long hours. What distinguishes the high performance organisation from the average organisation is a business plan. This article examines how to create a simple business plan that can be applied to the general practice setting and is drawn from material contained in The Royal Australian College of General Practitioners' 'General practice management toolkit'.

Ethical experiential learning in medical, nursing and allied health education: A narrative review.

PubMed

Grace, Sandra; Innes, Ev; Patton, Narelle; Stockhausen, Lynette

2017-04-01

Students enrolled in medical, nursing and health science programs often participate in experiential learning in their practical classes. Experiential learning includes peer physical examination and peer-assisted learning where students practise clinical skills on each other. To identify effective strategies that enable ethical experiential learning for health students during practical classes. A narrative review of the literature. Pubmed, Cinahl and Scopus databases were searched because they include most of the health education journals where relevant articles would be published. A data extraction framework was developed to extract information from the included papers. Data were entered into a fillable form in Google Docs. Findings from identified studies were extracted to a series of tables (e.g. strategies for fostering ethical conduct; facilitators and barriers to peer-assisted learning). Themes were identified from these findings through a process of line by line coding and organisation of codes into descriptive themes using a constant comparative method. Finally understandings and hypotheses of relevance to our research question were generated from the descriptive themes. A total of 35 articles were retrieved that met the inclusion criteria. A total of 13 strategies for ethical experiential learning were identified and one evaluation was reported. The most frequently reported strategies were gaining written informed consent from students, providing information about the benefits of experiential learning and what to expect in practical classes, and facilitating discussions in class about potential issues. Contexts that facilitated participation in experiential learning included allowing students to choose their own groups, making participation voluntary, and providing adequate supervision, feedback and encouragement. A total of 13 strategies for ethical experiential learning were identified in the literature. A formal process for written consent was evaluated as effective; the effectiveness of other strategies remains to be determined. A comprehensive framework that integrates all recommendations from the literature is needed to guide future research and practise of ethical experiential learning in health courses. Copyright © 2017 Elsevier Ltd. All rights reserved.

Mechanical cell disruption of Parachlorella kessleri microalgae: Impact on lipid fraction composition.

PubMed

Clavijo Rivera, E; Montalescot, V; Viau, M; Drouin, D; Bourseau, P; Frappart, M; Monteux, C; Couallier, E

2018-05-01

Samples of nitrogen-starved Parachlorella kessleri containing intact cells (IC), cells ground by bead milling (BM), and cells subjected to high-pressure cell disruption (HPD), together with their supernatants after centrifugation, were compared for granulometry and lipid profiles. The effects of disruption on the lipid profile and organisation were evaluated. The quantity of lipids available for extraction increased with disruption, and up to 81% could be recovered in supernatants after centrifugation, but a marked reorganization occurred. The proportion of amphiphilic free fatty acids and lysophosphatidylcholine increased during disruption due to their release or owing to lipid degradation by enzymes or physical conditions. This effect was more marked in HPD than in BM. Lipids contained in the aqueous phase, after disruption and centrifugation, were enriched in unsaturated fatty acids, BM leading to larger droplets than HPD. The larger liquid lipid droplet would be easier to recover in the following downstream processing. Copyright © 2018 Elsevier Ltd. All rights reserved.

Systematic review on embracing cultural diversity for developing and sustaining a healthy work environment in healthcare.

PubMed

Pearson, Alan; Srivastava, Rani; Craig, Dianna; Tucker, Donna; Grinspun, Doris; Bajnok, Irmajean; Griffin, Pat; Long, Leslye; Porritt, Kylie; Han, Thuzar; Gi, Aye A

The objective of this review was to evaluate evidence on the structures and processes that support development of effective culturally competent practices and a healthy work environment. Culturally competent practices are a congruent set of workforce behaviours, management practices and institutional policies within a practice setting resulting in an organisational environment that is inclusive of cultural and other forms of diversity. This review included quantitative and qualitative evidence, with a particular emphasis on identifying systematic reviews and randomised controlled trials. For quantitative evidence, other controlled, and descriptive designs were also included. For qualitative evidence, all methodologies were considered. Participants were staff, patients, and systems or policies that were involved or affected by concepts of cultural competence in the nursing workforce in a healthcare environment. Types of interventions included any strategy that had a cultural competence component, which influenced the work environment, and/or patient and nursing staff in the environment. The types of outcomes of interest to this review included nursing staff outcomes, patient outcomes, organisational outcomes and systems level outcomes. The search sought both published and unpublished literature written in the English language. A comprehensive three-step search strategy was used, first to identify appropriate key words, second to combine all optimal key words into a comprehensive search strategy for each database and finally to review the reference lists of all included reviews and research reports. The databases searched were CINAHL, Medline, Current Contents, the Database of Abstracts of Reviews of Effectiveness, The Cochrane Library, PsycINFO, Embase, Sociological Abstracts, Econ lit, ABI/Inform, ERIC and PubMed. The search for unpublished literature used Dissertation Abstracts International. Methodological quality was independently established by two reviewers, using standardised techniques from the Joanna Briggs Institute (JBI) System for the Unified Management, Assessment and Review of Information (SUMARI) package. Discussion with a third reviewer was initiated where a low level of agreement was identified for a particular paper. Following inclusion, data extraction was conducted using standardised data extraction tools from the JBI SUMARI suite for quantitative and qualitative research. Data synthesis was performed using the JBI Qualitative Assessment and Review Instrument and JBI Narrative, Opinion and Text Assessment and Review Instrument software to aggregate findings by identifying commonalities across texts. Quantitative data were presented in narrative summary, as statistical pooling was not appropriate with the included studies. Of the 659 identified papers, 45 were selected for full paper retrieval, and 19 were considered to meet the inclusion criteria for this review. The results identified a number of processes that would contribute to the development of a culturally competent workforce. Appropriate and competent linguistic services, and intercultural staff training and education, were identified as key findings in this review. The review recommends that health provider agencies establish links with organisations that can address needs of culturally diverse groups of patients, include cultural competence in decision support systems and staff education as well as embed them in patient brochures and educational materials. The review also concluded that staff in-service programs consider the skills needed to foster a culturally competent workforce, and recruitment strategies that also explicitly address this need.

Organisational culture and change: implementing person-centred care.

PubMed

Carlström, Eric D; Ekman, Inger

2012-01-01

The purpose of this paper is to explore the connection between organisational cultures and the employee's resistance to change at five hospital wards in Western Sweden. Staff had experienced extensive change during a research project implementing person-centred care (PCC) for patients with chronic heart failure. Surveys were sent out to 170 nurses. The survey included two instruments--the Organisational Values Questionnaire (OVQ) and the Resistance to Change Scale (RTC). The results indicate that a culture with a dominating focus on social competence decreases "routine seeking behaviour", i.e. tendencies to uphold stable routines and a reluctance to give up old habits. The results indicate that a culture of flexibility, cohesion and trust negatively covariate with the overall need for a stable and well-defined framework. An instrument that pinpoints the conditions of a particular healthcare setting can improve the results of a change project. Managers can use instruments such as the ones used in this study to investigate and plan for change processes. Earlier studies of organisational culture and its impact on the performance of healthcare organisations have often investigated culture at the highest level of the organisation. In this study, the culture of the production units--i.e. the health workers in different hospital wards--was described. Hospital wards develop their own culture and the cultures of different wards are mirrored in the hospital.

Predicting absenteeism and turnover intentions in the health professions.

PubMed

Albion, Majella J; Fogarty, Gerard J; Machin, Michael A; Patrick, Jeff

2008-05-01

The study examined the mediating influence of individual psychological reactions to work on the relationship between organisational climate and job withdrawal behaviours (viz, intention to leave and absenteeism). 1097 hospital employees were surveyed using the Queensland Public Agency Staff Survey (QPASS) to obtain measures of organisational climate, psychological reactions to work, job satisfaction, and self-reported levels of intention to leave. Group-level absenteeism data were provided from the Health Service District files. Two psychological states, quality of work life and job satisfaction, were found to fully mediate the relationship between the organisational climate variable, role clarity, and intention to leave, while individual distress was found to partially mediate the same relationship. However, the hypothesised mediation effect of psychological states on the relationship between organisational climate and absenteeism did not emerge. Skills shortages and increasing demands for health services make retention of staff in the health service industry vitally important. As a means of addressing this issue, this study presents an emergent mediating model defining relationships among individual psychological factors, aspects of organisational climate and intention to leave. Identification of the processes associated with staff withdrawal behaviours or intentions will assist in devising interventions to improve retention.

Coaching as a Developmental Intervention in Organisations: A Systematic Review of Its Effectiveness and the Mechanisms Underlying It.

PubMed

Grover, Simmy; Furnham, Adrian

2016-01-01

The primary aim of this paper is to conduct a thorough and systematic review of the empirical and practitioner research on executive, leadership and business coaching to assess the current empirical evidence for the effectiveness of coaching and the mechanisms underlying it. Organisations are increasingly using business coaching as an intervention to improve the productivity and performance of their senior personnel. A consequence of this increased application is the demand for empirical data to understand the process by which it operates and its demonstrable efficacy in achieving pre-set goals. This paper is a systematic review of the academic and practitioner literature pertaining to the effectiveness of business and executive coaching as a developmental intervention for organisations. It focuses on published articles, conference papers and theses that cover business, leadership or executive coaching within organisations over the last 10 years. The main findings show that coaching is an effective tool that benefits organisations and a number of underlying facets contribute to this effectiveness. However, there is deficiency and scope for further investigation in key aspects of the academic research and we identify several areas that need further research and practitioner attention. ​.

Managing resources in NHS dentistry: the views of decision-makers in primary care organisations.

PubMed

Holmes, R D; Donaldson, C; Exley, C; Steele, J G

2008-09-27

To investigate priority setting and decision-making in primary care organisations and to determine how resources are managed in order to meet the oral health needs of local populations. This is a qualitative study. The purposive sample comprised twelve dental public health consultants and six senior finance representatives from contrasting care systems across the United Kingdom. Participants completed a written information sheet followed by a recorded semi-structured telephone interview. Conversations were professionally transcribed verbatim and analysed independently by two investigators using the constant comparative method. The emergent themes focused upon: the role of participants in decision-making; professional relationships; managing change; information needs; and identifying and managing priorities. There was wide interpretation with respect to participants' roles and perceived information needs for decision-making and commissioning. A unifying factor was the importance placed by participants upon trust and the influence of individuals on the success of relationships forged between primary care organisations and general dental practitioners. To facilitate decision-making in primary care organisations, commissioners and managers could engage further with practitioners and incorporate them into commissioning and resource allocation processes. Greater clarity is required regarding the role of dental public health consultants within primary care organisations and commissioning decisions.

The development of ORACLe: a measure of an organisation's capacity to engage in evidence-informed health policy.

PubMed

Makkar, Steve R; Turner, Tari; Williamson, Anna; Louviere, Jordan; Redman, Sally; Haynes, Abby; Green, Sally; Brennan, Sue

2016-01-14

Evidence-informed policymaking is more likely if organisations have cultures that promote research use and invest in resources that facilitate staff engagement with research. Measures of organisations' research use culture and capacity are needed to assess current capacity, identify opportunities for improvement, and examine the impact of capacity-building interventions. The aim of the current study was to develop a comprehensive system to measure and score organisations' capacity to engage with and use research in policymaking, which we entitled ORACLe (Organisational Research Access, Culture, and Leadership). We used a multifaceted approach to develop ORACLe. Firstly, we reviewed the available literature to identify key domains of organisational tools and systems that may facilitate research use by staff. We interviewed senior health policymakers to verify the relevance and applicability of these domains. This information was used to generate an interview schedule that focused on seven key domains of organisational capacity. The interview was pilot-tested within four Australian policy agencies. A discrete choice experiment (DCE) was then undertaken using an expert sample to establish the relative importance of these domains. This data was used to produce a scoring system for ORACLe. The ORACLe interview was developed, comprised of 23 questions addressing seven domains of organisational capacity and tools that support research use, including (1) documented processes for policymaking; (2) leadership training; (3) staff training; (4) research resources (e.g. database access); and systems to (5) generate new research, (6) undertake evaluations, and (7) strengthen relationships with researchers. From the DCE data, a conditional logit model was estimated to calculate total scores that took into account the relative importance of the seven domains. The model indicated that our expert sample placed the greatest importance on domains (2), (3) and (4). We utilised qualitative and quantitative methods to develop a system to assess and score organisations' capacity to engage with and apply research to policy. Our measure assesses a broad range of capacity domains and identifies the relative importance of these capacities. ORACLe data can be used by organisations keen to increase their use of evidence to identify areas for further development.

Effectiveness of organisational infrastructures to promote evidence-based nursing practice.

PubMed

Flodgren, Gerd; Rojas-Reyes, Maria Ximena; Cole, Nick; Foxcroft, David R

2012-02-15

Nurses and midwives form the bulk of the clinical health workforce and play a central role in all health service delivery. There is potential to improve health care quality if nurses routinely use the best available evidence in their clinical practice. Since many of the factors perceived by nurses as barriers to the implementation of evidence-based practice (EBP) lie at the organisational level, it is of interest to devise and assess the effectiveness of organisational infrastructures designed to promote EBP among nurses. To assess the effectiveness of organisational infrastructures in promoting evidence-based nursing. We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, LILACS, BIREME, IBECS, NHS Economic Evaluations Database, Social Science Citation Index, Science Citation Index and Conference Proceedings Citation Indexes up to 9 March 2011.We developed a new search strategy for this update as the strategy published in 2003 omitted key terms. Additional search methods included: screening reference lists of relevant studies, contacting authors of relevant papers regarding any further published or unpublished work, and searching websites of selected research groups and organisations.  We considered randomised controlled trials, controlled clinical trials, interrupted times series (ITSs) and controlled before and after studies of an entire or identified component of an organisational infrastructure intervention aimed at promoting EBP in nursing. The participants were all healthcare organisations comprising nurses, midwives and health visitors. Two authors independently extracted data and assessed risk of bias. For the ITS analysis, we reported the change in the slopes of the regression lines, and the change in the level effect of the outcome at 3, 6, 12 and 24 months follow-up. We included one study from the USA (re-analysed as an ITS) involving one hospital and an unknown number of nurses and patients. The study evaluated the effects of a standardised evidence-based nursing procedure on nursing care for patients at risk of developing healthcare-acquired pressure ulcers (HAPUs). If a patient's admission Braden score was below or equal to 18 (i.e. indicating a high risk of developing pressure ulcers), nurses were authorised to initiate a pressure ulcer prevention bundle (i.e. a set of evidence-based clinical interventions) without waiting for a physician order. Re-analysis of data as a time series showed that against a background trend of decreasing HAPU rates, if that trend was assumed to be real, there was no evidence of an intervention effect at three months (mean rate per quarter 0.7%; 95% confidence interval (CI) 1.7 to 3.3; P = 0.457). Given the small percentages post intervention it was not statistically possible to extrapolate effects beyond three months. Despite extensive searching of published and unpublished research we identified only one low-quality study; we excluded many studies due to non-eligible study design. If policy-makers and healthcare organisations wish to promote evidence-based nursing successfully at an organisational level, they must ensure the funding and conduct of well-designed studies to generate evidence to guide policy.

The CNES Gaia Data Processing Center: A Challenge and its Solutions

NASA Astrophysics Data System (ADS)

Chaoul, Laurence; Valette, Veronique

2011-08-01

After a brief reminder of the ESA Gaia project, this paper presents the data processing consortium (DPAC) and then the CNES data processing centre (DPCC). We focus on the challenge in terms of organisational aspects, processing capabilities, databases volumetry, and how we deal with these topics.

'Act on oncology' as a new comprehensive approach to assess prostate cancer centres--method description and results of a pilot study.

PubMed

Voigt, Wieland; Hoellthaler, Josef; Magnani, Tiziana; Corrao, Vito; Valdagni, Riccardo

2014-01-01

Multidisciplinary care of prostate cancer is increasingly offered in specialised cancer centres. It requires the optimisation of medical and operational processes and the integration of the different medical and non-medical stakeholders. To develop a standardised operational process assessment tool basing on the capability maturity model integration (CMMI) able to implement multidisciplinary care and improve process quality and efficiency. Information for model development was derived from medical experts, clinical guidelines, best practice elements of renowned cancer centres, and scientific literature. Data were organised in a hierarchically structured model, consisting of 5 categories, 30 key process areas, 172 requirements, and more than 1500 criteria. Compliance with requirements was assessed through structured on-site surveys covering all relevant clinical and management processes. Comparison with best practice standards allowed to recommend improvements. 'Act On Oncology'(AoO) was applied in a pilot study on a prostate cancer unit in Europe. Several best practice elements such as multidisciplinary clinics or advanced organisational measures for patient scheduling were observed. Substantial opportunities were found in other areas such as centre management and infrastructure. As first improvements the evaluated centre administration described and formalised the organisation of the prostate cancer unit with defined personnel assignments and clinical activities and a formal agreement is being worked on to have structured access to First-Aid Posts. In the pilot study, the AoO approach was feasible to identify opportunities for process improvements. Measures were derived that might increase the operational process quality and efficiency.

Implementing medical revalidation in the United Kingdom: Findings about organisational changes and impacts from a survey of Responsible Officers

PubMed Central

Boyd, Alan; Bryce, Marie; Luscombe, Kayleigh; Tazzyman, Abigail; Tredinnick-Rowe, John; Archer, Julian

2017-01-01

Objective To describe the implementation of medical revalidation in healthcare organisations in the United Kingdom and to examine reported changes and impacts on the quality of care. Design A cross-sectional online survey gathering both quantitative and qualitative data about structures and processes for medical revalidation and wider quality management in the organisations which employ or contract with doctors (termed ‘designated bodies’) from the senior doctor in each organisation with statutory responsibility for medical revalidation (termed the ‘Responsible Officer’). Setting United Kingdom Participants Responsible Officers in designated bodies in the United Kingdom. Five hundred and ninety-five survey invitations were sent and 374 completed surveys were returned (63%). Main outcome measures The role of Responsible Officers, the development of organisational mechanisms for quality assurance or improvement, decision-making on revalidation recommendations, impact of revalidation and mechanisms for quality assurance or improvement on clinical practice and suggested improvements to revalidation arrangements. Results Responsible Officers report that revalidation has had some impacts on the way medical performance is assured and improved, particularly strengthening appraisal and oversight of quality within organisations and having some impact on clinical practice. They suggest changes to make revalidation less ‘one size fits all’ and more responsive to individual, organisational and professional contexts. Conclusions Revalidation appears primarily to have improved systems for quality improvement and the management of poor performance to date. There is more to be done to ensure it produces wider benefits, particularly in relation to doctors who already perform well. PMID:28084166

Implementing medical revalidation in the United Kingdom: Findings about organisational changes and impacts from a survey of Responsible Officers.

PubMed

Walshe, Kieran; Boyd, Alan; Bryce, Marie; Luscombe, Kayleigh; Tazzyman, Abigail; Tredinnick-Rowe, John; Archer, Julian

2017-01-01

Objective To describe the implementation of medical revalidation in healthcare organisations in the United Kingdom and to examine reported changes and impacts on the quality of care. Design A cross-sectional online survey gathering both quantitative and qualitative data about structures and processes for medical revalidation and wider quality management in the organisations which employ or contract with doctors (termed 'designated bodies') from the senior doctor in each organisation with statutory responsibility for medical revalidation (termed the 'Responsible Officer'). Setting United Kingdom Participants Responsible Officers in designated bodies in the United Kingdom. Five hundred and ninety-five survey invitations were sent and 374 completed surveys were returned (63%). Main outcome measures The role of Responsible Officers, the development of organisational mechanisms for quality assurance or improvement, decision-making on revalidation recommendations, impact of revalidation and mechanisms for quality assurance or improvement on clinical practice and suggested improvements to revalidation arrangements. Results Responsible Officers report that revalidation has had some impacts on the way medical performance is assured and improved, particularly strengthening appraisal and oversight of quality within organisations and having some impact on clinical practice. They suggest changes to make revalidation less 'one size fits all' and more responsive to individual, organisational and professional contexts. Conclusions Revalidation appears primarily to have improved systems for quality improvement and the management of poor performance to date. There is more to be done to ensure it produces wider benefits, particularly in relation to doctors who already perform well.

Pain management: a review of organisation models with integrated processes for the management of pain in adult cancer patients.

PubMed

Brink-Huis, Anita; van Achterberg, Theo; Schoonhoven, Lisette

2008-08-01

This paper reports a review of the literature conducted to identify organisation models in cancer pain management that contain integrated care processes and describe their effectiveness. Pain is experienced by 30-50% of cancer patients receiving treatment and by 70-90% of those with advanced disease. Efforts to improve pain management have been made through the development and dissemination of clinical guidelines. Early improvements in pain management were focussed on just one or two single processes such as pain assessment and patient education. Little is known about organisational models with multiple integrated processes throughout the course of the disease trajectory and concerning all stages of the care process. Systematic review. The review involved a systematic search of the literature, published between 1986-2006. Subject-specific keywords used to describe patients, disease, pain management interventions and integrated care processes, relevant for this review were selected using the thesaurus of the databases. Institutional models, clinical pathways and consultation services are three alternative models for the integration of care processes in cancer pain management. A clinical pathway is a comprehensive institutionalisation model, whereas a pain consultation service is a 'stand-alone' model that can be integrated in a clinical pathway. Positive patient and process outcomes have been described for all three models, although the level of evidence is generally low. Evaluation of the quality of pain management must involve standardised measurements of both patient and process outcomes. We recommend the development of policies for referrals to a pain consultation service. These policies can be integrated within a clinical pathway. To evaluate the effectiveness of pain management models standardised outcome measures are needed.

Efficiency improvement of technological preparation of power equipment manufacturing

NASA Astrophysics Data System (ADS)

Milukov, I. A.; Rogalev, A. N.; Sokolov, V. P.; Shevchenko, I. V.

2017-11-01

Competitiveness of power equipment primarily depends on speeding-up the development and mastering of new equipment samples and technologies, enhancement of organisation and management of design, manufacturing and operation. Actual political, technological and economic conditions cause the acute need in changing the strategy and tactics of process planning. At that the issues of maintenance of equipment with simultaneous improvement of its efficiency and compatibility to domestically produced components are considering. In order to solve these problems, using the systems of computer-aided process planning for process design at all stages of power equipment life cycle is economically viable. Computer-aided process planning is developed for the purpose of improvement of process planning by using mathematical methods and optimisation of design and management processes on the basis of CALS technologies, which allows for simultaneous process design, process planning organisation and management based on mathematical and physical modelling of interrelated design objects and production system. An integration of computer-aided systems providing the interaction of informative and material processes at all stages of product life cycle is proposed as effective solution to the challenges in new equipment design and process planning.

Managing change in health care institutions. The Austin experience 1973-1983.

PubMed

Price, I

1984-01-01

This article is written by Ian Price who was engaged as a consultant by the Austin Hospital in 1973 to conduct an organisation study. The result of his work was to establish a divisional organisation which integrated the University of Melbourne into the hospital management structure. His work set in train an extensive organisational development program which has become widely known and regarded in the hospital field. After an absence of nine years Ian Price has taken up an appointment with the Austin an Executive Assistant to the General Manager. This article summarises the process which he adopted and the rationale for the changes which were implemented. The article also presents a brief resume of these changes ten years on.

Contribution of physician assistants/associates to secondary care: a systematic review.

PubMed

Halter, Mary; Wheeler, Carly; Pelone, Ferruccio; Gage, Heather; de Lusignan, Simon; Parle, Jim; Grant, Robert; Gabe, Jonathan; Nice, Laura; Drennan, Vari M

2018-06-19

To appraise and synthesise research on the impact of physician assistants/associates (PA) in secondary care, specifically acute internal medicine, care of the elderly, emergency medicine, trauma and orthopaedics, and mental health. Systematic review. Electronic databases (Medline, Embase, ASSIA, CINAHL, SCOPUS, PsycINFO, Social Policy and Practice, EconLit and Cochrane), reference lists and related articles. Peer-reviewed articles of any study design, published in English, 1995-2017. Blinded parallel processes were used to screen abstracts and full text, data extractions and quality assessments against published guidelines. A narrative synthesis was undertaken. Impact on: patients' experiences and outcomes, service organisation, working practices, other professional groups and costs. 5472 references were identified and 161 read in full; 16 were included-emergency medicine (7), trauma and orthopaedics (6), acute internal medicine (2), mental health (1) and care of the elderly (0). All studies were observational, with variable methodological quality. In emergency medicine and in trauma and orthopaedics, when PAs are added to teams, reduced waiting and process times, lower charges, equivalent readmission rate and good acceptability to staff and patients are reported. Analgesia prescribing, operative complications and mortality outcomes were variable. In internal medicine outcomes of care provided by PAs and doctors were equivalent. PAs have been deployed to increase the capacity of a team, enabling gains in waiting time, throughput, continuity and medical cover. When PAs were compared with medical staff, reassuringly there was little or no negative effect on health outcomes or cost. The difficulty of attributing cause and effect in complex systems where work is organised in teams is highlighted. Further rigorous evaluation is required to address the complexity of the PA role, reporting on more than one setting, and including comparison between PAs and roles for which they are substituting. CRD42016032895. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Managing crises through organisational development: a conceptual framework.

PubMed

Lalonde, Carole

2011-04-01

This paper presents a synthesis of the guiding principles in crisis management in accordance with the four configurational imperatives (strategy, structure, leadership and environment) defined by Miller (1987) and outlines interventions in organisational development (OD) that may contribute to their achievement. The aim is to build a conceptual framework at the intersection of these two fields that could help to strengthen the resilient capabilities of individuals, organisations and communities to face crises. This incursion into the field of OD--to generate more efficient configurations of practices in crisis management--seems particularly fruitful considering the system-wide application of OD, based on open-systems theory (Burke, 2008). Various interventions proposed by OD in terms of human processes, structural designs and human resource management, as well as strategy, may help leaders, members of organisations and civil society apply effectively, and in a more sustainable way, the crisis management guiding principles defined by researchers. © 2011 The Author(s). Disasters © Overseas Development Institute, 2011.

Stakeholder Expectations of Service Quality in a University Web Portal

NASA Astrophysics Data System (ADS)

Tate, Mary; Evermann, Joerg; Hope, Beverley; Barnes, Stuart

Online service quality is a much-studied concept. There is considerable evidence that user expectations and perceptions of self-service and online service quality differ in different business domains. In addition, the nature of online services is continually changing and universities have been at the forefront of this change, with university websites increasingly acting as a portal for a wide range of online transactions for a wide range of stakeholders. In this qualitative study, we conduct focus groups with a range of stakeholders in a university web portal. Our study offers a number of insights into the changing nature of the relationship between organisations and customers. New technologies are influencing customer expectations. Customers increasingly expect organisations to have integrated information systems, and to utilise new technologies such as SMS and web portals. Organisations can be slow to adopt a customer-centric viewpoint, and persist in providing interfaces that are inconsistent or require inside knowledge of organisational structures and processes. This has a negative effect on customer perceptions.

Who should be doing what in the international health: a confusion of mandates in the United Nations?

PubMed Central

Lee, K.; Collinson, S.; Walt, G.; Gilson, L.

1996-01-01

Since 1945 at least five United Nations organisations have become substantially involved in international health activities. This has led to considerable confusion among policy makers, scholars, and UN staff over distinct and appropriate mandates. Interviews with staff an a historical analysis have shown that while formal mandates have been complementary, effective mandates have led to an unclear delineation of activities. The process of translating formal into effective mandates have been influenced by the decentralised nature of the UN, lack of a master plan for its activities, the considerable growth in the policy agenda and the shift towards a multisectoral approach to health. The identification of each organisation's comparative advantage, at both the global and country levels, is one way of understanding what each organisation does best and perhaps should be doing. There is a need for improved mechanisms to define effective mandates, taking into account comparative advantages, if the mandates of UN organisations are appropriate to meet future challenges in international health. PMID:8611793

Management of change in health care organisations and human resource role.

PubMed

Carignani, V

2000-01-01

The paper is focused on the analysis of the most relevant factors necessary to manage change in health care organisations. The approach suggested is the Stakeholder one. According to this approach, the hospital's managers seem to be successful if they are able to satisfy people (internal and external stakeholders) that have a stake in the health care institution. The attention of the author is mainly focused on the internal forces that make the health care sector competitive and successful. In order to motivate internal human resources to accept change and to achieve the organisational targets two main methods can be suggested. The former is based on tangible variables and in particular on a fair reward system; the latter is built on intangible elements e.g. communication, negotiation, contracting, and organisational values sharing. Moreover, in order to cope with change it is important to develop the information technology management and to reengineer delivery processes, taking into consideration both the costs and benefits of these kinds of innovations.

High performance work systems: the gap between policy and practice in health care reform.

PubMed

Leggat, Sandra G; Bartram, Timothy; Stanton, Pauline

2011-01-01

Studies of high-performing organisations have consistently reported a positive relationship between high performance work systems (HPWS) and performance outcomes. Although many of these studies have been conducted in manufacturing, similar findings of a positive correlation between aspects of HPWS and improved care delivery and patient outcomes have been reported in international health care studies. The purpose of this paper is to bring together the results from a series of studies conducted within Australian health care organisations. First, the authors seek to demonstrate the link found between high performance work systems and organisational performance, including the perceived quality of patient care. Second, the paper aims to show that the hospitals studied do not have the necessary aspects of HPWS in place and that there has been little consideration of HPWS in health system reform. The paper draws on a series of correlation studies using survey data from hospitals in Australia, supplemented by qualitative data collection and analysis. To demonstrate the link between HPWS and perceived quality of care delivery the authors conducted regression analysis with tests of mediation and moderation to analyse survey responses of 201 nurses in a large regional Australian health service and explored HRM and HPWS in detail in three casestudy organisations. To achieve the second aim, the authors surveyed human resource and other senior managers in all Victorian health sector organisations and reviewed policy documents related to health system reform planned for Australia. The findings suggest that there is a relationship between HPWS and the perceived quality of care that is mediated by human resource management (HRM) outcomes, such as psychological empowerment. It is also found that health care organisations in Australia generally do not have the necessary aspects of HPWS in place, creating a policy and practice gap. Although the chief executive officers of health service organisations reported high levels of strategic HRM, the human resource and other managers reported a distinct lack of HPWS from their perspectives. The authors discuss why health care organisations may have difficulty in achieving HPWS. Leaders in health care organisations should focus on ensuring human resource management systems, structures and processes that support HPWS. Policy makers need to consider HPWS as a necessary component of health system reform. There is a strong need to reorient organisational human resource management policies and procedures in public health care organisations towards high performing work systems.

Mental health service delivery: a profile of mental health non-government organisations in south-east Queensland, Australia.

PubMed

Byrne, Louise; Wilson, Michael; Burke, Karena J; Gaskin, Cadeyrn J; Happell, Brenda

2014-05-01

Non-government organisations make a substantial contribution to the provision of mental health services; despite this, there has been little research and evaluation targeted at understanding the role played by these services within the community mental health sector. The aim of the present study was to examine the depth and breadth of services offered by these organisations in south-east Queensland, Australia, across five key aspects of reach and delivery. Representatives from 52 purposively targeted non-government organisations providing mental health services to individuals with significant mental health challenges were interviewed regarding their approach to mental health service provision. The findings indicated a diverse pattern of service frameworks across the sector. The results also suggested a positive approach to the inclusion of consumer participation within the organisations, with most services reporting, at the very least, some form of consumer advocacy within their processes and as part of their services. This paper offers an important first look at the nature of non-government service provision within the mental health sector and highlights the importance of these organisations within the community sector. What is known about the topic? Non-government organisations make a substantial contribution to the multisectorial provision of services to mental health consumers in community settings. Non-government organisations in Australia are well established, with 79.9% of them being in operation for over 10 years. There is an increasing expectation that consumers influence the development, delivery and evaluation of mental health services, especially in the community sector. What does this paper add? This paper provides a profile of non-government organisations in one state in Australia with respect to the services they provide, the consumers they target, the practice frameworks they use, the use of peer workers and consumer participation, the success they have had with obtaining funding and the extent to which they collaborate with other services. What are the implications for practitioners? This paper provides readers with an understanding of the non-government organisations and the services they provide to people with mental health conditions. In addition, the findings provide an opportunity to learn from the experience of non-government organisations in implementing consumer participation initiatives.

Whistleblowing Need not Occur if Internal Voices Are Heard: From Deaf Effect to Hearer Courage

PubMed Central

Cleary, Sonja R.; Doyle, Kerrie E.

2016-01-01

Whistleblowing by health professionals is an infrequent and extraordinary event and need not occur if internal voices are heard. Mannion and Davies’ editorial on "Cultures of Silence and Cultures of Voice: The Role of Whistleblowing in Healthcare Organisations" asks the question whether whistleblowing ameliorates or exacerbates the ‘deaf effect’ prevalent in healthcare organisations. This commentary argues that the focus should remain on internal processes and hearer courage . PMID:26673652

Protocol for a mixed methods study of hospital readmissions: sensemaking in Veterans Health Administration healthcare system in the USA

PubMed Central

Leykum, Luci K; Noël, Polly; Finley, Erin P; Lanham, Holly Jordan; Pugh, Jacqueline

2018-01-01

Introduction Effective delivery of healthcare in complex systems requires managing interdependencies between professions and organisational units. Reducing 30-day hospital readmissions may be one of the most complex tasks that a healthcare system can undertake. We propose that these less than optimal outcomes are related to difficulties managing the complex interdependencies among organisational units and to a lack of effective sensemaking among individuals and organisational units regarding how best to coordinate patient needs. Methods and analysis This is a mixed method, multistepped study. We will conduct in-depth qualitative organisational case studies in 10 Veterans Health Administration facilities (6 with improving and 4 with worsening readmission rates), focusing on relationships, sensemaking and improvisation around care transition processes intended to reduce early readmissions. Data will be gathered through multiple methods (eg, chart reviews, surveys, interviews, observations) and analysed using analytic memos, qualitative coding and statistical analyses. We will construct an agent-based model based on those results to explore the influence of sensemaking and specific care transition processes on early readmissions. Ethics and dissemination Ethical approval has been obtained through the Institutional Review Board of the University of Texas Health Science Center at San Antonio (approval number: 14–258 hour). We will disseminate our findings in manuscripts in peer-reviewed journals, professional conferences and through short reports back to participating entities and stakeholders. PMID:29627815

Describing the organisational culture of a selection of community pharmacies using a tool borrowed from social science.

PubMed

Scahill, Shane; Harrison, Jeff; Carswell, Peter

2010-02-01

To describe the dimensions of organisational culture within a selection of community pharmacies. Community pharmacy in the New Zealand primary care sector which is partially government funded and currently undergoing major reform. Community pharmacy is under pressure to take on new roles, integrate within the wider primary care team and deliver the expectations of contemporary health policy. The mixed methods approach of concept mapping was undertaken with 10 representatives from six community pharmacies selected as case sites. The process was split into three parts (a) face to face brainstorming to generate statements describing culture, followed by (b) statement reduction, piloting and approval of statement list by participants, followed by (c) sorting the statements into 'like' groups. Multidimensional scaling analysis of participant sorting allows the development of discrete clusters of statements that describe aspects of organizational culture. A set of 105 statements were generated at the brainstorming meeting. Eight clusters of organisational culture resulted from participant sorting: leadership and staff management; valuing each other and the team; free thinking, fun and open to challenge; trusted behaviour; customer relations; focus on external integration; providing systematic advice; embracing innovation. Community pharmacy is under pressure to take on new roles and deliver and there is some evidence organisational culture of pharmacy may be a barrier. Our paper outlines the development of a survey instrument for describing organisational culture through Concept mapping, a tool borrowed from social sciences. This tool can be used for exploration of aspects of culture that may be important in the change management process for improving the effectiveness of community pharmacy as expected by contemporary primary health care policy.

Community empowerment and involvement of female sex workers in targeted sexual and reproductive health interventions in Africa: a systematic review.

PubMed

Moore, Lizzie; Chersich, Matthew F; Steen, Richard; Reza-Paul, Sushena; Dhana, Ashar; Vuylsteke, Bea; Lafort, Yves; Scorgie, Fiona

2014-06-10

Female sex workers (FSWs) experience high levels of sexual and reproductive health (SRH) morbidity, violence and discrimination. Successful SRH interventions for FSWs in India and elsewhere have long prioritised community mobilisation and structural interventions, yet little is known about similar approaches in African settings. We systematically reviewed community empowerment processes within FSW SRH projects in Africa, and assessed them using a framework developed by Ashodaya, an Indian sex worker organisation. In November 2012 we searched Medline and Web of Science for studies of FSW health services in Africa, and consulted experts and websites of international organisations. Titles and abstracts were screened to identify studies describing relevant services, using a broad definition of empowerment. Data were extracted on service-delivery models and degree of FSW involvement, and analysed with reference to a four-stage framework developed by Ashodaya. This conceptualises community empowerment as progressing from (1) initial engagement with the sex worker community, to (2) community involvement in targeted activities, to (3) ownership, and finally, (4) sustainability of action beyond the community. Of 5413 articles screened, 129 were included, describing 42 projects. Targeted services in FSW 'hotspots' were generally isolated and limited in coverage and scope, mostly offering only free condoms and STI treatment. Many services were provided as part of research activities and offered via a clinic with associated community outreach. Empowerment processes were usually limited to peer-education (stage 2 of framework). Community mobilisation as an activity in its own right was rarely documented and while most projects successfully engaged communities, few progressed to involvement, community ownership or sustainability. Only a few interventions had evolved to facilitate collective action through formal democratic structures (stage 3). These reported improved sexual negotiating power and community solidarity, and positive behavioural and clinical outcomes. Sustainability of many projects was weakened by disunity within transient communities, variable commitment of programmers, low human resource capacity and general resource limitations. Most FSW SRH projects in Africa implemented participatory processes consistent with only the earliest stages of community empowerment, although isolated projects demonstrate proof of concept for successful empowerment interventions in African settings.

The school environment and student health: a systematic review and meta-ethnography of qualitative research.

PubMed

Jamal, Farah; Fletcher, Adam; Harden, Angela; Wells, Helene; Thomas, James; Bonell, Chris

2013-09-03

There is increasing interest in promoting young people's health by modifying the school environment. However, existing research offers little guidance on how the school context enables or constrains students' health behaviours, or how students' backgrounds relate to these processes. For these reasons, this paper reports on a meta-ethnography of qualitative studies examining: through what processes does the school environment (social and physical) influence young people's health? Systematic review of qualitative studies. Sixteen databases were searched, eliciting 62,329 references which were screened, with included studies quality assessed, data extracted and synthesized using an adaptation of Noblit and Hare's meta-ethnographic approach. Nineteen qualitative studies were synthesised to explore processes through which school-level influences on young people's health might occur. Four over-arching meta-themes emerged across studies focused on a range of different health issues. First, aggressive behaviour and substance use are often a strong source of status and bonding at schools where students feel educationally marginalised or unsafe. Second, health-risk behaviours are concentrated in unsupervised 'hotspots' at the school. Third, positive relationships with teachers appear to be critical in promoting student wellbeing and limiting risk behaviour; however, certain aspects of schools' organisation and education policies constrain this, increasing the likelihood that students look for a sense of identity and social support via health-risk behaviours. Fourth, unhappiness at school can cause students to seek sources of 'escape', either by leaving school at lunchtime or for longer unauthorized spells or through substance use. These meta-themes resonate with Markham and Aveyard's theory of human functioning and school organisation, and we draw on these qualitative data to refine and extend this theory, in particular conceptualising more fully the role of young people's agency and student-led 'systems' in constituting school environments and generating health risks. Institutional features which may shape student health behaviours such as lack of safety, poor student-staff relationships and lack of student voice are amenable to interventions and should be the subject of future investigation. Future qualitative research should focus on health behaviours which are under-theorised in this context such as physical activity, sexual and mental health.

Community empowerment and involvement of female sex workers in targeted sexual and reproductive health interventions in Africa: a systematic review

PubMed Central

2014-01-01

Background Female sex workers (FSWs) experience high levels of sexual and reproductive health (SRH) morbidity, violence and discrimination. Successful SRH interventions for FSWs in India and elsewhere have long prioritised community mobilisation and structural interventions, yet little is known about similar approaches in African settings. We systematically reviewed community empowerment processes within FSW SRH projects in Africa, and assessed them using a framework developed by Ashodaya, an Indian sex worker organisation. Methods In November 2012 we searched Medline and Web of Science for studies of FSW health services in Africa, and consulted experts and websites of international organisations. Titles and abstracts were screened to identify studies describing relevant services, using a broad definition of empowerment. Data were extracted on service-delivery models and degree of FSW involvement, and analysed with reference to a four-stage framework developed by Ashodaya. This conceptualises community empowerment as progressing from (1) initial engagement with the sex worker community, to (2) community involvement in targeted activities, to (3) ownership, and finally, (4) sustainability of action beyond the community. Results Of 5413 articles screened, 129 were included, describing 42 projects. Targeted services in FSW ‘hotspots’ were generally isolated and limited in coverage and scope, mostly offering only free condoms and STI treatment. Many services were provided as part of research activities and offered via a clinic with associated community outreach. Empowerment processes were usually limited to peer-education (stage 2 of framework). Community mobilisation as an activity in its own right was rarely documented and while most projects successfully engaged communities, few progressed to involvement, community ownership or sustainability. Only a few interventions had evolved to facilitate collective action through formal democratic structures (stage 3). These reported improved sexual negotiating power and community solidarity, and positive behavioural and clinical outcomes. Sustainability of many projects was weakened by disunity within transient communities, variable commitment of programmers, low human resource capacity and general resource limitations. Conclusions Most FSW SRH projects in Africa implemented participatory processes consistent with only the earliest stages of community empowerment, although isolated projects demonstrate proof of concept for successful empowerment interventions in African settings. PMID:24916108

Medical revalidation as professional regulatory reform: Challenging the power of enforceable trust in the United Kingdom.

PubMed

Spendlove, Zoey

2018-05-01

For more than two decades, international healthcare crises and ensuing political debates have led to increasing professional governance and regulatory policy reform. Governance and policy reforms, commonly representing a shift from embodied trust in professionals to state enforceable trust, have challenged professional power and self-regulatory privileges. However, controversy remains as to whether such policies do actually shift the balance of power and what the resulting effects of policy introduction would be. This paper explores the roll-out and operationalisation of revalidation as medical regulatory reform within a United Kingdom National Health Service hospital from 2012 to 2013, and its impact upon professional power. Revalidation policy was subject to the existing governance and management structures of the organisation, resulting in the formal policy process being shaped at the local level. This paper explores how the disorganised nature of the organisation hindered rather than facilitated robust processes of professional governance and regulation, fostering formalistic rather than genuine professional engagement with the policy process. Formalistic engagement seemingly assisted the medical profession in retaining self-regulatory privileges whilst maintaining professional power over the policy process. The paper concludes by challenging the concept of state enforceable trust and the theorisation that professional groups are effectively regulated and controlled by means of national and organisational objectives, such as revalidation. Copyright © 2018 Elsevier Ltd. All rights reserved.

Economic and cultural correlates of subjective wellbeing in countries using data from the Organisation for Economic Co-Operation and Development (OECD).

PubMed

Gaygisiz, Esma

2010-06-01

The correlations among indicators of objective well-being, cultural dimensions, and subjective well-being were investigated using Organisation for Economic Co-operation and Development (OECD) data from 35 countries. The subjective well-being measures included life satisfaction as well as six positive and six negative indexes of experience. Positive and negative experience scores were subjected to principal component analysis, and two positive experience components (labeled as "positive experiences" and "time management") and two negative experience components (labeled as "pain, worry, and sadness" and "anger and boredom") were extracted. Objective well-being included economic indicators, education, and health. The cultural variables included Hofstede's and Schwartz's cultural dimensions, national Big Five personality scores, and national IQs. High life satisfaction was positively related to Gross Domestic Product, life expectancy, education, individualism, affective and intellectual autonomy, egalitarianism, and conscientiousness, whereas low life satisfaction was related to unemployment, unequal income distribution, power distance, masculinity uncertainty avoidance, embeddedness, hierarchy, and neuroticism.

A systematic review of Registered Nurses; experiences of the influence of workplace culture and climatic factors on nursing workloads.

PubMed

Ross-Walker, Cheryl; Rogers-Clark, Cath; Pearce, Susanne

Nursing workload is an issue that effects both the recruitment and retention of nurses, and patient safety. Historically, measurement has focussed on the delivery of direct patient care and excluded workload of facilitating hands-on care and supporting the organisation via duties that reflect organisation cultural and climate needs. Qualitative research is appropriate to understand this complexity. To determine the best available evidence in relation to registered nurses experiences of workplace cultural and climatic factors that influence nursing workloads, in an acute health care setting. This review sought high quality studies which explored registered nurses' experiences of the influence of cultural and climatic factors on their workloads. Qualitative research studies and opinion-based text were considered. An extensive search of the literature was conducted to identify published and unpublished studies between January 1990 and June 2011 in English, and indexed in the following databases: CINAHL, Medline, Medline-In Process, PsychINFO, Emerald, Current Contents, TRIP, JSTOR Nursing Consult Psychology & Behavioural Sciences collections, Emerald Management Reviews, Emerald Full Text Journals, Embase, Dissertation Abstracts, ERIC, Proquest and MedNar, EBSCOhost, Science Direct, Wiley Interscience. Two independent reviewers (CRW and CRC), using appraisal tools from the Joanna Briggs Institute (JBI), assessed fifteen articles; one was excluded. Data were extracted from included papers using standardised tools developed by the JBI. Data from qualitative studies and textual/opinion papers were meta-synthesised separately using standardised instruments. Data synthesis involved the pooling of findings, then grouped into categories on the basis of similarity of meaning. The categories were further aggregated into synthesised findings. 14 papers were identified as high quality and meeting the inclusion criteria. 81 findings were identified from the 10 qualitative research papers and 39 conclusions from the 4 text/ opinion papers. While the research and non research evidence was analysed separately, both sets of evidence gave the same synthesised findings. The qualitative research findings were grouped into eight categories and textual data into six categories; all textual categories were also identified in the qualitative synthesis. These categories were aggregated into two synthesised findings. Nursing workloads are influenced by the largely immeasurable cultural factors within hospital environments. These factors signify 'how we do things around here'. Organisational climate influences nursing workloads because of inter-professional relationships, clinical governance, workplace support, non-nursing duties, organisational structure and organisation, work redesign, workflow and diversity within nursing roles. The component of registered nurses' workloads that are not patient-care should be recognised. Reviewing nursing roles to remove unnecessary work unrelated to patient care would positively influence nursing workloads, giving time for cognitive workload and clinical education and mentorship. Further qualitative research should explore the complexity of clinical nurses' roles in a diversity of settings, to address the responsibilities that registered nurses routinely assume, but which do not involve direct patient care. New workload models, which capture the non-measurable aspects of a registered nurse's role, should be developed and evaluated.

Incorporating organisational safety culture within ergonomics practice.

PubMed

Bentley, Tim; Tappin, David

2010-10-01

This paper conceptualises organisational safety culture and considers its relevance to ergonomics practice. Issues discussed in the paper include the modest contribution that ergonomists and ergonomics as a discipline have made to this burgeoning field of study and the significance of safety culture to a systems approach. The relevance of safety culture to ergonomics work with regard to the analysis, design, implementation and evaluation process, and implications for participatory ergonomics approaches, are also discussed. A potential user-friendly, qualitative approach to assessing safety culture as part of ergonomics work is presented, based on a recently published conceptual framework that recognises the dynamic and multi-dimensional nature of safety culture. The paper concludes by considering the use of such an approach, where an understanding of different aspects of safety culture within an organisation is seen as important to the success of ergonomics projects. STATEMENT OF RELEVANCE: The relevance of safety culture to ergonomics practice is a key focus of this paper, including its relationship with the systems approach, participatory ergonomics and the ergonomics analysis, design, implementation and evaluation process. An approach to assessing safety culture as part of ergonomics work is presented.

Business continuity and risk management at a strategic level: Case study of the Flemish government.

PubMed

Bouve, Joris; Steens, Herman-Peter; Ruebens, Martin

2018-01-01

The Flemish government comprises a number of different departments and agencies with the autonomy to optimise their service level in a proactive and resilient manner. Recently, the Flemish government defined four organisational values: openness, decisiveness, trust and agility. In addition, the Internal Audit Agency developed guidelines concerning internal control and organisational management, in which risk management was emphasised. In combination with goal setting and process management, this paper considers risk management as a starting point for the overall management of Flemish government entities. The paper then develops tools to support the establishment of business continuity and risk management processes. These tools fit into the organisation's strategic framework and are easy to understand, pragmatically designed and flexible in their use. The paper goes on to illustrate how the Department of the Chancellery and Public Governance is implementing BCM and risk management, and how it is integrating BCM, risk management and crisis management. It will then focus on the Flemish government's long-term strategy across the boundaries between the different entities and the question of how risk management can become a useful tool for policy makers.

Creating knowledge structures in the pharmaceutical industry: the increasing significance of virtual organisation.

PubMed

Salazar, A; Howells, J

2000-01-01

This paper explores the specific trend and challenges facing the pharmaceutical industry regarding the exploitation of Internet e-commerce technology and virtual organisation to develop and maintain competitive advantage. There are two important facets of the current trend. One is the rapid development of a complex network of alliances between the established pharmaceutical companies and the specialised biotechnology company start-ups. The other is the rapid growth of internet e-commerce companies dedicated to developing specialised technological platforms for acquiring and selling genetic and biochemical knowledge. The underlying challenge is how big pharmaceutical companies can emulate some of the innovation processes of smaller biotechnology company start-ups, and how they can appropriate and applied new technological knowledge on the development of new drugs. Pharmaceutical companies in order to retain competitive advantage need to continuously monitor all aspects of knowledge management with regard to the R&D and manufacturing process (as well as customer management and marketing). Technological change and organisational restructuring should be aimed at boosting the capacity of large firms to innovate rapidly.

Political experiences of changing the focus in elderly care in one municipality.

PubMed

Evertsson, Paula; Rosengren, Kristina

2015-11-01

To describe local politicians' experiences of an ongoing planning process for elderly care for the future in a medium-sized municipality in western Sweden. Elderly care is facing challenges because of an ageing population. The study comprised a total of eight semi-structured interviews with politicians. The interviews were analysed using manifest qualitative content analysis. One category (political consensus) and three subcategories (involvement generates security, trust in change management and confidence to create visions) were identified. Political consensus across elderly care organisations could establish a sense of security for old people, their relatives and the staff in particular. Continuous information and support from different managerial levels is one way of implementing changes within large organisations. However, further research is needed to describe how to develop future elderly care. An ageing population requires cooperation across provider boundaries to further develop high-quality elderly care services. Nursing leadership during a change process is crucial to implement political decisions in care organisations. Furthermore, active marketing of the health care profession for elderly care is needed as well as new knowledge regarding old people. © 2014 John Wiley & Sons Ltd.

Calix

PubMed

Frkanec; Visnjevac; Kojic-Prodic; Zinic

2000-02-04

Chiral calix[4]arene derivatives with four O-(N-acetyl-PhgOMe), (1), (Phg denotes R-phenylglycine), or O-(N-acetyl-LeuOMe) (2) strands have been synthesised. Both compounds exist in chloroform in stable cone conformations with a noncovalently organised cavity at the lower rim that is formed by circular interstrand amidic hydrogen bonds. Such organisation affects both the selectivity and extraction/transport properties of 1 and 2 toward metal cations. Calix[4]arene derivatives with one OCH2COPhgOMe strand (3), two OCH2COPhgOMe strands (5) and with 1,3-OMe-2,4-(O-CH2COPhgOMe) substituents (4) at the lower rim have also been prepared. For 3, a conformation stabilised by a circular hydrogen-bond arrangement is found in chloroform, while 4 exists as a time-averaged C2 conformation with two intramolecular NH ...OCH3 hydrogen bonds. Compound 5 has a unique hydrogen-bonding motif in solution and in the solid state with two three-centred NH-.. O and two OH...O hydrogen bonds at the lower rim. This motif keeps 5 in the flattened cone conformation in chloroform. The X-ray structure analysis of 1 revealed a molecular structure with C2 symmetry; this structure is organised in infinite chains by intra- and intermolecular H bonds. The solid-state and solution structures of the [1-Na]ClO4 complex are identical, C4 symmetric cone conformations.

Surveys of current status in biomedical science grant review: funding organisations' and grant reviewers' perspectives

PubMed Central

2010-01-01

Background The objectives of this research were (a) to describe the current status of grant review for biomedical projects and programmes from the perspectives of international funding organisations and grant reviewers, and (b) to explore funders' interest in developing uniform requirements for grant review aimed at making the processes and practices of grant review more consistent, transparent, and user friendly. Methods A survey to a convenience sample of 57 international public and private organisations that give grants for biomedical research was conducted. Nine participating organisations then emailed a random sample of their external reviewers an invitation to participate in a second electronic survey. Results A total of 28 of 57 (49%) organisations in 19 countries responded. Organisations reported these problems as frequent or very frequent: declined review requests (16), late reports (10), administrative burden (7), difficulty finding new reviewers (4), and reviewers not following guidelines (4). The administrative burden of the process was reported to have increased over the past 5 years. In all, 17 organisations supported the idea of uniform requirements for conducting grant review and for formatting grant proposals. A total of 258/418 (62%) reviewers responded from 22 countries. Of those, 48% (123/258) said their institutions encouraged grant review, yet only 7% (17/258) were given protected time and 74% (192/258) received no academic recognition for this. Reviewers rated these factors as extremely or very important in deciding to review proposals: 51% (131/258) desire to support external fairness, 47% (120/258) professional duty, 46% (118/258) relevance of the proposal's topic, 43% (110/258) wanting to keep up to date, 40% (104/258) desire to avoid suppression of innovation. Only 16% (42/258) reported that guidance from funders was very clear. In all, 85% (220/258) had not been trained in grant review and 64% (166/258) wanted this. Conclusions Funders reported a growing workload of biomedical proposals that is getting harder to peer review. Just under half of grant reviewers take part for the good of science and professional development, but many report lack of academic and practical support and clear guidance. Around two-thirds of funders supported the development of uniform requirements for the format and peer review of proposals to help ease the current situation. PMID:20961441

Effects of organisational-level interventions at work on employees' health: a systematic review.

PubMed

Montano, Diego; Hoven, Hanno; Siegrist, Johannes

2014-02-08

Organisational-level workplace interventions are thought to produce more sustainable effects on the health of employees than interventions targeting individual behaviours. However, scientific evidence from intervention studies does not fully support this notion. It is therefore important to explore conditions of positive health effects by systematically reviewing available studies. We set out to evaluate the effectiveness of 39 health-related intervention studies targeting a variety of working conditions. Systematic review. Organisational-level workplace interventions aiming at improving employees' health were identified in electronic databases and manual searches. The appraisal of studies was adapted from the Cochrane Back Review Group guidelines. To improve comparability of the widely varying studies we classified the interventions according to the main approaches towards modifying working conditions. Based on this classification we applied a logistic regression model to estimate significant intervention effects. 39 intervention studies published between 1993 and 2012 were included. In terms of methodology the majority of interventions were of medium quality, and four studies only had a high level of evidence. About half of the studies (19) reported significant effects. There was a marginally significant probability of reporting effects among interventions targeting several organisational-level modifications simultaneously (Odds ratio (OR) 2.71; 95% CI 0.94-11.12), compared to those targeting one dimension only. Despite the heterogeneity of the 39 organisational-level workplace interventions underlying this review, we were able to compare their effects by applying broad classification categories. Success rates were higher among more comprehensive interventions tackling material, organisational and work-time related conditions simultaneously. To increase the number of successful organisational-level interventions in the future, commonly reported obstacles against the implementation process should be addressed in developing these studies.

Effects of organisational-level interventions at work on employees’ health: a systematic review

PubMed Central

2014-01-01

Background Organisational-level workplace interventions are thought to produce more sustainable effects on the health of employees than interventions targeting individual behaviours. However, scientific evidence from intervention studies does not fully support this notion. It is therefore important to explore conditions of positive health effects by systematically reviewing available studies. We set out to evaluate the effectiveness of 39 health-related intervention studies targeting a variety of working conditions. Methods Systematic review. Organisational-level workplace interventions aiming at improving employees’ health were identified in electronic databases and manual searches. The appraisal of studies was adapted from the Cochrane Back Review Group guidelines. To improve comparability of the widely varying studies we classified the interventions according to the main approaches towards modifying working conditions. Based on this classification we applied a logistic regression model to estimate significant intervention effects. Results 39 intervention studies published between 1993 and 2012 were included. In terms of methodology the majority of interventions were of medium quality, and four studies only had a high level of evidence. About half of the studies (19) reported significant effects. There was a marginally significant probability of reporting effects among interventions targeting several organisational-level modifications simultaneously (Odds ratio (OR) 2.71; 95% CI 0.94-11.12), compared to those targeting one dimension only. Conclusions Despite the heterogeneity of the 39 organisational-level workplace interventions underlying this review, we were able to compare their effects by applying broad classification categories. Success rates were higher among more comprehensive interventions tackling material, organisational and work-time related conditions simultaneously. To increase the number of successful organisational-level interventions in the future, commonly reported obstacles against the implementation process should be addressed in developing these studies. PMID:24507447

How to change organisational culture: Action research in a South African public sector primary care facility.

PubMed

Mash, Robert; De Sa, Angela; Christodoulou, Maria

2016-08-31

Organisational culture is a key factor in both patient and staff experience of the healthcare services. Patient satisfaction, staff engagement and performance are related to this experience. The department of health in the Western Cape espouses a values-based culture characterised by caring, competence, accountability, integrity, responsiveness and respect. However, transformation of the existing culture is required to achieve this vision. To explore how to transform the organisational culture in line with the desired values. Retreat Community Health Centre, Cape Town, South Africa. Participatory action research with the leadership engaged with action and reflection over a period of 18 months. Change in the organisational culture was measured at baseline and after 18 months by means of a cultural values assessment (CVA) survey. The three key leaders at the health centre also completed a 360-degree leadership values assessment (LVA) and had 6 months of coaching. Cultural entropy was reduced from 33 to 13% indicating significant transformation of organisational culture. The key driver of this transformation was change in the leadership style and functioning. Retreat health centre shifted from a culture that emphasised hierarchy, authority, command and control to one that established a greater sense of cohesion, shared vision, open communication, appreciation, respect, fairness and accountability. Transformation of organisational culture was possible through a participatory process that focused on the leadership style, communication and building relationships by means of CVA and feedback, 360-degree LVA, feedback and coaching and action learning in a co-operative inquiry group.

Does the engagement of clinicians and organisations in research improve healthcare performance: a three-stage review

PubMed Central

Boaz, Annette; Hanney, Stephen; Jones, Teresa; Soper, Bryony

2015-01-01

Objective There is a widely held assumption that engagement by clinicians and healthcare organisations in research improves healthcare performance at various levels, but little direct empirical evidence has previously been collated. The objective of this study was to address the question: Does research engagement (by clinicians and organisations) improve healthcare performance? Methods An hourglass-shaped review was developed, consisting of three stages: (1) a planning and mapping stage; (2) a focused review concentrating on the core question of whether or not research engagement improves healthcare performance; and (3) a wider (but less systematic) review of papers identified during the two earlier stages, focusing on mechanisms. Results Of the 33 papers included in the focused review, 28 identified improvements in health services performance. Seven out of these papers reported some improvement in health outcomes, with others reporting improved processes of care. The wider review demonstrated that mechanisms such as collaborative and action research can encourage some progress along the pathway from research engagement towards improved healthcare performance. Organisations that have deliberately integrated the research function into organisational structures demonstrate how research engagement can, among other factors, contribute to improved healthcare performance. Conclusions Current evidence suggests that there is an association between the engagement of individuals and healthcare organisations in research and improvements in healthcare performance. The mechanisms through which research engagement might improve healthcare performance overlap and rarely act in isolation, and their effectiveness often depends on the context in which they operate. PMID:26656023

Major transcriptome re-organisation and abrupt changes in signalling, cell cycle and chromatin regulation at neural differentiation in vivo.

PubMed

Olivera-Martinez, Isabel; Schurch, Nick; Li, Roman A; Song, Junfang; Halley, Pamela A; Das, Raman M; Burt, Dave W; Barton, Geoffrey J; Storey, Kate G

2014-08-01

Here, we exploit the spatial separation of temporal events of neural differentiation in the elongating chick body axis to provide the first analysis of transcriptome change in progressively more differentiated neural cell populations in vivo. Microarray data, validated against direct RNA sequencing, identified: (1) a gene cohort characteristic of the multi-potent stem zone epiblast, which contains neuro-mesodermal progenitors that progressively generate the spinal cord; (2) a major transcriptome re-organisation as cells then adopt a neural fate; and (3) increasing diversity as neural patterning and neuron production begin. Focussing on the transition from multi-potent to neural state cells, we capture changes in major signalling pathways, uncover novel Wnt and Notch signalling dynamics, and implicate new pathways (mevalonate pathway/steroid biogenesis and TGFβ). This analysis further predicts changes in cellular processes, cell cycle, RNA-processing and protein turnover as cells acquire neural fate. We show that these changes are conserved across species and provide biological evidence for reduced proteasome efficiency and a novel lengthening of S phase. This latter step may provide time for epigenetic events to mediate large-scale transcriptome re-organisation; consistent with this, we uncover simultaneous downregulation of major chromatin modifiers as the neural programme is established. We further demonstrate that transcription of one such gene, HDAC1, is dependent on FGF signalling, making a novel link between signals that control neural differentiation and transcription of a core regulator of chromatin organisation. Our work implicates new signalling pathways and dynamics, cellular processes and epigenetic modifiers in neural differentiation in vivo, identifying multiple new potential cellular and molecular mechanisms that direct differentiation. © 2014. Published by The Company of Biologists Ltd.

An Integrative Literature Review of Organisational Factors Associated with Admission and Discharge Delays in Critical Care

PubMed Central

Peltonen, Laura-Maria; McCallum, Louise; Siirala, Eriikka; Haataja, Marjaana; Lundgrén-Laine, Heljä; Salanterä, Sanna; Lin, Frances

2015-01-01

The literature shows that delayed admission to the intensive care unit (ICU) and discharge delays from the ICU are associated with increased adverse events and higher costs. Identifying factors related to delays will provide information to practice improvements, which contribute to better patient outcomes. The aim of this integrative review was to explore the incidence of patients' admission and discharge delays in critical care and to identify organisational factors associated with these delays. Seven studies were included. The major findings are as follows: (1) explanatory research about discharge delays is scarce and one study on admission delays was found, (2) delays are a common problem mostly due to organisational factors, occurring in 38% of admissions and 22–67% of discharges, and (3) redesigning care processes by improving information management and coordination between units and interdisciplinary teams could reduce discharge delays. In conclusion, patient outcomes can be improved through efficient and safe care processes. More exploratory research is needed to identify factors that contribute to admission and discharge delays to provide evidence for clinical practice improvements. Shortening delays requires an interdisciplinary and multifaceted approach to the whole patient flow process. Conclusions should be made with caution due to the limited number of articles included in this review. PMID:26558286

An assessment model for quality management

NASA Astrophysics Data System (ADS)

Völcker, Chr.; Cass, A.; Dorling, A.; Zilioli, P.; Secchi, P.

2002-07-01

SYNSPACE together with InterSPICE and Alenia Spazio is developing an assessment method to determine the capability of an organisation in the area of quality management. The method, sponsored by the European Space Agency (ESA), is called S9kS (SPiCE- 9000 for SPACE). S9kS is based on ISO 9001:2000 with additions from the quality standards issued by the European Committee for Space Standardization (ECSS) and ISO 15504 - Process Assessments. The result is a reference model that supports the expansion of the generic process assessment framework provided by ISO 15504 to nonsoftware areas. In order to be compliant with ISO 15504, requirements from ISO 9001 and ECSS-Q-20 and Q-20-09 have been turned into process definitions in terms of Purpose and Outcomes, supported by a list of detailed indicators such as Practices, Work Products and Work Product Characteristics. In coordination with this project, the capability dimension of ISO 15504 has been revised to be consistent with ISO 9001. As contributions from ISO 9001 and the space quality assurance standards are separable, the stripped down version S9k offers organisations in all industries an assessment model based solely on ISO 9001, and is therefore interesting to all organisations, which intend to improve their quality management system based on ISO 9001.

Developing Organisational Knowledge Management Initiatives: A Collaborative Research Approach

NASA Astrophysics Data System (ADS)

Linger, Henry

The articulation of the knowledge management (KM) concept has occurred in the context of a radical shift away from goods and services to an information- based economy (Porter and Millar, 1985; Drucker, 1993 Boisot 1995; Boisot 1998) The organisational response to this shift has been a move towards global enterprises with very flat structures that, in principle, enable enterprises to react rapidly to changes in their operating environments (Drucker, 1988; Scott Morton, 1991; Galliers and Baets, 1998). Organisations that operate in the information economy require an ability to generate, access and utilise the volumes of information that are now readily available without the constraint of media, geography or time (Boisot, 1995). A critical factor is the speed at which they are able to productively process such information.

Guidelines for drug donations.

PubMed Central

Hogerzeil, H. V.; Couper, M. R.; Gray, R.

1997-01-01

Drug donations are usually given in response to acute emergencies, but they can also be part of development aid. Donations may be given directly by governments, by non-governmental organisations, as corporate donations (direct or through private voluntary organisations), or as private donations to single health facilities. Although there are legitimate differences between these donations, basic rules should apply to them all. This common core of "good donation practice" is the basis for new guidelines which have recently been issued by the World Health Organisation after consultation with all relevant United Nations agencies, the Red Cross, and other major international agencies active in humanitarian emergency relief. This article summarises the need for such guidelines, the development process, the core principles, and the guidelines themselves and gives practical advice to recipients and donor agencies. PMID:9116555

Balancing Countervailing Processes at a Lithuanian University

ERIC Educational Resources Information Center

Leisyte, Liudvika; Vilkas, Mantas; Staniskiene, Egle; Zostautiene, Daiva

2017-01-01

Purpose: The purpose of this paper is to understand how the countervailing processes for enhancing academic excellence based on professional norms are balanced out with the market-oriented processes of standardisation and performance management in a university. Further, the authors aim to explore how and if organisational learning occurs in…

Indico central - events organisation, ergonomics and collaboration tools integration

NASA Astrophysics Data System (ADS)

Benito Gonzélez López, José; Ferreira, José Pedro; Baron, Thomas

2010-04-01

While the remote collaboration services at CERN slowly aggregate around the Indico event management software, its new version which is the result of a careful maturation process includes improvements which will set a new reference in its domain. The presentation will focus on the description of the new features of the tool, the user feedback process which resulted in a new record of usability. We will also describe the interactions with the worldwide community of users and server administrators and the impact this has had on our development process, as well as the tools set in place to streamline the work between the different collaborating sites. A last part will be dedicated to the use of Indico as a central hub for operating other local services around the event organisation (registration epayment, audiovisual recording, webcast, room booking, and videoconference support)

[Marketing approval and market surveillance of medical devices in Germany: Where does policy integration take place?].

PubMed

Lang, Achim

2014-01-01

Since 2011 new regulatory measures regarding medical devices have been set up with the aim to eliminate obstacles to innovations and to find more coordinated ways to marketing authorisation and market surveillance. This essay investigates whether these new and existing coordination mechanisms build up to a Joined-up Government approach. The analysis shows that the regulatory process should be adjusted along several dimensions. First, many organisations lack awareness regarding their stakeholders and focus solely on their immediate organisational activities. Second, the regulatory process (marketing authorisation and market surveillance) is too fragmented for an effective communication to take place. Finally, the underlying strategy process is an ad-hoc approach lacking continuity and continued involvement of, in particular, the responsible federal ministries. Copyright © 2013. Published by Elsevier GmbH.

Evidence mapping based on systematic reviews of therapeutic interventions for gastrointestinal stromal tumors (GIST).

PubMed

Ballesteros, Mónica; Montero, Nadia; López-Pousa, Antonio; Urrútia, Gerard; Solà, Ivan; Rada, Gabriel; Pardo-Hernandez, Hector; Bonfill, Xavier

2017-09-07

Gastrointestinal Stromal Tumours (GISTs) are the most common mesenchymal tumours. Currently, different pharmacological and surgical options are used to treat localised and metastatic GISTs, although this research field is broad and the body of evidence is scattered and expanding. Our objectives are to identify, describe and organise the current available evidence for GIST through an evidence mapping approach. We followed the methodology of Global Evidence Mapping (GEM). We searched Pubmed, EMBASE, The Cochrane Library and Epistemonikos in order to identify systematic reviews (SRs) with or without meta-analyses published between 1990 and March 2016. Two authors assessed eligibility and extracted data. Methodological quality of the included systematic reviews was assessed using AMSTAR. We organised the results according to identified PICO questions and presented the evidence map in tables and a bubble plot. A total of 17 SRs met eligibility criteria. These reviews included 66 individual studies, of which three quarters were either observational or uncontrolled clinical trials. Overall, the quality of the included SRs was moderate or high. In total, we extracted 14 PICO questions from them and the corresponding results mostly favoured the intervention arm. The most common type of study used to evaluate therapeutic interventions in GIST sarcomas has been non-experimental studies. However, the majority of the interventions are reported as beneficial or probably beneficial by the respective authors of SRs. The evidence mapping is a useful and reliable methodology to identify and present the existing evidence about therapeutic interventions.

‘Act on Oncology’ as a New Comprehensive Approach to Assess Prostate Cancer Centres – Method Description and Results of a Pilot Study

PubMed Central

Voigt, Wieland; Hoellthaler, Josef; Magnani, Tiziana; Corrao, Vito; Valdagni, Riccardo

2014-01-01

Background Multidisciplinary care of prostate cancer is increasingly offered in specialised cancer centres. It requires the optimisation of medical and operational processes and the integration of the different medical and non-medical stakeholders. Objective To develop a standardised operational process assessment tool basing on the capability maturity model integration (CMMI) able to implement multidisciplinary care and improve process quality and efficiency. Design, Setting, and Participants Information for model development was derived from medical experts, clinical guidelines, best practice elements of renowned cancer centres, and scientific literature. Data were organised in a hierarchically structured model, consisting of 5 categories, 30 key process areas, 172 requirements, and more than 1500 criteria. Compliance with requirements was assessed through structured on-site surveys covering all relevant clinical and management processes. Comparison with best practice standards allowed to recommend improvements. ‘Act On Oncology’(AoO) was applied in a pilot study on a prostate cancer unit in Europe. Results and Limitations Several best practice elements such as multidisciplinary clinics or advanced organisational measures for patient scheduling were observed. Substantial opportunities were found in other areas such as centre management and infrastructure. As first improvements the evaluated centre administration described and formalised the organisation of the prostate cancer unit with defined personnel assignments and clinical activities and a formal agreement is being worked on to have structured access to First-Aid Posts. Conclusions In the pilot study, the AoO approach was feasible to identify opportunities for process improvements. Measures were derived that might increase the operational process quality and efficiency. PMID:25192213

Does it matter who organises your health care?

PubMed Central

Dawda, Paresh; McRae, Ian S; Yen, Laurann; Islam, Md Mofizul; Bagheri, Nasser; Jowsey, Tanisha; Banfield, Michelle; Parkinson, Anne

2015-01-01

Background As the prevalence of long-term and multimorbid conditions is increasing, patients increasingly require consultations with multiple health care professionals and coordination of their care needs. Methods This study is based on a 2011 survey of older Australians which draws on sub-populations of people with diabetes aged 50 years or over, people with chronic obstructive pulmonary disease, and members of Nationals Seniors Australia. We develop a composite coordination measure and examine differences in the measure with different care coordination indicators using both descriptive and regression methods. Three categories of respondent-perceived care organisers are used: health care professionals; “no one”; and patients, their partner, relative or friend. Results Of the 2,540 survey respondents (an overall response rate of 24%), 1,865 provided information on who organised their health care, and composite coordination measures were calculated for 1,614. Multivariate analysis showed the composite score was highest where a health care professional coordinated care, followed by care organised by self or a carer, and then the group reporting no organiser. Conclusion In moving towards care coordination there are opportunities to improve the care coordination process itself, and the key enablers to improving care coordination appear to be the availability and communication of clinical information and the role of the clinical team. PMID:26150760

Coaching as a Developmental Intervention in Organisations: A Systematic Review of Its Effectiveness and the Mechanisms Underlying It

PubMed Central

Grover, Simmy; Furnham, Adrian

2016-01-01

Purpose The primary aim of this paper is to conduct a thorough and systematic review of the empirical and practitioner research on executive, leadership and business coaching to assess the current empirical evidence for the effectiveness of coaching and the mechanisms underlying it. Background Organisations are increasingly using business coaching as an intervention to improve the productivity and performance of their senior personnel. A consequence of this increased application is the demand for empirical data to understand the process by which it operates and its demonstrable efficacy in achieving pre-set goals. Method This paper is a systematic review of the academic and practitioner literature pertaining to the effectiveness of business and executive coaching as a developmental intervention for organisations. It focuses on published articles, conference papers and theses that cover business, leadership or executive coaching within organisations over the last 10 years. Conclusions The main findings show that coaching is an effective tool that benefits organisations and a number of underlying facets contribute to this effectiveness. However, there is deficiency and scope for further investigation in key aspects of the academic research and we identify several areas that need further research and practitioner attention. ​ PMID:27416061

Predictors of Workplace Bullying and Cyber-Bullying in New Zealand

PubMed Central

Gardner, Dianne; O’Driscoll, Michael; Cooper-Thomas, Helena D.; Roche, Maree; Bentley, Tim; Catley, Bevan; Teo, Stephen T. T.; Trenberth, Linda

2016-01-01

Background: The negative effects of in-person workplace bullying (WB) are well established. Less is known about cyber-bullying (CB), in which negative behaviours are mediated by technology. Drawing on the conservation of resources theory, the current research examined how individual and organisational factors were related to WB and CB at two time points three months apart. Methods: Data were collected by means of an online self-report survey. Eight hundred and twenty-six respondents (58% female, 42% male) provided data at both time points. Results: One hundred and twenty-three (15%) of participants had been bullied and 23 (2.8%) of participants had been cyber-bullied within the last six months. Women reported more WB, but not more CB, than men. Worse physical health, higher strain, more destructive leadership, more team conflict and less effective organisational strategies were associated with more WB. Managerial employees experienced more CB than non-managerial employees. Poor physical health, less organisational support and less effective organisational strategies were associated with more CB. Conclusion: Rates of CB were lower than those of WB, and very few participants reported experiencing CB without also experiencing WB. Both forms of bullying were associated with poorer work environments, indicating that, where bullying is occurring, the focus should be on organisational systems and processes. PMID:27128929

Predictors of Workplace Bullying and Cyber-Bullying in New Zealand.

PubMed

Gardner, Dianne; O'Driscoll, Michael; Cooper-Thomas, Helena D; Roche, Maree; Bentley, Tim; Catley, Bevan; Teo, Stephen T T; Trenberth, Linda

2016-04-27

The negative effects of in-person workplace bullying (WB) are well established. Less is known about cyber-bullying (CB), in which negative behaviours are mediated by technology. Drawing on the conservation of resources theory, the current research examined how individual and organisational factors were related to WB and CB at two time points three months apart. Data were collected by means of an online self-report survey. Eight hundred and twenty-six respondents (58% female, 42% male) provided data at both time points. One hundred and twenty-three (15%) of participants had been bullied and 23 (2.8%) of participants had been cyber-bullied within the last six months. Women reported more WB, but not more CB, than men. Worse physical health, higher strain, more destructive leadership, more team conflict and less effective organisational strategies were associated with more WB. Managerial employees experienced more CB than non-managerial employees. Poor physical health, less organisational support and less effective organisational strategies were associated with more CB. Rates of CB were lower than those of WB, and very few participants reported experiencing CB without also experiencing WB. Both forms of bullying were associated with poorer work environments, indicating that, where bullying is occurring, the focus should be on organisational systems and processes.

An integrated health and social care organisation in Sweden: creation and structure of a unique local public health and social care system.

PubMed

Øvretveit, John; Hansson, Johan; Brommels, Mats

2010-10-01

Research and citizens have noted failures in coordinating health and social services and professionals, and the need to address this issue to realize benefits from increasing specialisation. Different methods have been proposed and one has been structural integration of separate services within one organisation. This paper reports an empirical longitudinal study of the development of an integrated health and social care organisation in Sweden combining service provision, purchasing and political governance for a defined population. The study found a combination of influences contributed to the development of this new organisation. The initial structural macro-integration facilitated, but did not of itself result in better clinical care coordination. Other actions were needed to modify the specialised systems and cultures which the organisation inherited. The study design was not able to establish with any degree of certainty whether better patient and cost outcomes resulted, but it did find structural and process changes which make improved outcomes likely. The study concludes that coordinated actions at different levels and of different types were needed to achieve care coordination for patients and that a phased approach was necessary where management capacity and outside expertise are limited. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

Obstacles to TQM success in health care systems.

PubMed

Mosadeghrad, Ali Mohammad

2013-01-01

Many healthcare organisations have found it difficult to implement total quality management (TQM) successfully. The aim of this paper is to explore the barriers to TQM successful implementation in the healthcare sector. This paper reports a literature review exploring the major reasons for the failure of TQM programmes in healthcare organisations. TQM implementation and its impact depend heavily on the ability of managers to adopt and adapt its values and concepts in professional healthcare organisations. Unsuccessful TQM efforts in healthcare organisations can be attributed to the strongly departmentalised, bureaucratic and hierarchical structure, professional autonomy, tensions between managers and professionals and the difficulties involved in evaluating healthcare processes and outcomes. Other obstacles to TQM success include lack of consistent managers' and employees' commitment to and involvement in TQM implementation, poor leadership and management, lack of a quality-oriented culture, insufficient training, and inadequate resources. The review was limited to empirical articles written in the English language during the past 30 years (1980-2010). The findings of this article provide policy makers and managers with a practical understanding of the factors that are likely to obstruct TQM implementation in the healthcare sector. Understanding the factors that obstruct TQM implementation would enable managers to develop more effective strategies for implementing TQM successfully in healthcare organisations.

Patenting of university and non-university public research organisations in Germany: evidence from patent applications for medical research results.

PubMed

Tinnemann, Peter; Ozbay, Jonas; Saint, Victoria A; Willich, Stefan N

2010-11-18

Patents are one of the most important forms of intellectual property. They grant a time-limited exclusivity on the use of an invention allowing the recuperation of research costs. The use of patents is fiercely debated for medical innovation and especially controversial for publicly funded research, where the patent holder is an institution accountable to public interest. Despite this controversy, for the situation in Germany almost no empirical information exists. The purpose of this study is to examine the amount, types and trends of patent applications for health products submitted by German public research organisations. We conducted a systematic search for patent documents using the publicly accessible database search interface of the German Patent and Trademark Office. We defined keywords and search criteria and developed search patterns for the database request. We retrieved documents with application date between 1988 and 2006 and processed the collected data stepwise to compile the most relevant documents in patent families for further analysis. We developed a rationale and present individual steps of a systematic method to request and process patent data from a publicly accessible database. We retrieved and processed 10194 patent documents. Out of these, we identified 1772 relevant patent families, applied for by 193 different universities and non-university public research organisations. 827 (47%) of these patent families contained granted patents. The number of patent applications submitted by universities and university-affiliated institutions more than tripled since the introduction of legal reforms in 2002, constituting almost half of all patent applications and accounting for most of the post-reform increase. Patenting of most non-university public research organisations remained stable. We search, process and analyse patent applications from publicly accessible databases. Internationally mounting evidence questions the viability of policies to increase commercial exploitation of publicly funded research results. To evaluate the outcome of research policies a transparent evidence base for public debate is needed in Germany.

Patenting of University and Non-University Public Research Organisations in Germany: Evidence from Patent Applications for Medical Research Results

PubMed Central

Tinnemann, Peter; Özbay, Jonas; Saint, Victoria A.; Willich, Stefan N.

2010-01-01

Background Patents are one of the most important forms of intellectual property. They grant a time-limited exclusivity on the use of an invention allowing the recuperation of research costs. The use of patents is fiercely debated for medical innovation and especially controversial for publicly funded research, where the patent holder is an institution accountable to public interest. Despite this controversy, for the situation in Germany almost no empirical information exists. The purpose of this study is to examine the amount, types and trends of patent applications for health products submitted by German public research organisations. Methods/Principal Findings We conducted a systematic search for patent documents using the publicly accessible database search interface of the German Patent and Trademark Office. We defined keywords and search criteria and developed search patterns for the database request. We retrieved documents with application date between 1988 and 2006 and processed the collected data stepwise to compile the most relevant documents in patent families for further analysis. We developed a rationale and present individual steps of a systematic method to request and process patent data from a publicly accessible database. We retrieved and processed 10194 patent documents. Out of these, we identified 1772 relevant patent families, applied for by 193 different universities and non-university public research organisations. 827 (47%) of these patent families contained granted patents. The number of patent applications submitted by universities and university-affiliated institutions more than tripled since the introduction of legal reforms in 2002, constituting almost half of all patent applications and accounting for most of the post-reform increase. Patenting of most non-university public research organisations remained stable. Conclusions We search, process and analyse patent applications from publicly accessible databases. Internationally mounting evidence questions the viability of policies to increase commercial exploitation of publicly funded research results. To evaluate the outcome of research policies a transparent evidence base for public debate is needed in Germany. PMID:21124982

Understanding practice change in community pharmacy: a qualitative research instrument based on organisational theory.

PubMed

Roberts, Alison S; Hopp, Trine; Sørensen, Ellen Westh; Benrimoj, Shalom I; Chen, Timothy F; Herborg, Hanne; Williams, Kylie; Aslani, Parisa

2003-10-01

The past decade has seen a notable shift in the practice of pharmacy, with a strong focus on the provision of cognitive pharmaceutical services (CPS) by community pharmacists. The benefits of these services have been well documented, yet their uptake appears to be slow. Various strategies have been developed to overcome barriers to the implementation of CPS, with varying degrees of success, and little is known about the sustainability of the practice changes they produce. Furthermore, the strategies developed are often specific to individual programs or services, and their applicability to other CPS has not been explored. There seems to be a need for a flexible change management model for the implementation and dissemination of a range of CPS, but before it can be developed, a better understanding of the change process is required. This paper describes the development of a qualitative research instrument that may be utilised to investigate practice change in community pharmacy. Specific objectives included gaining knowledge about the circumstances surrounding attempts to implement CPS, and understanding relationships that are important to the change process. Organisational theory provided the conceptual framework for development of the qualitative research instrument, within which two theories were used to give insight into the change process: Borum's theory of organisational change, which categorizes change strategies as rational, natural, political or open; and Social Network Theory, which helps identify and explain the relationships between key people involved in the change process. A semi-structured affecting practice change found in the literature that warranted further investigation with the theoretical perspectives of organisational change and social networks. To address the research objectives, the instrument covered four broad themes: roles, experiences, strategies and networks. The qualitative research instrument developed in this study provides a starting point for future research to lead to a description and understanding of practice change in community pharmacy, and subsequent development of models for the sustainable implementation of CPS.

Organisational support, organisational identification and organisational citizenship behaviour among male nurses.

PubMed

Chen, Sheng-Hwang; Yu, Hsing-Yi; Hsu, Hsiu-Yueh; Lin, Fang-Chen; Lou, Jiunn-Horng

2013-11-01

The purpose of this study was to explore the relationship between organisational support, organisational identification, and organisational citizenship behaviour and the predictors of organisational citizenship behaviour in Taiwanese male nurses. The turnover rate among male nurses is twice that of female nurses. Organisational citizenship behaviour is the predictor of turnover intention. Little information is available on the relationship between organisational support, organisational identification and organisational citizenship behaviour, particularly for male nurses. Data were collected in 2010 from a questionnaire mailed to 167 male nurses in Taiwan. A cross-sectional survey with simple sampling was used in this study. The results showed that organisational identification and organisational support were correlated with organisational citizenship behaviour. Organisational distinctiveness, organisational support of work conditions and the type of organisation were the main predictors of organisational citizenship behaviour. Together they accounted for 40.7% of the total variation in organisational citizenship behaviour. Organisational distinctiveness was the most critical predictor, accounting for 29.6% of the variation. Organisational support and organisational identification have positive relationships with organisational behaviour. Organisational distinctiveness is an important factor in explaining organisational citizenship behaviour in male nurses. This finding provides concrete directions for managers to follow when providing organisational identification, in particular, the organisational distinctiveness will help male nurses to display increasingly more organisational citizenship behaviour. © 2012 John Wiley & Sons Ltd.

Collaborations for Leadership in Applied Health Research and Care: lessons from the theory of communities of practice

PubMed Central

2011-01-01

Background The paper combines the analytical and instrumental perspectives on communities of practice (CoPs) to reflect on potential challenges that may arise in the process of interprofessional and inter-organisational joint working within the Collaborations for Leaderships in Applied Health Research and Care (CLAHRCs)--partnerships between the universities and National Health Service (NHS) Trusts aimed at conducting applied health research and translating its findings into day-to-day clinical practice. Discussion The paper discusses seminal theoretical literature on CoPs as well as previous empirical research on the role of these communities in healthcare collaboration, which is organised around the following three themes: knowledge sharing within and across CoPs, CoP formation and manageability, and identity building in CoPs. It argues that the multiprofessional and multi-agency nature of the CLAHRCs operating in the traditionally demarcated organisational landscape of the NHS may present formidable obstacles to knowledge sharing between various professional groupings, formation of a shared 'collaborative' identity, and the development of new communities within the CLAHRCs. To cross multiple boundaries between various professional and organisational communities and hence enable the flow of knowledge, the CLAHRCs will have to create an effective system of 'bridges' involving knowledge brokers, boundary objects, and cross-disciplinary interactions as well as address a number of issues related to professional and organisational identification. Summary The CoP approach can complement traditional 'stage-of-change' theories used in the field of implementation research and provide a basis for designing theory-informed interventions and evaluations. It can help to illuminate multiple boundaries that exist between professional and organisational groups within the CLAHRCs and suggest ways of crossing those boundaries to enable knowledge transfer and organisational learning. Achieving the aims of the CLAHRCs and producing a sustainable change in the ways applied health research is conducted and implemented may be influenced by how effectively these organisations can navigate through the multiple CoPs involved and promote the development of new multiprofessional and multi-organisational communities united by shared practice and a shared sense of belonging--an assumption that needs to be explored by further empirical research. PMID:21699712

Collaborations for leadership in applied health research and care: lessons from the theory of communities of practice.

PubMed

Kislov, Roman; Harvey, Gill; Walshe, Kieran

2011-06-23

The paper combines the analytical and instrumental perspectives on communities of practice (CoPs) to reflect on potential challenges that may arise in the process of interprofessional and inter-organisational joint working within the Collaborations for Leaderships in Applied Health Research and Care (CLAHRCs)--partnerships between the universities and National Health Service (NHS) Trusts aimed at conducting applied health research and translating its findings into day-to-day clinical practice. The paper discusses seminal theoretical literature on CoPs as well as previous empirical research on the role of these communities in healthcare collaboration, which is organised around the following three themes: knowledge sharing within and across CoPs, CoP formation and manageability, and identity building in CoPs. It argues that the multiprofessional and multi-agency nature of the CLAHRCs operating in the traditionally demarcated organisational landscape of the NHS may present formidable obstacles to knowledge sharing between various professional groupings, formation of a shared 'collaborative' identity, and the development of new communities within the CLAHRCs. To cross multiple boundaries between various professional and organisational communities and hence enable the flow of knowledge, the CLAHRCs will have to create an effective system of 'bridges' involving knowledge brokers, boundary objects, and cross-disciplinary interactions as well as address a number of issues related to professional and organisational identification. The CoP approach can complement traditional 'stage-of-change' theories used in the field of implementation research and provide a basis for designing theory-informed interventions and evaluations. It can help to illuminate multiple boundaries that exist between professional and organisational groups within the CLAHRCs and suggest ways of crossing those boundaries to enable knowledge transfer and organisational learning. Achieving the aims of the CLAHRCs and producing a sustainable change in the ways applied health research is conducted and implemented may be influenced by how effectively these organisations can navigate through the multiple CoPs involved and promote the development of new multiprofessional and multi-organisational communities united by shared practice and a shared sense of belonging--an assumption that needs to be explored by further empirical research.

Reflective writing: a user-friendly guide.

PubMed

Hamilton, Stephen

2016-09-08

Stephen Hamilton, Nurse Education Consultant, Business Services Organisation. In this piece, he outlines the nature of the process of reflection to allay concerns that registered nurses may have about the process, as well as dispel any myths surrounding the purpose of reflection.

Effectiveness of organisational infrastructures to promote evidence-based nursing practice

PubMed Central

Flodgren, Gerd; Rojas-Reyes, Maria Ximena; Cole, Nick; Foxcroft, David R

2014-01-01

Background Nurses and midwives form the bulk of the clinical health workforce and play a central role in all health service delivery. There is potential to improve health care quality if nurses routinely use the best available evidence in their clinical practice. Since many of the factors perceived by nurses as barriers to the implementation of evidence-based practice (EBP) lie at the organisational level, it is of interest to devise and assess the effectiveness of organisational infrastructures designed to promote EBP among nurses. Objectives To assess the effectiveness of organisational infrastructures in promoting evidence-based nursing. Search methods We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, LILACS, BIREME, IBECS, NHS Economic Evaluations Database, Social Science Citation Index, Science Citation Index and Conference Proceedings Citation Indexes up to 9 March 2011. We developed a new search strategy for this update as the strategy published in 2003 omitted key terms. Additional search methods included: screening reference lists of relevant studies, contacting authors of relevant papers regarding any further published or unpublished work, and searching websites of selected research groups and organisations. Selection criteria We considered randomised controlled trials, controlled clinical trials, interrupted times series (ITSs) and controlled before and after studies of an entire or identified component of an organisational infrastructure intervention aimed at promoting EBP in nursing. The participants were all healthcare organisations comprising nurses, midwives and health visitors. Data collection and analysis Two authors independently extracted data and assessed risk of bias. For the ITS analysis, we reported the change in the slopes of the regression lines, and the change in the level effect of the outcome at 3, 6, 12 and 24 months follow-up. Main results We included one study from the USA (re-analysed as an ITS) involving one hospital and an unknown number of nurses and patients. The study evaluated the effects of a standardised evidence-based nursing procedure on nursing care for patients at risk of developing healthcare-acquired pressure ulcers (HAPUs). If a patient’s admission Braden score was below or equal to 18 (i.e. indicating a high risk of developing pressure ulcers), nurses were authorised to initiate a pressure ulcer prevention bundle (i.e. a set of evidence-based clinical interventions) without waiting for a physician order. Re-analysis of data as a time series showed that against a background trend of decreasing HAPU rates, if that trend was assumed to be real, there was no evidence of an intervention effect at three months (mean rate per quarter 0.7%; 95% confidence interval (CI) 1.7 to 3.3; P = 0.457). Given the small percentages post intervention it was not statistically possible to extrapolate effects beyond three months. Authors’ conclusions Despite extensive searching of published and unpublished research we identified only one low-quality study; we excluded many studies due to non-eligible study design. If policy-makers and healthcare organisations wish to promote evidence-based nursing successfully at an organisational level, they must ensure the funding and conduct of well-designed studies to generate evidence to guide policy. PMID:22336783

Implementation of a disability management policy in a large healthcare employer: a quasi-experimental, mixed-methods evaluation.

PubMed

Mustard, Cameron A; Skivington, Kathryn; Lay, Morgan; Lifshen, Marni; Etches, Jacob; Chambers, Andrea

2017-06-17

This study describes the process and outcomes of the implementation of a strengthened disability management policy in a large Canadian healthcare employer. Key elements of the strengthened policy included an emphasis on early contact, the training of supervisors and the integration of union representatives in return-to-work (RTW) planning. The study applied mixed methods, combining a process evaluation within the employer and a quasi-experimental outcome evaluation between employers for a 3-year period prior to and following policy implementation in January 2012. Staff in the implementation organisation (n=4000) and staff in a peer group of 29 large hospitals (n=1 19 000). Work disability episode incidence and duration. Both qualitative and quantitative measures of the implementation process were predominantly positive. Over the 6-year observation period, there were 624 work disability episodes in the organisation and 8604 in the comparison group of 29 large hospitals. The annual per cent change in episode incidence in the organisation was -5.6 (95% CI -9.9 to -1.1) comparable to the annual per cent change in the comparison group: -6.2 (-7.2 to -5.3). Disability episode durations also declined in the organisation, from a mean of 19.4 days (16.5, 22.3) in the preintervention period to 10.9 days (8.7, 13.2) in the postintervention period. Reductions in disability durations were also observed in the comparison group: from a mean of 13.5 days (12.9, 14.1) in the 2009-2011 period to 10.5 days (9.9, 11.1) in the 2012-2014 period. The incidence of work disability episodes and the durations of work disability declined strongly in this hospital sector over the 6-year observation period. The implementation of the organisation's RTW policy was associated with larger reductions in disability durations than observed in the comparison group. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

UNICEF's contribution to the adoption and implementation of option B+ for preventing mother-to-child transmission of HIV: a policy analysis.

PubMed

Chersich, M F; Newbatt, E; Ng'oma, K; de Zoysa, I

2018-06-01

Between 2011 and 2013, global and national guidelines for preventing mother-to-child transmission (PMTCT) of HIV shifted to recommend Option B+, the provision of lifelong antiretroviral treatment for all HIV-infected pregnant women. We aimed to analyse how Option B+ reached the policy agenda, and unpack the processes, actors and politics that explain its adoption, with a focus on examining UNICEF's contribution to these events. Analysis drew on published articles and other documentation, 30 key informants interviews with staff at UNICEF, partner organisations and government officials, and country case studies. Cameroon, India, South Africa and Zimbabwe were each visited for 5-8 days. Interview transcripts were analysed using Dedoose software, reviewed several times and then coded thematically. A national policy initiative in Malawi in 2011, in which the country adopted Option B+, rather than existing WHO recommended regimens, irrevocably placed the policy on the global agenda. UNICEF and other organisations recognised the policy's potential impact and strategically crafted arguments to support it, framing these around operational considerations, cost-effectiveness and values. As 'policy entrepreneurs', these organisations vigorously promoted the policy through a variety of channels and means, overcoming concerted opposition. WHO, on the basis of scanty evidence, released a series of documents towards the policy's endorsement, paving the way for its widespread adoption. National-level policy transformation was rapid and definitive, distinct from previous incremental policy processes. Many organisations, including UNICEF, facilitated these changes in country, acting individually, or in concert. The adoption of the Option B+ policy marked a departure from established processes for PMTCT policy formulation which had been led by WHO with the support of technical experts, and in which recommendations were developed following shifts in evidence. Rather, changes were spurred by a country-level initiative, and a set of strategically framed arguments that resonated with funders and country-level actors. This bottom-up approach, supported by normative agencies, was transformative. For UNICEF, alignment between the organisation's country focus and the policy's underpinning values, enabled it to work with partners and accelerate widespread policy change.

Improving discharge care: the potential of a new organisational intervention to improve discharge after hospitalisation for acute stroke, a controlled before-after pilot study.

PubMed

Cadilhac, Dominique A; Andrew, Nadine E; Stroil Salama, Enna; Hill, Kelvin; Middleton, Sandy; Horton, Eleanor; Meade, Ian; Kuhle, Sarah; Nelson, Mark R; Grimley, Rohan

2017-08-04

Provision of a discharge care plan and prevention therapies is often suboptimal. Our objective was to design and pilot test an interdisciplinary, organisational intervention to improve discharge care using stroke as the case study using a mixed-methods, controlled before-after observational study design. Acute care public hospitals in Queensland, Australia (n=15). The 15 hospitals were ranked against a benchmark based on a composite outcome of three discharge care processes. Clinicians from a 'top-ranked' hospital participated in a focus group to elicit their success factors. Two pilot hospitals then participated in the organisational intervention that was designed with experts and consumers. Hospital clinicians involved in discharge care for stroke and patients admitted with acute stroke or transient ischaemic attack. A four-stage, multifaceted organisational intervention that included data reviews, education and facilitated action planning. Three discharge processes collected in Queensland hospitals within the Australian Stroke Clinical Registry were used to select study hospitals: (1) discharge care plan; (2) antihypertensive medication prescription and (3) antiplatelet medication prescription (ischaemic events only). Primary measure: composite outcome. Secondary measures: individual adherence changes for each discharge process; sensitivity analyses. The performance outcomes were compared 3 months before the intervention (preintervention), 3 months postintervention and at 12 months (sustainability). Data from 1289 episodes of care from the two pilot hospitals were analysed. Improvements from preintervention adherence were: antiplatelet therapy (88%vs96%, p=0.02); antihypertensive prescription (61%vs79%, p<0.001); discharge planning (72%vs94%, p<0.001); composite outcome (73%vs89%, p<0.001). There was an insignificant decay effect over the 12-month sustainability period (composite outcome: 89% postintervention vs 85% sustainability period, p=0.08). Discharge care in hospitals may be effectively improved and sustained through a staged and peer-informed, organisational intervention. The intervention warrants further application and trialling on a larger scale. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Data Science: History repeated? - The heritage of the Free and Open Source GIS community

NASA Astrophysics Data System (ADS)

Löwe, Peter; Neteler, Markus

2014-05-01

Data Science is described as the process of knowledge extraction from large data sets by means of scientific methods. The discipline draws heavily from techniques and theories from many fields, which are jointly used to furthermore develop information retrieval on structured or unstructured very large datasets. While the term Data Science was already coined in 1960, the current perception of this field places is still in the first section of the hype cycle according to Gartner, being well en route from the technology trigger stage to the peak of inflated expectations. In our view the future development of Data Science could benefit from the analysis of experiences from related evolutionary processes. One predecessor is the area of Geographic Information Systems (GIS). The intrinsic scope of GIS is the integration and storage of spatial information from often heterogeneous sources, data analysis, sharing of reconstructed or aggregated results in visual form or via data transfer. GIS is successfully applied to process and analyse spatially referenced content in a wide and still expanding range of science areas, spanning from human and social sciences like archeology, politics and architecture to environmental and geoscientific applications, even including planetology. This paper presents proven patterns for innovation and organisation derived from the evolution of GIS, which can be ported to Data Science. Within the GIS landscape, three strategic interacting tiers can be denoted: i) Standardisation, ii) applications based on closed-source software, without the option of access to and analysis of the implemented algorithms, and iii) Free and Open Source Software (FOSS) based on freely accessible program code enabling analysis, education and ,improvement by everyone. This paper focuses on patterns gained from the synthesis of three decades of FOSS development. We identified best-practices which evolved from long term FOSS projects, describe the role of community-driven global umbrella organisations such as OSGeo, as well as the standardization of innovative services. The main driver is the acknowledgement of a meritocratic attitude. These patterns follow evolutionary processes of establishing and maintaining a web-based democratic culture spawning new kinds of communication and projects. This culture transcends the established compartmentation and stratification of science by creating mutual benefits for the participants, irrespective of their respective research interest and standing. Adopting these best practices will enable the emerging Data Science communities to avoid pitfalls and to accelerate the progress to stages of productivity.

Development of a theoretical framework of factors affecting patient safety incident reporting: a theoretical review of the literature

PubMed Central

Hull, Louise; Soukup, Tayana; Mayer, Erik; Athanasiou, Thanos; Sevdalis, Nick; Darzi, Ara

2017-01-01

Objectives The development and implementation of incident reporting systems within healthcare continues to be a fundamental strategy to reduce preventable patient harm and improve the quality and safety of healthcare. We sought to identify factors contributing to patient safety incident reporting. Design To facilitate improvements in incident reporting, a theoretical framework, encompassing factors that act as barriers and enablers ofreporting, was developed. Embase, Ovid MEDLINE(R) and PsycINFO were searched to identify relevant articles published between January 1980 and May 2014. A comprehensive search strategy including MeSH terms and keywords was developed to identify relevant articles. Data were extracted by three independent researchers; to ensure the accuracy of data extraction, all studies eligible for inclusion were rescreened by two reviewers. Results The literature search identified 3049 potentially eligible articles; of these, 110 articles, including >29 726 participants, met the inclusion criteria. In total, 748 barriers were identified (frequency count) across the 110 articles. In comparison, 372 facilitators to incident reporting and 118 negative cases were identified. The top two barriers cited were fear of adverse consequences (161, representing 21.52% of barriers) and process and systems of reporting (110, representing 14.71% of barriers). In comparison, the top two facilitators were organisational (97, representing 26.08% of facilitators) and process and systems of reporting (75, representing 20.16% of facilitators). Conclusion A wide range of factors contributing to engagement in incident reporting exist. Efforts that address the current tendency to under-report must consider the full range of factors in order to develop interventions as well as a strategic policy approach for improvement. PMID:29284714

Development of a theoretical framework of factors affecting patient safety incident reporting: a theoretical review of the literature.

PubMed

Archer, Stephanie; Hull, Louise; Soukup, Tayana; Mayer, Erik; Athanasiou, Thanos; Sevdalis, Nick; Darzi, Ara

2017-12-27

The development and implementation of incident reporting systems within healthcare continues to be a fundamental strategy to reduce preventable patient harm and improve the quality and safety of healthcare. We sought to identify factors contributing to patient safety incident reporting. To facilitate improvements in incident reporting, a theoretical framework, encompassing factors that act as barriers and enablers ofreporting, was developed. Embase, Ovid MEDLINE(R) and PsycINFO were searched to identify relevant articles published between January 1980 and May 2014. A comprehensive search strategy including MeSH terms and keywords was developed to identify relevant articles. Data were extracted by three independent researchers; to ensure the accuracy of data extraction, all studies eligible for inclusion were rescreened by two reviewers. The literature search identified 3049 potentially eligible articles; of these, 110 articles, including >29 726 participants, met the inclusion criteria. In total, 748 barriers were identified (frequency count) across the 110 articles. In comparison, 372 facilitators to incident reporting and 118 negative cases were identified. The top two barriers cited were fear of adverse consequences (161, representing 21.52% of barriers) and process and systems of reporting (110, representing 14.71% of barriers). In comparison, the top two facilitators were organisational (97, representing 26.08% of facilitators) and process and systems of reporting (75, representing 20.16% of facilitators). A wide range of factors contributing to engagement in incident reporting exist. Efforts that address the current tendency to under-report must consider the full range of factors in order to develop interventions as well as a strategic policy approach for improvement. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Relationship between stakeholders' information value perception and information security behaviour

NASA Astrophysics Data System (ADS)

Tajuddin, Sharul; Olphert, Wendy; Doherty, Neil

2015-02-01

The study, reported in this paper, aims to explore the relationship between the stakeholders' perceptions about the value of information and their resultant information security behaviours. Moreover, this study seeks to explore the role of national and organisational culture in facilitating information value assignment. Information Security is a concept that formed from the recognition that information is valuable and that there is a need to protect it. The ISO 27002 defines information as an asset, which, like other important business assets, is essential to an organisation's business and consequently needs to be appropriately protected. By definition, an asset has a value to the organisation hence it requires protection. Information protection is typically accomplished through the implementation of countermeasures against the threats and vulnerabilities of information security, for example, implementation of technological processes and mechanisms such as firewall and authorization and authentication systems, set-up of deterrence procedures such as password control and enforcement of organisational policy on information handling procedures. However, evidence routinely shows that despite such measures, information security breaches and incidents are on the rise. These breaches lead to loss of information, personal records, or other data, with consequent implications for the value of the information asset. A number of studies have suggested that such problems are not related primarily to technology problems or procedural deficiencies, but rather to stakeholders' poor compliance with the security measures that are in place. Research indicates that compliance behaviour is affected by many variables including perceived costs and benefits, national and organisational culture and norms. However, there has been little research to understand the concept of information value from the perspective of those who interact with the data, and the consequences for information security behaviours. This study seeks to address this gap in the research. Data will be presented from a pilot study consisting of interviews with 6 participants from public organisations in Brunei Darussalam which illustrate the nature of the value assignment process, together with an initial model of the relationship between perceived information value and information security behaviours.

The relationship between energy information management and energy management performance in higher education sector in Thailand, considering from resource and process based views

NASA Astrophysics Data System (ADS)

Mongkolsawat, Darunee

The performance of energy management is usually considered through the energy reduction result however this does not sufficient for managing facility's energy in the long term. In combination to that, this study decides to investigate the relationship between the effectiveness of energy information management and the energy management performance. The interested sector is higher education institutions in Thailand due to their complex organisation both in management and property aspects. By not focusing on quantitative energy reduction as centre, the study seeks to establish a framework or tool in helping to understand such relationship qualitatively through organisation resource and process based view. Additionally, energy management structure is also accounted as initial factor. In relation to such framework, the performance of energy management is considered on its primary results concerning the issues of the data available, analysis results, and energy action. After the investigation, it is found that between the concerned factors and primary performance there are various specific relationships. For example, some tend to have direct connections as relations between the energy management structure and implemented actions, and between the investment in organisation resources and data available. While some have flexible relations as between data collection and results of analysed data. Furthermore, the load of energy management has been found influencing on organisation's motivation to invest in energy management. At the end of the paper, further application to the study is also proposed.

Using information communication technologies to increase the institutional capacity of local health organisations in Africa: a case study of the Kenya Civil Society Portal for Health.

PubMed

Juma, Charles; Sundsmo, Aaron; Maket, Boniface; Powell, Richard; Aluoch, Gilbert

2015-01-01

Achieving the healthcare components of the United Nations' Millennium Development Goals is significantly premised on effective service delivery by civil society organisations (CSOs). However, many CSOs across Africalack the necessary capacity to perform this role robustly. This paper reports on an evaluation of the use, and perceived impact, of aknowledge management tool upon institutional strengthening among CSOs working in Kenya's health sector. Three methods were used: analytics data; user satisfaction surveys; and a furtherkey informant survey. Satisfaction with the portal was consistently high, with 99% finding the quality and relevance of the content very good or good for institutional strengthening standards, governance, and planning and resource mobilisation. Critical facilitators to the success of knowledge management for CSO institutional strengthening were identified as people/culture (developed resources and organisational narratives) and technology (easily accessible, enabling information exchange, tools/resources available, access to consultants/partners). Critical barriers were identified as people/culture (database limitations, materials limitations, and lack of active users), and process (limited access, limited interactions, and limited approval process). This pilot study demonstrated the perceived utility of a web-based knowledge management portal among developing nations' CSOs, with widespread satisfaction across multiple domains, which increased over time. Providing increased opportunities for collective mutual learning, promoting a culture of data use for decision making, and encouraging all health organisations to be learning institutions should be a priority for those interested in promoting sustainable long-term solutions for Africa.

Understanding the work done by NHS commissioning managers: an exploration of the microprocesses underlying day-to-day sensemaking in UK primary care organisations.

PubMed

Checkland, Kath; Harrison, Stephen; Snow, Stephanie; Coleman, Anna; McDermott, Imelda

2013-01-01

The purpose of this paper is to explore the practical daily work undertaken by middle-level managers in Primary Care Trusts (PCTs), focusing upon the micro-processes by which these managers enact sensemaking in their organisations. The research took a case study approach, undertaking detailed case studies in four PCTs in England. Data collection included shadowing managers, meeting observations and interviews. The research elucidated two categories of enactment behaviour exhibited by PCT managers: presence/absence; and the production of artefacts. Being "present" in or "absent" from meetings enacted sensemaking over and above any concrete contribution to the meeting made by the actors involved. This paper explores the factors affecting these processes, and describes the situations in which enactment of sense is most likely to occur. Producing artefacts such as meeting minutes or PowerPoint slides also enacted sense in the study sites in addition to the content of the artefact. The factors affecting this are explored. The study has practical implications for all managers seeking to maximise their influence in their organisations. It also provides specific evidence relevant to managers working in the new Clinical Commissioning Groups currently being formed in England. The study expands the understanding of sensemaking in organisations in two important ways. Firstly, it moves beyond discourse to explore the ways in which behaviours can enact sense. Secondly, it explores the distinction between active and unconscious sensemaking.

[Innovation in healthcare processes and patient safety using clinical simulation].

PubMed

Rojo, E; Maestre, J M; Díaz-Mendi, A R; Ansorena, L; Del Moral, I

2016-01-01

Many excellent ideas are never implemented or generalised by healthcare organisations. There are two related paradigms: thinking that individuals primarily change through accumulating knowledge, and believing that the dissemination of that knowledge within the organisation is the key element to facilitate change. As an alternative, a description and evaluation of a simulation-based inter-professional team training program conducted in a Regional Health Service to promote and facilitate change is presented. The Department of Continuing Education completed the needs assessment using the proposals presented by clinical units and management. Skills and behaviors that could be learned using simulation were selected, and all personnel from the units participating were included. Experiential learning principles based on clinical simulation and debriefing, were used for the instructional design. The Kirkpatrick model was used to evaluate the program. Objectives included: a) decision-making and teamwork skills training in high prevalence diseases with a high rate of preventable complications; b) care processes reorganisation to improve efficiency, while maintaining patient safety; and, c) implementation of new complex techniques with a long learning curve, and high preventable complications rate. Thirty clinical units organised 39 training programs in the 3 public hospitals, and primary care of the Regional Health Service during 2013-2014. Over 1,559 healthcare professionals participated, including nursing assistants, nurses and physicians. Simulation in healthcare to train inter-professional teams can promote and facilitate change in patient care, and organisational re-engineering. Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

‘Newcomer adaptation’: a lens through which to understand how nursing students fit in with the real world of practice

PubMed Central

Houghton, Catherine E

2014-01-01

Aims and objectives To present a discussion on newcomer adaptation as a lens through which to understand how nursing students adapt to clinical practice and raise awareness of strategies that can be used to enhance their learning experiences. Background Socialisation is an important factor that facilitates students’ learning in the clinical setting. Therefore, it is beneficial to examine organisational socialisation literature, particularly that pertaining to newcomer adaptation. Design This is a critical review of organisational socialisation literature. Methods Seminal literature and more recent research in the field of organisational socialisation and newcomer adaptation were accessed. In addition, nursing and allied health literature examining students’ socialisation and the clinical learning environment was retrieved. Conclusions It is revealed in this article that to create an appropriate clinical learning environment, an understanding of socialisation tactics could be beneficial. Role modelling is deemed crucial to successful newcomer adaptation. Peer support is necessary but must be advocated with caution as it can have a negative impact when students form a ‘parallel community’. Students with some knowledge of the workplace tend to adapt more easily. Likewise, students’ disposition and, in particular, their confidence can also enhance the socialisation process. Relevance to clinical practice Both the organisation and the student can impact on how successfully the nursing student ‘fits in’. Understanding this through the lens of newcomer adaptation means that strategies can be put in place to facilitate this process. PMID:24455974

Reframing implementation as an organisational behaviour problem.

PubMed

Clay-Williams, Robyn; Braithwaite, Jeffrey

2015-01-01

The purpose of this paper is to report on a process evaluation of a randomised controlled trial (RCT) intervention study that tested the effectiveness of classroom- and simulation-based crew resource management courses, alone and in combination, and identifies organisational barriers and facilitators to implementation of team training programmes in healthcare. The RCT design consisted of a before and after study with a team training intervention. Quantitative data were gathered on utility and affective reactions to training, and on teamwork knowledge, attitudes, and behaviours of the learners. A sample of participants was interviewed at the conclusion of the study. Interview responses were analysed, alongside qualitative elements of the classroom course critique, to search for evidence, context, and facilitation clues to the implementation process. The RCT method provided scientifically robust data that supported the benefits of classroom training. Qualitative data identified a number of facilitators to implementation of team training, and shed light on some of the ways that learning was diffused throughout the organisation. Barriers to successful implementation were also identified, including hospital time and resource constraints and poor organisational communication. Quantitative randomised methods have intermittently been used to evaluate team training interventions in healthcare. Despite two decades of team training trials, however, the authors do not know as well as the authors would like what goes on inside the "black box" of such RCTs. While results are usually centred on outcomes, this study also provides insight into the context and mechanisms associated with those outcomes and identifies barriers and facilitators to successful intervention implementation.

Stroke units: research and reality. Results from the National Sentinel Audit of Stroke

PubMed Central

Rudd, A; Hoffman, A; Irwin, P; Pearson, M; Lowe, D; on, b

2005-01-01

Objectives: To use data from the 2001–2 National Stroke Audit to describe the organisation of stroke units in England, Wales and Northern Ireland, and to see if key characteristics deemed effective from the research literature were present. Design: Data were collected as part of the National Sentinel Audit of Stroke in 2001, both on the organisation and structure of inpatient stroke care and the process of care to hospitals managing stroke patients. Setting: 240 hospitals from England, Wales and Northern Ireland took part in the 2001–2 National Stroke Audit, a response rate of over 95%. These sites audited a total of 8200 patients. Audit tool: Royal College of Physicians Intercollegiate Working Party Stroke Audit Tool. Results: 73% of hospitals participating in the audit had a stroke unit but only 36% of stroke admissions spent any time on one. Only 46% of all units describing themselves as stroke units had all five organisational characteristics that previous research literature had identified as being key features, while 26% had four and 28% had three or less. Better organisation was associated with better process of care for patients, with patients managed on stroke units receiving better care than those managed in other settings. Conclusion: The National Service Framework for Older People set a target for all hospitals treating stroke patients to have a stroke unit by April 2004. This study suggests that in many hospitals this is being achieved without adequate resource and expertise. PMID:15691997

Hexagonal comb cells of honeybees are not produced via a liquid equilibrium process

NASA Astrophysics Data System (ADS)

Bauer, Daniel; Bienefeld, Kaspar

2013-01-01

The nests of European honeybees ( Apis mellifera) are organised into wax combs that contain many cells with a hexagonal structure. Many previous studies on comb-building behaviour have been made in order to understand how bees produce this geometrical structure; however, it still remains a mystery. Direct construction of hexagons by bees was suggested previously, while a recent hypothesis postulated the self-organised construction of hexagonal comb cell arrays; however, infrared and thermographic video observations of comb building in the present study failed to support the self-organisation hypothesis because bees were shown to be engaged in direct construction. Bees used their antennae, mandibles and legs in a regular sequence to manipulate the wax, while some bees supported their work by actively warming the wax. During the construction of hexagonal cells, the wax temperature was between 33.6 and 37.6 °C. This is well below 40 °C, i.e. the temperature at which wax is assumed to exist in the liquid equilibrium that is essential for self-organised building.

An overview of the European Organization for External Quality Assurance Providers in Laboratory Medicine (EQALM)

PubMed Central

Stavelin, Anne; Albe, Xavier; Meijer, Piet; Sarkany, Erika; MacKenzie, Finlay

2017-01-01

The European Organisation for External Quality Assurance Providers in Laboratory Medicine (EQALM) was founded in 1996 and currently has members from 29 European countries and 6 countries from outside Europe. EQALM provides a forum for co-operation and exchange of knowledge on quality-related matters in laboratory medicine, especially with regard to external quality assessment (EQA) programs in Europe. In addition, EQALM represent the EQA providers in laboratory medicine at European level vis-ŕ-vis political, professional, scientific and other bodies, including patients’ organisations. To this end EQALM promotes activities such as organizing meetings with scientific and practical themes for members and other interested parties, issuing scientific publications, developing EQA projects and representing laboratory medicine EQA activities within other organisations and networks. EQALM is active in scientific and educational activity in different fields such as survey frequency, haematology, haemostasis, microbiology, nomenclature, virtual microscopy, traceability, accreditation, and quality assurance of the total testing process. The aim of this paper is to give an overview of the EQALM organisation. PMID:28392724

Quality Leadership and Quality Control

PubMed Central

Badrick, Tony

2003-01-01

Different quality control rules detect different analytical errors with varying levels of efficiency depending on the type of error present, its prevalence and the number of observations. The efficiency of a rule can be gauged by inspection of a power function graph. Control rules are only part of a process and not an end in itself; just as important are the trouble-shooting systems employed when a failure occurs. 'Average of patient normals' may develop as a usual adjunct to conventional quality control serum based programmes. Acceptable error can be based on various criteria; biological variation is probably the most sensible. Once determined, acceptable error can be used as limits in quality control rule systems. A key aspect of an organisation is leadership, which links the various components of the quality system. Leadership is difficult to characterise but its key aspects include trust, setting an example, developing staff and critically setting the vision for the organisation. Organisations also have internal characteristics such as the degree of formalisation, centralisation, and complexity. Medical organisations can have internal tensions because of the dichotomy between the bureaucratic and the shadow medical structures. PMID:18568046

IAU Public Astronomical Organisations Network

NASA Astrophysics Data System (ADS)

Canas, Lina; Cheung, Sze Leung

2015-08-01

The Office for Astronomy Outreach has devoted intensive means to create and support a global network of public astronomical organisations around the world. Focused on bringing established and newly formed amateur astronomy organizations together, providing communications channels and platforms for disseminating news to the global community and the sharing of best practices and resources among these associations around the world. In establishing the importance that these organizations have for the dissemination of activities globally and acting as key participants in IAU various campaigns social media has played a key role in keeping this network engaged and connected. Here we discuss the implementation process of maintaining this extensive network, the processing and gathering of information and the interactions between local active members at a national and international level.

Older people. Rising SAP.

PubMed

Wilson, Keith

2003-07-10

Single assessment is a complex process involving a variety of agencies, professions and functions. A key decision will be about the development or purchase of a standard assessment tool. A single assessment process lead needs to be appointed with support from senior management in all relevant organisations.

Beyond the word and image: II- Structural and functional connectivity of a common semantic system.

PubMed

Jouen, A L; Ellmore, T M; Madden-Lombardi, C J; Pallier, C; Dominey, P F; Ventre-Dominey, J

2018-02-01

Understanding events requires interplaying cognitive processes arising in neural networks whose organisation and connectivity remain subjects of controversy in humans. In the present study, by combining diffusion tensor imaging and functional interaction analysis, we aim to provide new insights on the organisation of the structural and functional pathways connecting the multiple nodes of the identified semantic system -shared by vision and language (Jouen et al., 2015). We investigated a group of 19 healthy human subjects during experimental tasks of reading sentences or seeing pictures. The structural connectivity was realised by deterministic tractography using an algorithm to extract white matter fibers terminating in the selected regions of interest (ROIs) and the functional connectivity by independent component analysis to measure correlated activities among these ROIs. The major connections link ventral neural stuctures including the parietal and temporal cortices through inferior and middle longitudinal fasciculi, the retrosplenial and parahippocampal cortices through the cingulate bundle, and the temporal and prefrontal structures through the uncinate fasciculus. The imageability score provided when the subject was reading a sentence was significantly correlated with the factor of anisotropy of the left parieto-temporal connections of the middle longitudinal fasciculus. A large part of this ventrally localised structural connectivity corresponds to functional interactions between the main parietal, temporal and frontal nodes. More precisely, the strong coactivation both in the anterior temporal pole and in the region of the temporo-parietal cortex suggests dual and cooperating roles for these areas within the semantic system. These findings are discussed in terms of two semantics-related sub-systems responsible for conceptual representation. Copyright © 2017 Elsevier Inc. All rights reserved.

Key factors of case management interventions for frequent users of healthcare services: a thematic analysis review

PubMed Central

Hudon, Catherine; Chouinard, Maud-Christine; Lambert, Mireille; Diadiou, Fatoumata; Bouliane, Danielle; Beaudin, Jérémie

2017-01-01

Objective The aim of this paper was to identify the key factors of case management (CM) interventions among frequent users of healthcare services found in empirical studies of effectiveness. Design Thematic analysis review of CM studies. Methods We built on a previously published review that aimed to report the effectiveness of CM interventions for frequent users of healthcare services, using the Medline, Scopus and CINAHL databases covering the January 2004–December 2015 period, then updated to July 2017, with the keywords ‘CM’ and ‘frequent use’. We extracted factors of successful (n=7) and unsuccessful (n=6) CM interventions and conducted a mixed thematic analysis to synthesise findings. Chaudoir’s implementation of health innovations framework was used to organise results into four broad levels of factors: (1) environmental/organisational level, (2) practitioner level, (3) patient level and (4) programme level. Results Access to, and close partnerships with, healthcare providers and community services resources were key factors of successful CM interventions that should target patients with the greatest needs and promote frequent contacts with the healthcare team. The selection and training of the case manager was also an important factor to foster patient engagement in CM. Coordination of care, self-management support and assistance with care navigation were key CM activities. The main issues reported by unsuccessful CM interventions were problems with case finding or lack of care integration. Conclusions CM interventions for frequent users of healthcare services should ensure adequate case finding processes, rigorous selection and training of the case manager, sufficient intensity of the intervention, as well as good care integration among all partners. Other studies could further evaluate the influence of contextual factors on intervention impacts. PMID:29061623

Uncovering treatment burden as a key concept for stroke care: a systematic review of qualitative research.

PubMed

Gallacher, Katie; Morrison, Deborah; Jani, Bhautesh; Macdonald, Sara; May, Carl R; Montori, Victor M; Erwin, Patricia J; Batty, G David; Eton, David T; Langhorne, Peter; Mair, Frances S

2013-01-01

Patients with chronic disease may experience complicated management plans requiring significant personal investment. This has been termed 'treatment burden' and has been associated with unfavourable outcomes. The aim of this systematic review is to examine the qualitative literature on treatment burden in stroke from the patient perspective. The search strategy centred on: stroke, treatment burden, patient experience, and qualitative methods. We searched: Scopus, CINAHL, Embase, Medline, and PsycINFO. We tracked references, footnotes, and citations. Restrictions included: English language, date of publication January 2000 until February 2013. Two reviewers independently carried out the following: paper screening, data extraction, and data analysis. Data were analysed using framework synthesis, as informed by Normalization Process Theory. Sixty-nine papers were included. Treatment burden includes: (1) making sense of stroke management and planning care, (2) interacting with others, (3) enacting management strategies, and (4) reflecting on management. Health care is fragmented, with poor communication between patient and health care providers. Patients report inadequate information provision. Inpatient care is unsatisfactory, with a perceived lack of empathy from professionals and a shortage of stimulating activities on the ward. Discharge services are poorly coordinated, and accessing health and social care in the community is difficult. The study has potential limitations because it was restricted to studies published in English only and data from low-income countries were scarce. Stroke management is extremely demanding for patients, and treatment burden is influenced by micro and macro organisation of health services. Knowledge deficits mean patients are ill equipped to organise their care and develop coping strategies, making adherence less likely. There is a need to transform the approach to care provision so that services are configured to prioritise patient needs rather than those of health care systems.

Understanding public drug procurement in India: a comparative qualitative study of five Indian states

PubMed Central

Singh, Prabal Vikram; Tatambhotla, Anand; Kalvakuntla, Rohini; Chokshi, Maulik

2013-01-01

Objective To perform an initial qualitative comparison of the different procurement models in India to frame questions for future research in this area; to capture the finer differences between the state models through 53 process and price parameters to determine their functional efficiencies. Design Qualitative analysis is performed for the study. Five states: Tamil Nadu, Kerala, Odisha, Punjab and Maharashtra were chosen to ensure heterogeneity in a number of factors such as procurement type (centralised, decentralised or mixed); autonomy of the procurement organisation; state of public health infrastructure; geography and availability of data through Right to Information Act (RTI). Data on procurement processes were collected through key informant analysis by way of semistructured interviews with leadership teams of procuring organisations. These process data were validated through interviews with field staff (stakeholders of district hospitals, taluk hospitals, community health centres and primary health centres) in each state. A total of 30 actors were interviewed in all five states. The data collected are analysed against 52 process and price parameters to determine the functional efficiency of the model. Results The analysis indicated that autonomous procurement organisations were more efficient in relation to payments to suppliers, had relatively lower drug procurement prices and managed their inventory more scientifically. Conclusions The authors highlight critical success factors that significantly influence the outcome of any procurement model. In a way, this study raises more questions and seeks the need for further research in this arena to aid policy makers. PMID:23388196

Understanding public drug procurement in India: a comparative qualitative study of five Indian states.

PubMed

Singh, Prabal Vikram; Tatambhotla, Anand; Kalvakuntla, Rohini; Chokshi, Maulik

2013-01-01

To perform an initial qualitative comparison of the different procurement models in India to frame questions for future research in this area; to capture the finer differences between the state models through 53 process and price parameters to determine their functional efficiencies. Qualitative analysis is performed for the study. Five states: Tamil Nadu, Kerala, Odisha, Punjab and Maharashtra were chosen to ensure heterogeneity in a number of factors such as procurement type (centralised, decentralised or mixed); autonomy of the procurement organisation; state of public health infrastructure; geography and availability of data through Right to Information Act (RTI). Data on procurement processes were collected through key informant analysis by way of semistructured interviews with leadership teams of procuring organisations. These process data were validated through interviews with field staff (stakeholders of district hospitals, taluk hospitals, community health centres and primary health centres) in each state. A total of 30 actors were interviewed in all five states. The data collected are analysed against 52 process and price parameters to determine the functional efficiency of the model. The analysis indicated that autonomous procurement organisations were more efficient in relation to payments to suppliers, had relatively lower drug procurement prices and managed their inventory more scientifically. The authors highlight critical success factors that significantly influence the outcome of any procurement model. In a way, this study raises more questions and seeks the need for further research in this arena to aid policy makers.

Identification and verification of critical performance dimensions. Phase 1 of the systematic process redesign of drug distribution.

PubMed

Colen, Hadewig B; Neef, Cees; Schuring, Roel W

2003-06-01

Worldwide patient safety has become a major social policy problem for healthcare organisations. As in other organisations, the patients in our hospital also suffer from an inadequate distribution process, as becomes clear from incident reports involving medication errors. Medisch Spectrum Twente is a top primary-care, clinical, teaching hospital. The hospital pharmacy takes care of 1070 internal beds and 1120 beds in an affiliated psychiatric hospital and nursing homes. In the beginning of 1999, our pharmacy group started a large interdisciplinary research project to develop a safe, effective and efficient drug distribution system by using systematic process redesign. The process redesign includes both organisational and technological components. This article describes the identification and verification of critical performance dimensions for the design of drug distribution processes in hospitals (phase 1 of the systematic process redesign of drug distribution). Based on reported errors and related causes, we suggested six generic performance domains. To assess the role of the performance dimensions, we used three approaches: flowcharts, interviews with stakeholders and review of the existing performance using time studies and medication error studies. We were able to set targets for costs, quality of information, responsiveness, employee satisfaction, and degree of innovation. We still have to establish what drug distribution system, in respect of quality and cost-effectiveness, represents the best and most cost-effective way of preventing medication errors. We intend to develop an evaluation model, using the critical performance dimensions as a starting point. This model can be used as a simulation template to compare different drug distribution concepts in order to define the differences in quality and cost-effectiveness.

Net analyte signal standard addition method for simultaneous determination of sulphadiazine and trimethoprim in bovine milk and veterinary medicines.

PubMed

Hajian, Reza; Mousavi, Esmat; Shams, Nafiseh

2013-06-01

Net analyte signal standard addition method has been used for the simultaneous determination of sulphadiazine and trimethoprim by spectrophotometry in some bovine milk and veterinary medicines. The method combines the advantages of standard addition method with the net analyte signal concept which enables the extraction of information concerning a certain analyte from spectra of multi-component mixtures. This method has some advantages such as the use of a full spectrum realisation, therefore it does not require calibration and prediction step and only a few measurements require for the determination. Cloud point extraction based on the phenomenon of solubilisation used for extraction of sulphadiazine and trimethoprim in bovine milk. It is based on the induction of micellar organised media by using Triton X-100 as an extraction solvent. At the optimum conditions, the norm of NAS vectors increased linearly with concentrations in the range of 1.0-150.0 μmolL(-1) for both sulphadiazine and trimethoprim. The limits of detection (LOD) for sulphadiazine and trimethoprim were 0.86 and 0.92 μmolL(-1), respectively. Copyright © 2012 Elsevier Ltd. All rights reserved.

Civil society and the negotiation of the Framework Convention on Tobacco Control

PubMed Central

MAMUDU, H. M.

2008-01-01

Tobacco control civil society organisations mobilised to influence countries during the negotiation of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) between 1999 and 2003. Tobacco control civil society organisations and coalitions around the world embraced the idea of an international tobacco control treaty and came together as the Framework Convention Alliance (FCA), becoming an important non-state actor within the international system of tobacco control. Archival documents and interviews demonstrate that the FCA successfully used strategies including publication of a newsletter, shaming, symbolism and media advocacy to influence policy positions of countries during the FCTC negotiation. The FCA became influential in the negotiation process by mobilising tobacco control civil society organisations and resources with the help of the Internet and framing the tobacco control discussion around global public health. PMID:19333806

Preventing Unintended Disclosure of Personally Identifiable Data Following Anonymisation.

PubMed

Smith, Chris

2017-01-01

Errors and anomalies during the capture and processing of health data have the potential to place personally identifiable values into attributes of a dataset that are expected to contain non-identifiable values. Anonymisation focuses on those attributes that have been judged to enable identification of individuals. Attributes that are judged to contain non-identifiable values are not considered, but may be included in datasets that are shared by organisations. Consequently, organisations are at risk of sharing datasets that unintendedly disclose personally identifiable values through these attributes. This would have ethical and legal implications for organisations and privacy implications for individuals whose personally identifiable values are disclosed. In this paper, we formulate the problem of unintended disclosure following anonymisation, describe the necessary steps to address this problem, and discuss some key challenges to applying these steps in practice.

Turnaround in an aged persons' mental health service in crisis: a case study of organisational renewal.

PubMed

Stafrace, Simon; Lilly, Alan

2008-08-01

This case study demonstrates how leadership was harnessed to turn around a decline in the performance of an aged persons' mental health service - the Namarra Nursing Home at Caulfield General Medical Centre in Melbourne, Australia. In 2000 the nursing home faced a crisis of public confidence due to failings in the management of quality, clinical risk and human resources within the service. These problems reflected structural and operational shortcomings in the clinical directorate and wider organisation. In this article, we detail the process of turnaround from the perspective of senior executive managers with professional and operational responsibility for the service. This turnaround required attention to local clinical accountability and transformation of the mental health program from a collocated but operationally isolated service to one integrated within the governance structures of the auspicing organisation.

Capability maturity models for offshore organisational management.

PubMed

Strutt, J E; Sharp, J V; Terry, E; Miles, R

2006-12-01

The goal setting regime imposed by the UK safety regulator has important implications for an organisation's ability to manage health and safety related risks. Existing approaches to safety assurance based on risk analysis and formal safety assessments are increasingly considered unlikely to create the step change improvement in safety to which the offshore industry aspires and alternative approaches are being considered. One approach, which addresses the important issue of organisational behaviour and which can be applied at a very early stage of design, is the capability maturity model (CMM). The paper describes the development of a design safety capability maturity model, outlining the key processes considered necessary to safety achievement, definition of maturity levels and scoring methods. The paper discusses how CMM is related to regulatory mechanisms and risk based decision making together with the potential of CMM to environmental risk management.

"Communicate to vaccinate": the development of a taxonomy of communication interventions to improve routine childhood vaccination.

PubMed

Willis, Natalie; Hill, Sophie; Kaufman, Jessica; Lewin, Simon; Kis-Rigo, John; De Castro Freire, Sara Bensaude; Bosch-Capblanch, Xavier; Glenton, Claire; Lin, Vivian; Robinson, Priscilla; Wiysonge, Charles S

2013-05-11

Vaccination is a cost-effective public health measure and is central to the Millennium Development Goal of reducing child mortality. However, childhood vaccination coverage remains sub-optimal in many settings. While communication is a key feature of vaccination programmes, we are not aware of any comprehensive approach to organising the broad range of communication interventions that can be delivered to parents and communities to improve vaccination coverage. Developing a classification system (taxonomy) organised into conceptually similar categories will aid in: understanding the relationships between different types of communication interventions; facilitating conceptual mapping of these interventions; clarifying the key purposes and features of interventions to aid implementation and evaluation; and identifying areas where evidence is strong and where there are gaps. This paper reports on the development of the 'Communicate to vaccinate' taxonomy. The taxonomy was developed in two stages. Stage 1 included: 1) forming an advisory group; 2) searching for descriptions of interventions in trials (CENTRAL database) and general health literature (Medline); 3) developing a sampling strategy; 4) screening the search results; 5) developing a data extraction form; and 6) extracting intervention data. Stage 2 included: 1) grouping the interventions according to purpose; 2) holding deliberative forums in English and French with key vaccination stakeholders to gather feedback; 3) conducting a targeted search of grey literature to supplement the taxonomy; 4) finalising the taxonomy based on the input provided. The taxonomy includes seven main categories of communication interventions: inform or educate, remind or recall, teach skills, provide support, facilitate decision making, enable communication and enhance community ownership. These categories are broken down into 43 intervention types across three target groups: parents or soon-to-be-parents; communities, community members or volunteers; and health care providers. Our taxonomy illuminates and organises this field and identifies the range of available communication interventions to increase routine childhood vaccination uptake. We have utilised a variety of data sources, capturing information from rigorous evaluations such as randomised trials as well as experiences and knowledge of practitioners and vaccination stakeholders. The taxonomy reflects current public health practice and can guide the future development of vaccination programmes.

“Communicate to vaccinate”: the development of a taxonomy of communication interventions to improve routine childhood vaccination

PubMed Central

2013-01-01

Background Vaccination is a cost-effective public health measure and is central to the Millennium Development Goal of reducing child mortality. However, childhood vaccination coverage remains sub-optimal in many settings. While communication is a key feature of vaccination programmes, we are not aware of any comprehensive approach to organising the broad range of communication interventions that can be delivered to parents and communities to improve vaccination coverage. Developing a classification system (taxonomy) organised into conceptually similar categories will aid in: understanding the relationships between different types of communication interventions; facilitating conceptual mapping of these interventions; clarifying the key purposes and features of interventions to aid implementation and evaluation; and identifying areas where evidence is strong and where there are gaps. This paper reports on the development of the ‘Communicate to vaccinate’ taxonomy. Methods The taxonomy was developed in two stages. Stage 1 included: 1) forming an advisory group; 2) searching for descriptions of interventions in trials (CENTRAL database) and general health literature (Medline); 3) developing a sampling strategy; 4) screening the search results; 5) developing a data extraction form; and 6) extracting intervention data. Stage 2 included: 1) grouping the interventions according to purpose; 2) holding deliberative forums in English and French with key vaccination stakeholders to gather feedback; 3) conducting a targeted search of grey literature to supplement the taxonomy; 4) finalising the taxonomy based on the input provided. Results The taxonomy includes seven main categories of communication interventions: inform or educate, remind or recall, teach skills, provide support, facilitate decision making, enable communication and enhance community ownership. These categories are broken down into 43 intervention types across three target groups: parents or soon-to-be-parents; communities, community members or volunteers; and health care providers. Conclusions Our taxonomy illuminates and organises this field and identifies the range of available communication interventions to increase routine childhood vaccination uptake. We have utilised a variety of data sources, capturing information from rigorous evaluations such as randomised trials as well as experiences and knowledge of practitioners and vaccination stakeholders. The taxonomy reflects current public health practice and can guide the future development of vaccination programmes. PMID:23663327

Spatial Knowledge Infrastructures - Creating Value for Policy Makers and Benefits the Community

NASA Astrophysics Data System (ADS)

Arnold, L. M.

2016-12-01

The spatial data infrastructure is arguably one of the most significant advancements in the spatial sector. It's been a game changer for governments, providing for the coordination and sharing of spatial data across organisations and the provision of accessible information to the broader community of users. Today however, end-users such as policy-makers require far more from these spatial data infrastructures. They want more than just data; they want the knowledge that can be extracted from data and they don't want to have to download, manipulate and process data in order to get the knowledge they seek. It's time for the spatial sector to reduce its focus on data in spatial data infrastructures and take a more proactive step in emphasising and delivering the knowledge value. Nowadays, decision-makers want to be able to query at will the data to meet their immediate need for knowledge. This is a new value proposal for the decision-making consumer and will require a shift in thinking. This paper presents a model for a Spatial Knowledge Infrastructure and underpinning methods that will realise a new real-time approach to delivering knowledge. The methods embrace the new capabilities afforded through the sematic web, domain and process ontologies and natural query language processing. Semantic Web technologies today have the potential to transform the spatial industry into more than just a distribution channel for data. The Semantic Web RDF (Resource Description Framework) enables meaning to be drawn from data automatically. While pushing data out to end-users will remain a central role for data producers, the power of the semantic web is that end-users have the ability to marshal a broad range of spatial resources via a query to extract knowledge from available data. This can be done without actually having to configure systems specifically for the end-user. All data producers need do is make data accessible in RDF and the spatial analytics does the rest.

How to change organisational culture: Action research in a South African public sector primary care facility

PubMed Central

De Sa, Angela; Christodoulou, Maria

2016-01-01

Background Organisational culture is a key factor in both patient and staff experience of the healthcare services. Patient satisfaction, staff engagement and performance are related to this experience. The department of health in the Western Cape espouses a values-based culture characterised by caring, competence, accountability, integrity, responsiveness and respect. However, transformation of the existing culture is required to achieve this vision. Aim To explore how to transform the organisational culture in line with the desired values. Setting Retreat Community Health Centre, Cape Town, South Africa. Methods Participatory action research with the leadership engaged with action and reflection over a period of 18 months. Change in the organisational culture was measured at baseline and after 18 months by means of a cultural values assessment (CVA) survey. The three key leaders at the health centre also completed a 360-degree leadership values assessment (LVA) and had 6 months of coaching. Results Cultural entropy was reduced from 33 to 13% indicating significant transformation of organisational culture. The key driver of this transformation was change in the leadership style and functioning. Retreat health centre shifted from a culture that emphasised hierarchy, authority, command and control to one that established a greater sense of cohesion, shared vision, open communication, appreciation, respect, fairness and accountability. Conclusion Transformation of organisational culture was possible through a participatory process that focused on the leadership style, communication and building relationships by means of CVA and feedback, 360-degree LVA, feedback and coaching and action learning in a co-operative inquiry group. PMID:27608671

Policy interventions implemented through sporting organisations for promoting healthy behaviour change.

PubMed

Priest, Naomi; Armstrong, Rebecca; Doyle, Jodie; Waters, Elizabeth

2008-07-16

Sporting organisations provide an important setting for health promotion strategies that involve policies, communication of healthy messages and creation of health promoting environments. The introduction of policy interventions within sporting organisations is one strategy to target high risk behaviours such as smoking, alcohol consumption, excess sun exposure, unhealthy eating and discrimination. To update a review of all controlled studies evaluating policy interventions organised through sporting settings to increase healthy behaviour (related to smoking, alcohol, healthy eating, sun protection, discrimination, safety and access). We updated the original (2004) searches in May 2007. We searched: the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2 2007); MEDLINE and MEDLINE In-Process and Other Non-Indexed Citations (2004 to Week 3 April 2007); EMBASE (2004 to Week 17 2007); PsyclNFO (2004 to April Week 1 2007); CINAHL (2004 to Week 1 May 2007); SPORTDiscus (2004 to April 2007); Sociological Abstracts (2004 to 2007); Dissertation Abstracts (2004 to May 2007), ERIC (2000 to 2007), freely available online health promotion and sports-related databases hosted by leading agencies, and the internet using sport and policy-related key words. Controlled studies evaluating any policy intervention implemented through sporting organisations to instigate and/or sustain healthy behaviour change, intention to change behaviour, or changes in attitudes, knowledge or awareness of healthy behaviour, in people of all ages. Policies must address any of the following: smoking, alcohol, healthy eating, sun protection, access for disadvantaged groups, physical safety (not including injuries), and social and emotional health (e.g. anti-vilification, anti-discrimination). Uncontrolled studies which met the other inclusion criteria were to be reported in an annex to the review. We assessed whether identified citations met the inclusion criteria. Abstracts were inspected independently by two review authors and full papers were obtained where necessary. As we located no controlled evaluation studies, we did not undertake data collection or analysis. We found no uncontrolled studies meeting other inclusion criteria, and therefore present no annex to the review. We found no rigorous studies evaluating the effectiveness of policy interventions organised through sporting organisations to increase healthy behaviours, attitudes, knowledge or the inclusion of health-oriented policies within the organisations. We found no controlled studies to guide the use of policy interventions used in sporting settings. The original (2004) searches identified a number of case studies with anecdotal reporting of outcomes. We strongly recommend that rigorous evaluation techniques are employed more commonly in this field to illuminate the impact of health promoting policy on outcomes, and the contexts and processes which are likely to be effective in reducing harmful behaviours.

Benefits negotiation: three Swedish hospitals pursuit of potential electronic health record benefits.

PubMed

Jeansson, John S

2013-01-01

At the very heart of Swedish healthcare digitalisation are large investments in electronic health records (EHRs). These integrated information systems (ISs) carry promises of great benefits and value for organisations. However, realising IS benefits and value has, in general, proven to be a challenging task, and as organisations strive to formalise their realisation efforts a misconception of rationality threatens to emerge. This misconception manifests itself when the formality of analysis threatens to underrate the impact of social processes in deciding which potential benefits to pursue. This paper suggests that these decisions are the result of a social process of negotiation. The purpose of this paper is to observe three benefits analysis projects of three Swedish hospitals to better understand the character and management of proposed benefits negotiations. Findings depict several different categories of benefits negotiations, as well as key factors to consider during the benefits negotiation process.

Experience with the Implementation of Clinical Pharmacy Services and Processes in a University Hospital in Belgium.

PubMed

Somers, Annemie; Claus, Barbara; Vandewoude, Koen; Petrovic, Mirko

2016-03-01

This article summarizes the experience with the development of clinical pharmacy services in the Ghent University Hospital in Belgium. Implementation of clinical pharmacy services in Belgian hospitals has not been evident because these activities were initially not structurally financed. The aim is to describe the strengths and weaknesses of the clinical pharmacy development process, and the milestones that enhanced the progress. Furthermore, the organisation of clinical pharmacy in the Ghent University Hospital is explained, including back- and front-office activities, seamless pharmaceutical care and medication safety improvement. Some working methods, procedures and tools are explained for different clinical pharmacy services. In particular, the clinical pharmacy projects for geriatric patients as well as the preparation of clinical pharmacy services for the accreditation process are explained. We also reflect on the organisation model and the future development of clinical pharmacy, taking into consideration facilitators and potential barriers.

Systematic review on embracing cultural diversity for developing and sustaining a healthy work environment in healthcare.

PubMed

Pearson, Alan; Srivastava, Rani; Craig, Dianna; Tucker, Donna; Grinspun, Doris; Bajnok, Irmajean; Griffin, Pat; Long, Leslye; Porritt, Kylie; Han, Thuzar; Gi, Aye A

2007-03-01

Objectives  The objective of this review was to evaluate evidence on the structures and processes that support development of effective culturally competent practices and a healthy work environment. Culturally competent practices are a congruent set of workforce behaviours, management practices and institutional policies within a practice setting resulting in an organisational environment that is inclusive of cultural and other forms of diversity. Inclusion criteria  This review included quantitative and qualitative evidence, with a particular emphasis on identifying systematic reviews and randomised controlled trials. For quantitative evidence, other controlled, and descriptive designs were also included. For qualitative evidence, all methodologies were considered. Participants were staff, patients, and systems or policies that were involved or affected by concepts of cultural competence in the nursing workforce in a healthcare environment. Types of interventions included any strategy that had a cultural competence component, which influenced the work environment, and/or patient and nursing staff in the environment. The types of outcomes of interest to this review included nursing staff outcomes, patient outcomes, organisational outcomes and systems level outcomes. Search strategy  The search sought both published and unpublished literature written in the English language. A comprehensive three-step search strategy was used, first to identify appropriate key words, second to combine all optimal key words into a comprehensive search strategy for each database and finally to review the reference lists of all included reviews and research reports. The databases searched were CINAHL, Medline, Current Contents, the Database of Abstracts of Reviews of Effectiveness, The Cochrane Library, PsycINFO, Embase, Sociological Abstracts, Econ lit, ABI/Inform, ERIC and PubMed. The search for unpublished literature used Dissertation Abstracts International. Methodological quality  Methodological quality was independently established by two reviewers, using standardised techniques from the Joanna Briggs Institute (JBI) System for the Unified Management, Assessment and Review of Information (SUMARI) package. Discussion with a third reviewer was initiated where a low level of agreement was identified for a particular paper. Following inclusion, data extraction was conducted using standardised data extraction tools from the JBI SUMARI suite for quantitative and qualitative research. Data synthesis was performed using the JBI Qualitative Assessment and Review Instrument and JBI Narrative, Opinion and Text Assessment and Review Instrument software to aggregate findings by identifying commonalities across texts. Quantitative data were presented in narrative summary, as statistical pooling was not appropriate with the included studies. Results  Of the 659 identified papers, 45 were selected for full paper retrieval, and 19 were considered to meet the inclusion criteria for this review. The results identified a number of processes that would contribute to the development of a culturally competent workforce. Appropriate and competent linguistic services, and intercultural staff training and education, were identified as key findings in this review. Conclusions  The review recommends that health provider agencies establish links with organisations that can address needs of culturally diverse groups of patients, include cultural competence in decision support systems and staff education as well as embed them in patient brochures and educational materials. The review also concluded that staff in-service programs consider the skills needed to foster a culturally competent workforce, and recruitment strategies that also explicitly address this need.

Surface water connectivity drives richness and composition of Arctic lake fish assemblages

USGS Publications Warehouse

Laske, Sarah M.; Haynes, Trevor B.; Rosenberger, Amanda E.; Koch, Joshua C.; Wipfli, Mark S.; Whitman, Matthew; Zimmerman, Christian E.

2016-01-01

This work provides useful baseline information on the processes that drive the relations between patch connectivity and fish species richness and assemblage composition. The environmental processes that organise fish assemblages in Arctic lakes are likely to change in a warming climate.

Towards Cross-Organizational Innovative Business Process Interoperability Services

NASA Astrophysics Data System (ADS)

Karacan, Ömer; Del Grosso, Enrico; Carrez, Cyril; Taglino, Francesco

This paper presents the vision and initial results of the COIN (FP7-IST-216256) European project for the development of open source Collaborative Business Process Interoperability (CBPip) in cross-organisational business collaboration environments following the Software-as-a-Service Utility (SaaS-U) paradigm.

Improving health professionals' management and the organisation of care for overweight and obese people.

PubMed

Harvey, E L; Glenny, A; Kirk, S F; Summerbell, C D

2000-01-01

Obesity is increasing throughout the industrialised world. If left unchecked it will have major implications for both population health and costs to health services. Health professionals have a key role to play in tackling the obesity problem, but little is known about how they may be encouraged to work more effectively with overweight and obese people. The main objective was to determine whether health professionals' management or the organisation of care for overweight and obese people could be improved. We searched the specialised registers of the Cochrane Effective Practice and Organisation of Care Group (May 1997), the Cochrane Depression, Anxiety and Neurosis Group (August 1997), the Cochrane Diabetes Group (August 1997), the Cochrane Controlled Trials Register (September 1997), MEDLINE to January 1998, EMBASE to December 1997, Cinahl (1982 to November 1997), PsycLit (1974 to December 1997), Sigle (1980 to November 1997), Sociofile (1974 to October 1997), Dissertation Abstracts (1861 to January 1998), Conference Papers Index (1973 to January 1998), Resource Database in Continuing Medical Education. We also hand searched seven key journals and contacted experts in the field. Randomised trials, controlled before-and-after studies and interrupted time series analyses of providers' management of obesity or the organisation of care to improve provider practice or patient outcomes. We addressed three a priori comparisons and a fourth post hoc comparison. 1. Interventions aimed at improving health professionals' management or the delivery of health care for overweight/obese patients are more effective than usual care. 2. Interventions aimed at redressing negative attitudes and related practices towards overweight/obese patients are more effective than usual care. 3. Organisational interventions designed to change the structure of services for overweight/obese people are more effective than educational or behavioural interventions for health professionals. 4. Comparisons of different organisational interventions. Two reviewers independently extracted data and assessed study quality. Twelve studies were included involving more than 393 providers and 3392 patients. Four studies were identified for comparison 1. Three were professional-oriented interventions (the use of reminders and training) and the fourth was a study of professional and organisational interventions of shared care. No studies were identified for comparisons 2 or 3. Eight studies were identified for post hoc comparison 4. These compared either the deliverer of weight loss interventions or the setting of interventions. The included studies were heterogeneous and of generally poor quality. At present, decisions about improving provision of services must be based on the evidence of patient interventions and good clinical judgement. Further research is needed to identify cost effective strategies for improving the management of obesity.

The Context, Process, and Outcome Evaluation Model for Organisational Health Interventions

PubMed Central

Fridrich, Annemarie; Jenny, Gregor J.; Bauer, Georg F.

2015-01-01

To facilitate evaluation of complex, organisational health interventions (OHIs), this paper aims at developing a context, process, and outcome (CPO) evaluation model. It builds on previous model developments in the field and advances them by clearly defining and relating generic evaluation categories for OHIs. Context is defined as the underlying frame that influences and is influenced by an OHI. It is further differentiated into the omnibus and discrete contexts. Process is differentiated into the implementation process, as the time-limited enactment of the original intervention plan, and the change process of individual and collective dynamics triggered by the implementation process. These processes lead to proximate, intermediate, and distal outcomes, as all results of the change process that are meaningful for various stakeholders. Research questions that might guide the evaluation of an OHI according to the CPO categories and a list of concrete themes/indicators and methods/sources applied within the evaluation of an OHI project at a hospital in Switzerland illustrate the model's applicability in structuring evaluations of complex OHIs. In conclusion, the model supplies a common language and a shared mental model for improving communication between researchers and company members and will improve the comparability and aggregation of evaluation study results. PMID:26557665

The Context, Process, and Outcome Evaluation Model for Organisational Health Interventions.

PubMed

Fridrich, Annemarie; Jenny, Gregor J; Bauer, Georg F

2015-01-01

To facilitate evaluation of complex, organisational health interventions (OHIs), this paper aims at developing a context, process, and outcome (CPO) evaluation model. It builds on previous model developments in the field and advances them by clearly defining and relating generic evaluation categories for OHIs. Context is defined as the underlying frame that influences and is influenced by an OHI. It is further differentiated into the omnibus and discrete contexts. Process is differentiated into the implementation process, as the time-limited enactment of the original intervention plan, and the change process of individual and collective dynamics triggered by the implementation process. These processes lead to proximate, intermediate, and distal outcomes, as all results of the change process that are meaningful for various stakeholders. Research questions that might guide the evaluation of an OHI according to the CPO categories and a list of concrete themes/indicators and methods/sources applied within the evaluation of an OHI project at a hospital in Switzerland illustrate the model's applicability in structuring evaluations of complex OHIs. In conclusion, the model supplies a common language and a shared mental model for improving communication between researchers and company members and will improve the comparability and aggregation of evaluation study results.

Organisational values and organisational commitment: do nurses' ethno-cultural differences matter?

PubMed

Hendel, Tova; Kagan, Ilya

2014-05-01

To examine the association between perceived organisational values and organisational commitment among Israeli nurses in relation to their ethno-cultural background. Differences and the discrepancy between individuals' organisational values and those of their organisational culture are a potential source of adjustment difficulties. Organisational values are considered to be the bond of the individual to their organisation. In multicultural societies, such as Israel, the differences in perception of organisational values and organisational commitment may be reflected within workgroups. Data were collected using a questionnaire among 106 hospital nurses. About 59.8% of the sample were Israeli-born. A positive correlation was found between organisational values and organisational commitment. Significant differences were found in organisational values and organisational commitment between Israeli-born-, USSR-born- and Ethiopian-born nurses. The socio-demographic profile modified the effect of organisational values on organisational commitment: when the nurse was male, Muslim, religiously orthodox and without academic education, the effect of organisational values on organisational commitment was higher. Findings confirm the role of culture and ethnicity in the perception of organisational values and the level of organisational commitment among nurses. Assessing ethno-cultural differences in organisational values and organisational commitment provides a fuller understanding of nurses' ability to adjust to their work environment and helps nurse managers devise means to increase nurses' commitment. © 2012 John Wiley & Sons Ltd.

An optimal baseline selection methodology for data-driven damage detection and temperature compensation in acousto-ultrasonics

NASA Astrophysics Data System (ADS)

Torres-Arredondo, M.-A.; Sierra-Pérez, Julián; Cabanes, Guénaël

2016-05-01

The process of measuring and analysing the data from a distributed sensor network all over a structural system in order to quantify its condition is known as structural health monitoring (SHM). For the design of a trustworthy health monitoring system, a vast amount of information regarding the inherent physical characteristics of the sources and their propagation and interaction across the structure is crucial. Moreover, any SHM system which is expected to transition to field operation must take into account the influence of environmental and operational changes which cause modifications in the stiffness and damping of the structure and consequently modify its dynamic behaviour. On that account, special attention is paid in this paper to the development of an efficient SHM methodology where robust signal processing and pattern recognition techniques are integrated for the correct interpretation of complex ultrasonic waves within the context of damage detection and identification. The methodology is based on an acousto-ultrasonics technique where the discrete wavelet transform is evaluated for feature extraction and selection, linear principal component analysis for data-driven modelling and self-organising maps for a two-level clustering under the principle of local density. At the end, the methodology is experimentally demonstrated and results show that all the damages were detectable and identifiable.

Framework development for the assessment of interprofessional teamwork in mental health settings.

PubMed

Tomizawa, Ryoko; Shigeta, Masahiro; Reeves, Scott

2017-01-01

In mental health settings, interprofessional practice is regarded as a comprehensive approach to prevent relapse and manage chronic conditions with practice of various teamwork interventions. To reinforce the potential of interprofessional teamwork, it is recommended that theories or conceptual frameworks be employed. There continues, however, to be a limited use of such approaches that assess the quality of interprofessional teamwork in mental health settings. This article aimed to present a new conceptual framework for the assessment of interprofessional teamwork based on the findings of a scoping review of the literature. This review was undertaken to identify conceptual frameworks utilised in interprofessional teamwork in mental health settings. After reviewing 952 articles, the methodological characteristics extracted from 12 articles were considered. The included studies were synthesised into the Donabedian structure-process-outcome model. The findings revealed that structural issues comprised three elements: professional characteristics, client-care characteristics, and contextual characteristics in organisations. Process issues comprised two elements: team mechanisms and community-oriented services. Finally, outcome issues comprised the following elements: clients' outcomes and professionals' outcomes. The review findings suggested possibilities for further development of how to assess the quality of interprofessional teamwork and provided information about what specific approach is required to improve interprofessional teamwork. Future research should utilise various areas and cultures to clarify the adaptation potential.

Illusion or delusion--Lean management in the health sector.

PubMed

McIntosh, Bryan; Sheppy, Bruce; Cohen, Ivan

2014-01-01

There has been considerable interest in the implementation of practices imported from manufacturing into healthcare as a solution to rising healthcare spending and disappointing patient safety indicators. One approach that has attracted particular interest is Lean management and the purpose of this paper is to engage with this topic. Secondary research. Despite widespread enthusiasm about the potential of Lean management processes, evidence about its contribution to higher organisational performance remains inconsistent. This paper engages with the major Lean concepts of operations management and human resource management, including just-in-time, total quality management, total productive maintenance and does not engage in-depth with concepts related to employee empowerment, and training This paper contributes to the organisational management literature in healthcare by showing that although Lean management seems to have the potential to improve organisational performance it is far from a panacea against under performing hospitals. It informs policy making by suggesting that a progressive managerial philosophy has a stronger impact on healthcare performance than the adoption of practices from any particular managerial approach. This paper provides a critical evaluation of the impact of Lean practices in informing healthcare policy. The paper contributes to the organisational management literature in healthcare by showing that even though Lean management in healthcare appears to have the potential to improve organisational performance; there remain problems with its application.

Improving delivery of a health-promoting-environments program: experiences from Queensland Health.

PubMed

Dwyer, S

1997-01-01

The purpose of this paper is to outline the key components of a statewide multisite health-promoting-environments program. Contemporary health-promotion programs in settings such as schools, workplaces and hospitals use organisational development theory to address the health issues of the setting, including the physical environment, the organisational environment, and the specific health needs of the employees and consumers of the service. Program principles include management of each project by the participant organisation or site (for example, a school or workplace), using resources available within the organisation and the local community, voluntary participation, social justice and participant-based priority setting, and evaluation and monitoring. Adoption of these principles implies a shift in the role of the health worker from implementer to facilitator. Based on the experience of Queensland Health, it is proposed that the essential building blocks of the health-promoting-environments program are an intersectoral policy base, a model for action, training and resources, local facilitators, support from local organisations, a supportive network of sites, marketing of the program, and a state-based evaluation and monitoring system. The program in Queensland was able to develop a significant number of these components over the 1990-1996 period. In regard to evaluation, process measures can be built around the program components; however, further research is required for development of impact indicators and benchmarks on quality.

Mediating toxic emotions in the workplace--the impact of abusive supervision.

PubMed

Chu, Li-Chuan

2014-11-01

This study explores whether abusive supervision can effectively predict employees' counterproductive work behaviour (CWB) and organisational citizenship behaviour (OCB) and the role of toxic emotions at work as a potential mediator of these relationships in nursing settings. Workplace bullying is widespread in nursing. Despite the growing literature on abusive supervision and employees' counterproductive work behaviour and organisational citizenship behaviour, few studies have examined the relationships between abusive supervision and these work behaviours from the viewpoint of the victimed employee's emotion process. This study adopted a two-stage survey of 212 nurses, all of whom were employed by hospitals in Taiwan. Hypotheses were tested through the use of hierarchical multiple regression. The results showed that abusive supervision was positively associated with toxic emotions. Moreover, toxic emotions could effectively predict nurses' counterproductive work behaviour and organisational citizenship behaviour. Finally, it was found that toxic emotions partially mediated the negative effects of abusive supervision on both work behaviours. Toxic emotions at work are a critical mediating variable between abusive supervision and both counterproductive work behaviour and organisational citizenship behaviour. Hospital administrators can implement policies designed to manage events effectively that can spark toxic emotions in their employees. Work empowerment may be an effective way to reduce counterproductive work behaviour and to enhance organisational citizenship behaviour among nurses when supervisors do not promote a healthy work environment for them. © 2013 John Wiley & Sons Ltd.

Field trials of a novel toolkit for evaluating 'intangible' values-related dimensions of projects.

PubMed

Burford, Gemma; Velasco, Ismael; Janoušková, Svatava; Zahradnik, Martin; Hak, Tomas; Podger, Dimity; Piggot, Georgia; Harder, Marie K

2013-02-01

A novel toolkit has been developed, using an original approach to develop its components, for the purpose of evaluating 'soft' outcomes and processes that have previously been generally considered 'intangible': those which are specifically values based. This represents a step-wise, significant, change in provision for the assessment of values-based achievements that are of absolutely key importance to most civil society organisations (CSOs) and values-based businesses, and fills a known gap in evaluation practice. In this paper, we demonstrate the significance and rigour of the toolkit by presenting an evaluation of it in three diverse scenarios where different CSOs use it to co-evaluate locally relevant outcomes and processes to obtain results which are both meaningful to them and potentially comparable across organisations. A key strength of the toolkit is its original use of a prior generated, peer-elicited 'menu' of values-based indicators which provides a framework for user CSOs to localise. Principles of participatory, process-based and utilisation-focused evaluation are embedded in this toolkit and shown to be critical to its success, achieving high face-validity and wide applicability. The emerging contribution of this next-generation evaluation tool to other fields, such as environmental values, development and environmental sustainable development, shared values, business, education and organisational change is outlined. Copyright © 2012 Elsevier Ltd. All rights reserved.

Creating meaningful business continuity management programme metrics.

PubMed

Strong, Brian

2010-11-01

The popular axiom, 'what gets measured gets done', is often applied in the quality management and continuous improvement disciplines. This truism is also useful to business continuity practitioners as they continually strive to prove the value of their organisation's investment in a business continuity management (BCM) programme. BCM practitioners must also remain relevant to their organisations as executives focus on the bottom line and maintaining stakeholder confidence. It seems that executives always find a way, whether in a hallway or elevator, to ask BCM professionals about the company's level of readiness. When asked, they must be ready with an informed response. The establishment of a process to measure business continuity programme performance and organisational readiness has emerged as a key component of US Department of Homeland Security 'Voluntary Private Sector Preparedness (PS-Prep) Program' standards where the overarching goal is to improve private sector preparedness for disasters and emergencies. The purpose of this paper is two-fold: to introduce continuity professionals to best practices that should be considered when developing a BCM metrics programme as well as providing a case study of how a large health insurance company researched, developed and implemented a process to measure BCM programme performance and company readiness.

A case study of the changing nature of a non-government organisation: a focus on disability and development.

PubMed

Yoshida, Karen K; Parnes, Penny; Brooks, Dina; Cameron, Deb

2009-01-01

The purpose of this article is to describe the changing nature, process and structure of an international non-governmental organisation (NGO) in response to internal and external factors. This article is based on the interview data collected for the study which focussed on the experiences and perception of key informants on trends related to official development assistance, local governments' perspective of the NGO as a development partner and the NGO's perception of corporate and foundation support. Qualitative descriptive data analysis was used. Three main themes were developed with the interview data. Our analysis indicated shifts in the: (1) vision/nature (single to cross disability focus), (2) structure (building internal and external relationships) and (3) process (from ad hoc to systemic evaluations). These broader issues of vision, structure (relationships) and evaluation within and outside of the organisation, needs to be addressed to provide a foundation upon which funding initiatives can be developed. A closer relationship between funders and projects/programmes would do much to enhance the partnership and would ensure that the projects are able to measure and report results in a manner that is conducive to increasing support.

Locating regional health policy: Institutions, politics, and practices.

PubMed

Riggirozzi, Pia; Yeates, Nicola

2015-12-01

Poverty reduction and health became central in the agendas of Southern regional organisations in the last two decades. Yet, little is known about how these organisations address poverty, inclusion and social inequality, and how Southern regional formations are engaging in power constellations, institutions, processes, interests and ideological positions within different spheres of governance. This article reviews academic literatures spanning global social policy, regional studies and diplomacy studies, and the state of knowledge and understanding of the 'place' of regional actors in health governance as a global political practice therein. It identifies theoretical and thematic points of connection between disparate literatures and how these can be bridged through research focusing on the social policies of regional organisations and regional integration processes. This framework hence locates the contributions of each of the research articles of this Special Issue of Global Social Policy on the regional dimension of health policy and diplomacy in relation to Southern Africa and South America. It also highlights the ways in which the articles bring new evidence about how social relations of welfare are being (re)made over larger scales and how regional actors may initiate new norms to improve health rights in international arenas engaging in new forms of 'regional' diplomacy.

Revalidation and quality assurance: the application of the MUSIQ framework in independent verification visits to healthcare organisations

PubMed Central

Griffin, Ann; Viney, Rowena; Welland, Trevor; Gafson, Irene

2017-01-01

Objectives We present a national evaluation of the impact of independent verification visits (IVVs) performed by National Health Service (NHS) England as part of quality assuring medical revalidation. Organisational visits are central to NHS quality assurance. They are costly, yet little empirical research evidence exists concerning their impact, and what does exist is conflicting. Setting The focus was on healthcare providers in the NHS (in secondary care) and private sector across England, who were designated bodies (DBs). DBs are healthcare organisations that have a statutory responsibility, via the lead clinician, the responsible officer (RO), to implement medical revalidation. Participants All ROs who had undergone an IVV in England in 2014 and 2015 were invited to participate. 46 ROs were interviewed. Ethnographic data were gathered at 18 observations of the IVVs and 20 IVV post visit reports underwent documentary analysis. Primary and secondary outcome measures Primary outcomes were the findings pertaining to the effectiveness of the IVV system in supporting the revalidation processes at the DBs. Secondary outcomes were methodological, relating to the Model for Understanding Success in Quality (MUSIQ) and how its application to the IVV reveals the relevance of contextual factors described in the model. Results The impact of the IVVs varied by DB according to three major themes: the personal context of the RO; the organisational context of the DB; and the visit and its impact. ROs were largely satisfied with visits which raised the status of appraisal within their organisations. Inadequate or untimely feedback was associated with dissatisfaction. Conclusions Influencing teams whose prime responsibility is establishing processes and evaluating progress was crucial for internal quality improvement. Visits acted as a nudge, generating internal quality review, which was reinforced by visit teams with relevant expertise. Diverse team membership, knowledge transfer and timely feedback made visits more impactful. PMID:28196952

Revalidation and quality assurance: the application of the MUSIQ framework in independent verification visits to healthcare organisations.

PubMed

Griffin, Ann; McKeown, Alex; Viney, Rowena; Rich, Antonia; Welland, Trevor; Gafson, Irene; Woolf, Katherine

2017-02-14

We present a national evaluation of the impact of independent verification visits (IVVs) performed by National Health Service (NHS) England as part of quality assuring medical revalidation. Organisational visits are central to NHS quality assurance. They are costly, yet little empirical research evidence exists concerning their impact, and what does exist is conflicting. The focus was on healthcare providers in the NHS (in secondary care) and private sector across England, who were designated bodies (DBs). DBs are healthcare organisations that have a statutory responsibility, via the lead clinician, the responsible officer (RO), to implement medical revalidation. All ROs who had undergone an IVV in England in 2014 and 2015 were invited to participate. 46 ROs were interviewed. Ethnographic data were gathered at 18 observations of the IVVs and 20 IVV post visit reports underwent documentary analysis. Primary outcomes were the findings pertaining to the effectiveness of the IVV system in supporting the revalidation processes at the DBs. Secondary outcomes were methodological, relating to the Model for Understanding Success in Quality (MUSIQ) and how its application to the IVV reveals the relevance of contextual factors described in the model. The impact of the IVVs varied by DB according to three major themes: the personal context of the RO; the organisational context of the DB; and the visit and its impact. ROs were largely satisfied with visits which raised the status of appraisal within their organisations. Inadequate or untimely feedback was associated with dissatisfaction. Influencing teams whose prime responsibility is establishing processes and evaluating progress was crucial for internal quality improvement. Visits acted as a nudge, generating internal quality review, which was reinforced by visit teams with relevant expertise. Diverse team membership, knowledge transfer and timely feedback made visits more impactful. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

How reliable are clinical systems in the UK NHS? A study of seven NHS organisations

PubMed Central

Franklin, Bryony Dean; Moorthy, Krishna; Cooke, Matthew W; Vincent, Charles

2012-01-01

Background It is well known that many healthcare systems have poor reliability; however, the size and pervasiveness of this problem and its impact has not been systematically established in the UK. The authors studied four clinical systems: clinical information in surgical outpatient clinics, prescribing for hospital inpatients, equipment in theatres, and insertion of peripheral intravenous lines. The aim was to describe the nature, extent and variation in reliability of these four systems in a sample of UK hospitals, and to explore the reasons for poor reliability. Methods Seven UK hospital organisations were involved; each system was studied in three of these. The authors took delivery of the systems' intended outputs to be a proxy for the reliability of the system as a whole. For example, for clinical information, 100% reliability was defined as all patients having an agreed list of clinical information available when needed during their appointment. Systems factors were explored using semi-structured interviews with key informants. Common themes across the systems were identified. Results Overall reliability was found to be between 81% and 87% for the systems studied, with significant variation between organisations for some systems: clinical information in outpatient clinics ranged from 73% to 96%; prescribing for hospital inpatients 82–88%; equipment availability in theatres 63–88%; and availability of equipment for insertion of peripheral intravenous lines 80–88%. One in five reliability failures were associated with perceived threats to patient safety. Common factors causing poor reliability included lack of feedback, lack of standardisation, and issues such as access to information out of working hours. Conclusions Reported reliability was low for the four systems studied, with some common factors behind each. However, this hides significant variation between organisations for some processes, suggesting that some organisations have managed to create more reliable systems. Standardisation of processes would be expected to have significant benefit. PMID:22495099

Civil society engagement in multi-stakeholder dialogue: a qualitative study exploring the opinions and perceptions of MeTA members.

PubMed

Buckland-Merrett, Gemma L; Kilkenny, Catherine; Reed, Tim

2017-01-01

The Medicines Transparency Alliance (MeTA) is an initiative that brings together all stakeholders in the medicines market to create a multi-stakeholder dialogue and improve access, availability and affordability of medicines. Key to this multi-stakeholder dialogue is the participation of Civil Society Organisations. A recent MeTA annual review, identified uneven engagement of civil society organisations in the multi-stakeholder process. This study was designed to explore the engagement of Civil Society Organisations in the MeTA multi-stakeholder process and the factors influencing their participation. Participants were drawn from a convenience sample of key MeTA informants attending a MeTA global meeting in Geneva in 2014. Study participants consisted of members of MeTA, which included representatives from government, the private sector and civil society. In-depth semi-structured face-to-face interviews were conducted to identify perceptions around the barriers to civil society engagement in the multi-stakeholder process. Interviews were guided by a conceptual framework exploring the three main themes of the political environment, relative stakeholder strength and agenda setting/gatekeepers. Interviews were structured to enable additional themes to emerge and be explored. Fifteen interviews were conducted. The interviews were audio recorded, transcribed verbatim and analysed using a general inductive approach. All interviewees provided written informed consent. Findings were captured within three main overarching themes: the political environment, relative stakeholder strength and agenda setting/gatekeepers, with the opportunity for additional themes to emerge in the interviewing process. The study conformed these three themes were important in the engagement process. Participants reported that civil society engagement is particularly limited by those who set the agenda. It was largely seen that the political environment was the significant factor that enabled or disabled all others. The findings counter the argument that CSO barriers to engagement are predominantly due to capacity issues. This study enriches previous findings by providing insights into civil society participation in multi-stakeholder dialogue, specifically the MeTA initiative. The development of more rigorous and systematic accountability mechanisms in order to maintain the legitimacy of decision-making processes and establish more equal power relations would significantly benefit the engagement of civil society organisations. The results inform practical recommendations for MeTA and future multi-stakeholder programmes tasked with improving policy on the access, availability and affordability of medicines.

How alcohol industry organisations mislead the public about alcohol and cancer.

PubMed

Petticrew, Mark; Maani Hessari, Nason; Knai, Cécile; Weiderpass, Elisabete

2018-03-01

Alcohol consumption increases the risk of several types of cancer, including several common cancers. As part of their corporate social responsibility activities, the alcohol industry (AI) disseminates information about alcohol and cancer. We examined the information on this which the AI disseminates to the public through its 'social aspects and public relations organizations' and related bodies. The aim of the study was to determine its comprehensiveness and accuracy. Qualitative analysis of websites and documents from 27 AI organisations. All text relating to cancer was extracted and analysed thematically. Most of the organisations were found to disseminate misrepresentations of the evidence about the association between alcohol and cancer. Three main industry strategies were identified: (i) denial/omission: denying, omitting or disputing the evidence that alcohol consumption increases cancer risk; (ii) distortion: mentioning cancer, but misrepresenting the risk; and (iii) distraction: focussing discussion away from the independent effects of alcohol on common cancers. Breast cancer and colorectal cancer appeared to be a particular focus for this misrepresentation. The AI appears to be engaged in the extensive misrepresentation of evidence about the alcohol-related risk of cancer. These activities have parallels with those of the tobacco industry. This finding is important because the industry is involved in developing alcohol policy in many countries, and in disseminating health information to the public, including schoolchildren. Policymakers, academics, public health and other practitioners should reconsider the appropriateness of their relationships to these AI bodies. © 2017 Australasian Professional Society on Alcohol and other Drugs.

Methodological Challenges for Collaborative Learning Research

ERIC Educational Resources Information Center

Strijbos, Jan-Willem; Fischer, Frank

2007-01-01

Research on collaborative learning, both face-to-face and computer-supported, has thrived in the past 10 years. The studies range from outcome-oriented (individual and group learning) to process-oriented (impact of interaction on learning processes, motivation and organisation of collaboration) to mixed studies. Collaborative learning research is…

Language processing is not a race against time.

PubMed

Baggio, Giosuè; Vicario, Carmelo M

2016-01-01

We agree with Christiansen & Chater (C&C) that language processing and acquisition are tightly constrained by the limits of sensory and memory systems. However, the human brain supports a range of cognitive functions that mitigate the effects of information processing bottlenecks. The language system is partly organised around these moderating factors, not just around restrictions on storage and computation.

Concept Development in Learning Physics: The Case of Electric Current and Voltage Revisited

ERIC Educational Resources Information Center

Koponen, Ismo T.; Huttunen, Laura

2013-01-01

In learning conceptual knowledge in physics, a common problem is the development and differentiation of concepts in the learning process. An important part of this development process is the re-organisation or re-structuring process in which students' conceptual knowledge and concepts change. This study proposes a new view of concept…

Innovative Use of Quality Management Methods for Product Improvement

NASA Astrophysics Data System (ADS)

Midor, Katarzyna; Žarnovský, Jozef

2016-12-01

Organisations constantly look for new, innovative solutions and methods which could be used to improve their efficiency and increase the quality of their products. Identifying the causes for returns is an important issue for modern companies, as returns are the cause for the increase in production costs and, most importantly, the loss of credibility in the eyes of the client. Therefore, for the company to be able to sustain or strengthen its position on the market, it has to follow the rules of quality management. Especially important is the rule of constant improvement. This rule is primarily connected with preventing errors and defects from occurring at all the stages of the production process. To achieve that, one must, among other things, use quality management tools. The article presents an analysis of causes for returns of a vibrating screen produced by a company which manufactures machinery and equipment for the extractive industry, using quality management tools such as the Ishikawa diagram and Pareto analysis. The analysis allowed for the identification of the causes of client returns which could not be previously identified, and proposing solutions for them.

[Cognitive experimental approach to anxiety disorders].

PubMed

Azaïs, F

1995-01-01

Cognitive psychology is proposing a functional model to explain the mental organisation leading to emotional disorders. Among these disorders, anxiety spectrum represents a domain in which this model seems to be interesting for an efficient and comprehensive approach of the pathology. Number of behavioral or cognitive psychotherapeutic methods are relating to these cognitive references, but the theorical concepts of cognitive "shemata" or cognitive "processes" evoked to describe mental functioning in anxiety need an experimental approach for a better rational understanding. Cognitive function as perception, attention or memory can be explored in this domaine in an efficient way, allowing a more precise study of each stage of information processing. The cognitive model proposed in the psychopathology of anxiety suggests that anxious subjects are characterized by biases in processing of emotionally valenced information. This hypothesis suggests functional interference in information processing in these subjects, leading to an anxious response to the most of different stimuli. Experimental approach permit to explore this hypothesis, using many tasks for testing different cognitive dysfunction evoked in the anxious cognitive organisation. Impairments revealed in anxiety disorders seem to result from specific biases in threat-related information processing, involving several stages of cognitive processes. Semantic interference, attentional bias, implicit memory bias and priming effect are the most often disorders observed in anxious pathology, like simple phobia, generalised anxiety, panic disorder or post-traumatic stress disorder. These results suggest a top-down organisation of information processing in anxious subjects, who tend to detect, perceive and label many situations as threatening experience. The processes of reasoning and elaboration are consequently impaired in their adaptative function to threat, leading to the anxious response observed in clinical condition. The cognitive, behavioral and emotional components of this anxious reaction maintain the stressful experience for the subject, in which the self cognitive competence remain pathologically decreased. Cognitive psychology proposes an interesting model for the understanding of anxiety, in a domain in which subjectivity could benefit from an experimental approach.(ABSTRACT TRUNCATED AT 400 WORDS)

A conceptual framework and classification of capability areas for business process maturity

NASA Astrophysics Data System (ADS)

Van Looy, Amy; De Backer, Manu; Poels, Geert

2014-03-01

The article elaborates on business process maturity, which indicates how well an organisation can perform based on its business processes, i.e. on its way of working. This topic is of paramount importance for managers who try to excel in today's competitive world. Hence, business process maturity is an emerging research field. However, no consensus exists on the capability areas (or skills) needed to excel. Moreover, their theoretical foundation and synergies with other fields are frequently neglected. To overcome this gap, our study presents a conceptual framework with six main capability areas and 17 sub areas. It draws on theories regarding the traditional business process lifecycle, which are supplemented by recognised organisation management theories. The comprehensiveness of this framework is validated by mapping 69 business process maturity models (BPMMs) to the identified capability areas, based on content analysis. Nonetheless, as a consensus neither exists among the collected BPMMs, a classification of different maturity types is proposed, based on cluster analysis and discriminant analysis. Consequently, the findings contribute to the grounding of business process literature. Possible future avenues are evaluating existing BPMMs, directing new BPMMs or investigating which combinations of capability areas (i.e. maturity types) contribute more to performance than others.

Characteristics of funding of clinical trials: cross-sectional survey and proposed guidance

PubMed Central

Jouni, Nahla; Abou-Jaoude, Eliane A; Hasbani, Divina Justina; Abou-Jaoude, Elias A; Khaldieh, Mariam; Hammoud, Mira Zein; Al-Gibbawi, Mounir; Anouti, Sirine; Guyatt, Gordon; Akl, Elie A

2017-01-01

Objectives To provide a detailed and current characterisation of funding of a representative sample clinical trials. We also aimed to develop guidance for standardised reporting of funding information. Methods We addressed the extent to which clinical trials published in 2015 in any of the 119 Core Clinical Journals included a statement on the funding source (eg, whether a not-for-profit organisation was supported by a private-for-profit organisation), type of funding, amount and role of funder. We used a stepwise approach to develop a guidance and an instrument for standardised reporting of funding information. Results Of 200 trials, 178 (89%) included a funding statement, of which 171 (96%) reported being funded. Funding statements in the 171 funded trials indicated the source in 100%, amount in 1% and roles of funders in 50%. The most frequent sources were governmental (58%) and private-for-profit (40%). Of 54 funding statements in which the source was a not-for-profit organisation, we found evidence of undisclosed support of those from private-for-profit organisation(s) in 26 (48%). The most frequently reported roles of funders in the 171 funded trials related to study design (42%) and data analysis, interpretation or management (41%). Of 139 randomised controlled trials (RCTs) addressing pharmacological or surgical interventions, 29 (21%) reported information on the supplier of the medication or device. The proposed guidance addresses both the funding information that RCTs should report and the reporting process. Attached to the guidance is a fillable PDF document for use as an instrument for standardised reporting of funding information. Conclusion Although the majority of RCTs report funding, there is considerable variability in the reporting of funding source, amount and roles of funders. A standardised approach to reporting of funding information would address these limitations. Future research should explore the implications of funding by not-for-profit organisations that are supported by for-profit organisations. PMID:28982811

Field-scale multi-phase LNAPL remediation: Validating a new computational framework against sequential field pilot trials.

PubMed

Sookhak Lari, Kaveh; Johnston, Colin D; Rayner, John L; Davis, Greg B

2018-03-05

Remediation of subsurface systems, including groundwater, soil and soil gas, contaminated with light non-aqueous phase liquids (LNAPLs) is challenging. Field-scale pilot trials of multi-phase remediation were undertaken at a site to determine the effectiveness of recovery options. Sequential LNAPL skimming and vacuum-enhanced skimming, with and without water table drawdown were trialled over 78days; in total extracting over 5m 3 of LNAPL. For the first time, a multi-component simulation framework (including the multi-phase multi-component code TMVOC-MP and processing codes) was developed and applied to simulate the broad range of multi-phase remediation and recovery methods used in the field trials. This framework was validated against the sequential pilot trials by comparing predicted and measured LNAPL mass removal rates and compositional changes. The framework was tested on both a Cray supercomputer and a cluster. Simulations mimicked trends in LNAPL recovery rates (from 0.14 to 3mL/s) across all remediation techniques each operating over periods of 4-14days over the 78day trial. The code also approximated order of magnitude compositional changes of hazardous chemical concentrations in extracted gas during vacuum-enhanced recovery. The verified framework enables longer term prediction of the effectiveness of remediation approaches allowing better determination of remediation endpoints and long-term risks. Copyright © 2017 Commonwealth Scientific and Industrial Research Organisation. Published by Elsevier B.V. All rights reserved.

Coroners' recommendations for prevention of resident deaths in aged care: The role of primary care providers

PubMed

Aitken, Georgia; Demosthenous, Athena; Bugeja, Lyndal; Willoughby, Melissa; Young, Carmel; E Ibrahim, Joseph

2018-05-01

Currently, very little is known about how coroners consider a role for general practitioners (GPs) and registered nurses (RNs) in recommendations for the prevention of premature death. Involving these professions in recommendations generally directed towards government organisations or residential aged care providers and management may contribute to more successful broader policy changes. The aim of this article was to examine whether coroners' recommendations describe a specific role for GPs and RNs in the prevention of premature death in residential aged care settings and, if so, what domains of practice were considered. This study was part of a larger retrospective cohort study. The National Coronial Information System (NCIS) was used to extract coroners' reports that included recommendations directed towards GPs and RNs. The following information was extracted: mechanism of death, incident location, text of coroners' recommendations. Of 162 unique recommendations, 14 (8.6%) were relevant to GPs and 10 (6.2%) were relevant to RNs. Most recommendations were made in the domains of 'applied professional knowledge and skills', 'organisations and legal dimensions' and 'provision and coordination of care'. Recommendations were primarily made in response to natural cause deaths and complications of clinical care. Coroners' recommendations have a limited focus directed towards GPs and RNs, and recommendations focus on their roles in application of skills and knowledge, legal domains, and provision and coordination of care. Recommendations were mainly made in response to deaths due to suboptimal care or from 'complications of clinical care'. Formulating recommendations for these health professions may increase accountability and the likelihood of a recommendation being effectively implemented.

Competency-based Education and Training of medical staff. A Programm of the Medical Academy Waldbreitbach: Concept – Implementation – Materials

PubMed Central

Hasske, Eva; Beil, Michael; Keller, Katrin

2017-01-01

Objective: The aim of the Medical Academy Waldbreitbach is to connect individual and organisational requirements in order to promote an appropriate and multi-locational development of medical competency in the face of the continuously evolving challenges of clinical practice. Integral processes in this are the reduction of organisational learning barriers and the successive integration of competency-oriented learning events in the structures of personnel and organisational development. The modular system for the further development of doctors’ skills serves here as a supplementary and recommendation system for both existing curricula and those defined by regulatory organisations and professional associations. Methods: The Medical Academy’s modular system has a two-dimensional structure. In addition to the axis of biography orientation, the model orients itself around issues relating to the needs of a doctor in any individual professional position, as well as with whom he comes into contact and where his primary challenges lie. In order to achieve better integration in day-to-day routine and a needs-specific orientation of content, the modular system provides a combination of “one, two or three day and two- three- or four-hour training units” depending upon the topic. The transfer of experiential knowledge with the aid of practical exercises is a central element of the didactic model. Results: Through the combined use of summative and formative assessment, the significance of a dialogue-orientated approach in both planning and in the organisational process was highlighted. In feedback discussions and quantitative evaluation sheets, participants identified in particular cross-generational knowledge sharing as a central element for the development of personal values alongside the interdisciplinary transfer of knowledge. The combination of specialist and interdisciplinary topics, for example on team processes or communication, is frequently emphasised, indicating that this had been taught insufficiently and impractically during medical school. Longitudinal evaluations of continuous course units support this, so that the reinforcement of informal learning processes through feedback and exchange of experience is established as an effective and integral learning pattern within the modular system. Conclusion: The of the modular system of the Medical Academy Waldbreitbach – as an institution of the Marienhaus Hospitals Ltd. – is to develop the knowledge, ability and motivation of doctors both individually and professionally. Here, an equally high demand is placed upon the advancement of individual dispositions, attitudes and values, as well as on specialised topics, in order to promote/develop solutions-based and overall medical activity. PMID:29085885

Competency-based Education and Training of medical staff. A Programm of the Medical Academy Waldbreitbach: Concept - Implementation - Materials.

PubMed

Hasske, Eva; Beil, Michael; Keller, Katrin

2017-01-01

Objective: The aim of the Medical Academy Waldbreitbach is to connect individual and organisational requirements in order to promote an appropriate and multi-locational development of medical competency in the face of the continuously evolving challenges of clinical practice. Integral processes in this are the reduction of organisational learning barriers and the successive integration of competency-oriented learning events in the structures of personnel and organisational development. The modular system for the further development of doctors' skills serves here as a supplementary and recommendation system for both existing curricula and those defined by regulatory organisations and professional associations. Methods: The Medical Academy's modular system has a two-dimensional structure. In addition to the axis of biography orientation, the model orients itself around issues relating to the needs of a doctor in any individual professional position, as well as with whom he comes into contact and where his primary challenges lie. In order to achieve better integration in day-to-day routine and a needs-specific orientation of content, the modular system provides a combination of "one, two or three day and two- three- or four-hour training units" depending upon the topic. The transfer of experiential knowledge with the aid of practical exercises is a central element of the didactic model. Results: Through the combined use of summative and formative assessment, the significance of a dialogue-orientated approach in both planning and in the organisational process was highlighted. In feedback discussions and quantitative evaluation sheets, participants identified in particular cross-generational knowledge sharing as a central element for the development of personal values alongside the interdisciplinary transfer of knowledge. The combination of specialist and interdisciplinary topics, for example on team processes or communication, is frequently emphasised, indicating that this had been taught insufficiently and impractically during medical school. Longitudinal evaluations of continuous course units support this, so that the reinforcement of informal learning processes through feedback and exchange of experience is established as an effective and integral learning pattern within the modular system. Conclusion: The of the modular system of the Medical Academy Waldbreitbach - as an institution of the Marienhaus Hospitals Ltd. - is to develop the knowledge, ability and motivation of doctors both individually and professionally. Here, an equally high demand is placed upon the advancement of individual dispositions, attitudes and values, as well as on specialised topics, in order to promote/develop solutions-based and overall medical activity.

Using information communication technologies to increase the institutional capacity of local health organisations in Africa: a case study of the Kenya Civil Society Portal for Health

PubMed Central

Juma, Charles; Sundsmo, Aaron; Maket, Boniface; Powell, Richard; Aluoch, Gilbert

2015-01-01

Introduction Achieving the healthcare components of the United Nations’ Millennium Development Goals is significantly premised on effective service delivery by civil society organisations (CSOs). However, many CSOs across Africalack the necessary capacity to perform this role robustly. This paper reports on an evaluation of the use, and perceived impact, of aknowledge management tool upon institutional strengthening among CSOs working in Kenya's health sector. Methods Three methods were used: analytics data; user satisfaction surveys; and a furtherkey informant survey. Results Satisfaction with the portal was consistently high, with 99% finding the quality and relevance of the content very good or good for institutional strengthening standards, governance, and planning and resource mobilisation. Critical facilitators to the success of knowledge management for CSO institutional strengthening were identified as people/culture (developed resources and organisational narratives) and technology (easily accessible, enabling information exchange, tools/resources available, access to consultants/partners). Critical barriers were identified as people/culture (database limitations, materials limitations, and lack of active users), and process (limited access, limited interactions, and limited approval process). Conclusion This pilot study demonstrated the perceived utility of a web-based knowledge management portal among developing nations’ CSOs, with widespread satisfaction across multiple domains, which increased over time. Providing increased opportunities for collective mutual learning, promoting a culture of data use for decision making, and encouraging all health organisations to be learning institutions should be a priority for those interested in promoting sustainable long-term solutions for Africa. PMID:26401217

The Management of Long-Term Sickness Absence in Large Public Sector Healthcare Organisations: A Realist Evaluation Using Mixed Methods.

PubMed

Higgins, Angela; O'Halloran, Peter; Porter, Sam

2015-09-01

The success of measures to reduce long-term sickness absence (LTSA) in public sector organisations is contingent on organisational context. This realist evaluation investigates how interventions interact with context to influence successful management of LTSA. Multi-method case study in three Health and Social Care Trusts in Northern Ireland comprising realist literature review, semi-structured interviews (61 participants), Process-Mapping and feedback meetings (59 participants), observation of training, analysis of documents. Important activities included early intervention; workplace-based occupational rehabilitation; robust sickness absence policies with clear trigger points for action. Used appropriately, in a context of good interpersonal and interdepartmental communication and shared goals, these are able to increase the motivation of staff to return to work. Line managers are encouraged to take a proactive approach when senior managers provide support and accountability. Hindering factors: delayed intervention; inconsistent implementation of policy and procedure; lack of resources; organisational complexity; stakeholders misunderstanding each other's goals and motives. Different mechanisms have the potential to encourage common motivations for earlier return from LTSA, such as employees feeling that they have the support of their line manager to return to work and having the confidence to do so. Line managers' proactively engage when they have confidence in the support of seniors and in their own ability to address LTSA. Fostering these motivations calls for a thoughtful, diagnostic process, taking into account the contextual factors (and whether they can be modified) and considering how a given intervention can be used to trigger the appropriate mechanisms.

A feasibility study of expert patient and community mental health team led bipolar psychoeducation groups: implementing an evidence based practice

PubMed Central

2013-01-01

Background Group psychoeducation is a cost effective intervention which reduces relapse and improves functioning in bipolar disorder but is rarely implemented. The aim of this study was to identify the acceptability and feasibility of a group psychoeducation programme delivered by community mental health teams (CMHTs) and peer specialist (PS) facilitators. Organisational learning was used to identify and address systematically barriers and enablers, at organisational, health professional and patient levels, to its implementation into a routine service. Methods A systematic examination of barriers and enablers to a three day training process informed the delivery of a first treatment group and a similar process informed the delivery of the second treatment group. Triangulation of research methods improved its internal validity: direct observation of training, self-rated surveys of participant experiences, group discussion, and thematically analysed individual participant and facilitator interviews were employed. Results Barriers and enablers were identified at organisational, educational, treatment content, facilitator and patient levels. All barriers under the control of the research team were addressed with subsequent improvements in patient knowledge about the condition and about local service. In addition, self-management, agency and altruism were enhanced. Barriers that could not be addressed required senior clinical and education leadership outside the research team’s control. PS and professional facilitators were successfully trained and worked together to deliver groups which were generally reported as being beneficial. Conclusion Psychoeducation groups involving CMHT and PS facilitators is acceptable and feasible but their sustainment requires senior leadership within and outside the organisation that control finance and education services. PMID:24215655

Protocol for a mixed methods study of hospital readmissions: sensemaking in Veterans Health Administration healthcare system in the USA.

PubMed

Penney, Lauren S; Leykum, Luci K; Noël, Polly; Finley, Erin P; Lanham, Holly Jordan; Pugh, Jacqueline

2018-04-07

Effective delivery of healthcare in complex systems requires managing interdependencies between professions and organisational units. Reducing 30-day hospital readmissions may be one of the most complex tasks that a healthcare system can undertake. We propose that these less than optimal outcomes are related to difficulties managing the complex interdependencies among organisational units and to a lack of effective sensemaking among individuals and organisational units regarding how best to coordinate patient needs. This is a mixed method, multistepped study. We will conduct in-depth qualitative organisational case studies in 10 Veterans Health Administration facilities (6 with improving and 4 with worsening readmission rates), focusing on relationships, sensemaking and improvisation around care transition processes intended to reduce early readmissions. Data will be gathered through multiple methods (eg, chart reviews, surveys, interviews, observations) and analysed using analytic memos, qualitative coding and statistical analyses. We will construct an agent-based model based on those results to explore the influence of sensemaking and specific care transition processes on early readmissions. Ethical approval has been obtained through the Institutional Review Board of the University of Texas Health Science Center at San Antonio (approval number: 14-258 hour). We will disseminate our findings in manuscripts in peer-reviewed journals, professional conferences and through short reports back to participating entities and stakeholders. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Governance in community based health programmes in I.R of Iran.

PubMed

Falahat, Katayoun; Eftekhari, Monir Baradaran; Malekafzali, Hossein; Forouzan, Ameneh Setareh; Dejman, Masoumeh

2013-02-01

To assess the nature of community-based health programme experience in Iran, and use the results in order to advocate more friendly policies in community, academy and funding organisations. The qualitative study was done in 2010-11 at various locations in Iran using semi structural in-depth interviews with the principals and managers of programmes, and focus group discussions with volunteers and service users of 13 Community Based Health Programmes which were active for at least five years. A total of 21 in-depth interviews and 20 focus group discussions were conducted. Data analysis was based on deductive-inductive content analysis approach considering the pre-determined structure in accordance with the study questions. The participants' views were analysed within the main category of governance, including the three sub-categories of leadership, monitoring and evaluation, and resource mobilisation. According to the participants, governmental programmes have centralised decision-making and management processes and local volunteers have no role in selecting managers at different levels of a programme. Such programmes are funded by the governmental core resources. In non-government organisations, resources available for such purposes mainly come through charitable individuals, service delivery fees and profitable economical activities, financial participation of volunteers and by using other organisations' facilities. In most programmes, there were no systematic process for monitoring and evaluation. Community-based Health programmes in Iran need to be revised in line with the positive input.There is a need to have community-based units within the Ministry of Health and Medical Education and other relevant organisations.

Variability in the organisation and management of hospital care for COPD exacerbations in the UK.

PubMed

Hosker, Harold; Anstey, Katharine; Lowe, Derek; Pearson, Michael; Roberts, C Michael

2007-04-01

Previous smaller UK audits have demonstrated wide variation in organisation, resources, and process of care for acute chronic obstructive pulmonary disease (COPD) admissions. Smallest units appeared to do less well. UK acute hospitals supplied information on (1) resources and organisation of care, (2) clinical data on process of care and outcomes for up to 40 consecutive COPD admissions. Comparisons were made against national recommendations. Eight thousand and thirteen admissions involved 7529 patients from 233 units (93% of UK acute Trusts). Twenty-six percent of units had at most one whole-time equivalent respiratory consultant while 12% had at least four. Thirty percent patients were admitted under a respiratory specialist and 48% discharged under their care whilst 28% had no specialist input at all. Variation in care provision was wide across all hospitals but patients in smaller hospitals had less access to specialist respiratory or admission wards, pulmonary rehabilitation programs, specialty triage or an early discharge scheme. Six percent of units did not have access to NIV and 18% to invasive ventilatory support. There remains wide variation in all aspects of acute hospital COPD care in the UK, with smaller hospitals offering fewest services. Those receiving specialist input are more likely to be offered interventions of proven effect. Management guidelines alone are insufficient to address inequalities of care and a clear statement of minimum national standards for resource provision and organisation of COPD care are required. This study provides a unique insight into the current state of care for patients admitted with COPD exacerbations in the UK.

The social process of escalation: a promising focus for crisis management research

PubMed Central

2012-01-01

Background This study identifies a promising, new focus for the crisis management research in the health care domain. After reviewing the literature on health care crisis management, there seems to be a knowledge-gap regarding organisational change and adaption, especially when health care situations goes from normal, to non-normal, to pathological and further into a state of emergency or crisis. Discussion Based on studies of escalating situations in obstetric care it is suggested that two theoretical perspectives (contingency theory and the idea of failure as a result of incomplete interaction) tend to simplify the issue of escalation rather than attend to its complexities (including the various power relations among the stakeholders involved). However studying the process of escalation as inherently complex and social allows us to see the definition of a situation as normal or non-normal as an exercise of power in itself, rather than representing a putatively correct response to a particular emergency. Implications The concept of escalation, when treated this way, can help us further the analysis of clinical and institutional acts and competence. It can also turn our attention to some important elements in a class of social phenomenon, crises and emergencies, that so far have not received the attention they deserve. Focusing on organisational choreography, that interplay of potential factors such as power, professional identity, organisational accountability, and experience, is not only a promising focus for future naturalistic research but also for developing more pragmatic strategies that can enhance organisational coordination and response in complex events. PMID:22704075

Playing the role of a ‘boundary organisation’: getting smarter with networking

PubMed Central

2011-01-01

Background This paper discusses the practices of organisations that cross the boundary between research and politics, to promote evidence-based policies and programmes. Methods It uses the experience of a network of organisations in Africa to describe the methodology, challenges and successes of efforts to promote utilisation of research on the inter-connections between HIV/AIDS, food security and nutrition in South Africa. It emphasises that crossing the boundary between science and politics can be done systematically and is inevitable for any attempt that seeks influence policy making. Results The paper reveals the complexity of the research-policy making interface and identifies key lessons for the practice of networking and engaging policy and decision-makers. Conclusion The concept of boundary organisation is a helpful means to understand the methodological underpinnings of efforts to get research into policy and practice and to understand the ‘messy’ process of doing so. PMID:21679378

Effective crisis decision-making.

PubMed

Kaschner, Holger

2017-01-01

When an organisation's reputation is at stake, crisis decision-making (CDM) is challenging and prone to failure. Most CDM schemes are strong at certain aspects of the overall CDM process, but almost none are strong at all of them. This paper defines criteria for good CDM schemes, analyses common approaches and introduces an alternative, stakeholder-driven scheme. Focusing on the most important stakeholders and directing any actions to preserve the relationships with them is crucial. When doing so, the interdependencies between the stakeholders must be identified and considered. Without knowledge of the sometimes less than obvious links, wellmeaning actions can cause adverse effects, so a cross-check for the impacts of potential options is recommended before making the final decision. The paper also gives recommendations on how to implement these steps at any organisation in order to enhance the quality of CDM and thus protect the organisation's reputation.

Important considerations about nursing intelligence and information systems.

PubMed

Ballard, E C

1997-01-01

This discussion focuses on the importance of nursing intelligence to the organisation, and the nurses' role in gathering and utilising such intelligence. Deliberations with professional colleagues suggest that intelligence can only be utilised fully when the information systems are developed in such a way as to meet the needs of the people who manage and provide nursing care at the consumer level; that is, the activity of nursing itself. If accommodation is made for the recycling of nursing intelligence, there would be a support and furtherance of 'professional' intelligence. Two main issues emerge: how can nurses support the needs of management to optimise intelligence input? how can organisations optimise the contribution of nurses to its information processes and interpretation of intelligence? The expansion of this 'professional' intelligence would promote a generation of constantly reviewed data, offering a quality approach to nursing activities and an organisation's intelligence system.

Exploring the decision-making process in the delivery of physiotherapy in a stroke unit.

PubMed

McGlinchey, Mark P; Davenport, Sally

2015-01-01

The aim of this study was to explore the decision-making process in the delivery of physiotherapy in a stroke unit. A focused ethnographical approach involving semi-structured interviews and observations of clinical practice was used. A purposive sample of seven neurophysiotherapists and four patients participated in semi-structured interviews. From this group, three neurophysiotherapists and four patients were involved in observation of practice. Data from interviews and observations were analysed to generate themes. Three themes were identified: planning the ideal physiotherapy delivery, the reality of physiotherapy delivery and involvement in the decision-making process. Physiotherapists used a variety of clinical reasoning strategies and considered many factors to influence their decision-making in the planning and delivery of physiotherapy post-stroke. These factors included the therapist's clinical experience, patient's presentation and response to therapy, prioritisation, organisational constraints and compliance with organisational practice. All physiotherapists highlighted the importance to involve patients in planning and delivering their physiotherapy. However, there were varying levels of patient involvement observed in this process. The study has generated insight into the reality of decision-making in the planning and delivery of physiotherapy post-stroke. Further research involving other stroke units is required to gain a greater understanding of this aspect of physiotherapy. Implications for Rehabilitation Physiotherapists need to consider multiple patient, therapist and organisational factors when planning and delivering physiotherapy in a stroke unit. Physiotherapists should continually reflect upon how they provide physiotherapy, with respect to the duration, frequency and time of day sessions are delivered, in order to guide current and future physiotherapy delivery. As patients may demonstrate varying levels of participation in deciding and understanding how physiotherapy is delivered, physiotherapists need to adjust how they engage patients in the decision-making process and manage patient expectations accordingly.

Using ‘appreciative inquiry’ in India to improve infection control practices in maternity care: a qualitative study

PubMed Central

Sharma, Bharati; Ramani, K.V.; Mavalankar, Dileep; Kanguru, Lovney; Hussein, Julia

2015-01-01

Background Infections acquired during childbirth are a common cause of maternal and perinatal mortality and morbidity. Changing provider behaviour and organisational settings within the health system is key to reducing the spread of infection. Objective To explore the opinions of health personnel on health system factors related to infection control and their perceptions of change in a sample of hospital maternity units. Design An organisational change process called ‘appreciative inquiry’ (AI) was introduced in three maternity units of hospitals in Gujarat, India. AI is a change process that builds on recognition of positive actions, behaviours, and attitudes. In-depth interviews were conducted with health personnel to elicit information on the environment within which they work, including physical and organisational factors, motivation, awareness, practices, perceptions of their role, and other health system factors related to infection control activities. Data were obtained from three hospitals which implemented AI and another three not involved in the intervention. Results Challenges which emerged included management processes (e.g. decision-making and problem-solving modalities), human resource shortages, and physical infrastructure (e.g. space, water, and electricity supplies). AI was perceived as having a positive influence on infection control practices. Respondents also said that management processes improved although some hospitals had already undergone an accreditation process which could have influenced the changes described. Participants reported that team relationships had been strengthened due to AI. Conclusion Technical knowledge is often emphasised in health care settings and less attention is paid to factors such as team relationships, leadership, and problem solving. AI can contribute to improving infection control by catalysing and creating forums for team building, shared decision making and problem solving in an enabling environment. PMID:26119249

Using 'appreciative inquiry' in India to improve infection control practices in maternity care: a qualitative study.

PubMed

Sharma, Bharati; Ramani, K V; Mavalankar, Dileep; Kanguru, Lovney; Hussein, Julia

2015-01-01

Infections acquired during childbirth are a common cause of maternal and perinatal mortality and morbidity. Changing provider behaviour and organisational settings within the health system is key to reducing the spread of infection. To explore the opinions of health personnel on health system factors related to infection control and their perceptions of change in a sample of hospital maternity units. An organisational change process called 'appreciative inquiry' (AI) was introduced in three maternity units of hospitals in Gujarat, India. AI is a change process that builds on recognition of positive actions, behaviours, and attitudes. In-depth interviews were conducted with health personnel to elicit information on the environment within which they work, including physical and organisational factors, motivation, awareness, practices, perceptions of their role, and other health system factors related to infection control activities. Data were obtained from three hospitals which implemented AI and another three not involved in the intervention. Challenges which emerged included management processes (e.g. decision-making and problem-solving modalities), human resource shortages, and physical infrastructure (e.g. space, water, and electricity supplies). AI was perceived as having a positive influence on infection control practices. Respondents also said that management processes improved although some hospitals had already undergone an accreditation process which could have influenced the changes described. Participants reported that team relationships had been strengthened due to AI. Technical knowledge is often emphasised in health care settings and less attention is paid to factors such as team relationships, leadership, and problem solving. AI can contribute to improving infection control by catalysing and creating forums for team building, shared decision making and problem solving in an enabling environment.

Analysing the spatial patterns of erosion scars using point process theory at the coastal chalk cliff of Mesnil-Val, (Normandy, Northern France)

NASA Astrophysics Data System (ADS)

Rohmer, J.; Dewez, D.

2014-09-01

Over the last decade, many cliff erosion studies have focused on frequency-size statistics using inventories of sea cliff retreat sizes. By comparison, only a few paid attention to quantifying the spatial and temporal organisation of erosion scars over a cliff face. Yet, this spatial organisation carries essential information about the external processes and the environmental conditions that promote or initiate sea-cliff instabilities. In this article, we use summary statistics of spatial point process theory as a tool to examine the spatial and temporal pattern of a rockfall inventory recorded with repeated terrestrial laser scanning surveys at the chalk coastal cliff site of Mesnil-Val (Normandy, France). Results show that: (1) the spatial density of erosion scars is specifically conditioned alongshore by the distance to an engineered concrete groin, with an exponential-like decreasing trend, and vertically focused both at wave breaker height and on strong lithological contrasts; (2) small erosion scars (10-3-10-2 m3) aggregate in clusters within a radius of 5 to 10 m, which suggests some sort of attraction or focused causative process, and disperse above this critical distance; (3) on the contrary, larger erosion scars (10-2-101 m3) tend to disperse above a radius of 1 to 5 m, possibly due to the spreading of successive failures across the cliff face; (4) large scars significantly occur albeit moderately, where previous large rockfalls have occurred during preceeding winter; (5) this temporal trend is not apparent for small events. In conclusion, this study shows, with a worked example, how spatial point process summary statistics are a tool to test and quantify the significance of geomorphological observation organisation.

Analysing the spatial patterns of erosion scars using point process theory at the coastal chalk cliff of Mesnil-Val, Normandy, northern France

NASA Astrophysics Data System (ADS)

Rohmer, J.; Dewez, T.

2015-02-01

Over the last decade, many cliff erosion studies have focused on frequency-size statistics using inventories of sea cliff retreat sizes. By comparison, only a few paid attention to quantifying the spatial and temporal organisation of erosion scars over a cliff face. Yet, this spatial organisation carries essential information about the external processes and the environmental conditions that promote or initiate sea-cliff instabilities. In this article, we use summary statistics of spatial point process theory as a tool to examine the spatial and temporal pattern of a rockfall inventory recorded with repeated terrestrial laser scanning surveys at the chalk coastal cliff site of Mesnil-Val (Normandy, France). Results show that: (1) the spatial density of erosion scars is specifically conditioned alongshore by the distance to an engineered concrete groyne, with an exponential-like decreasing trend, and vertically focused both at wave breaker height and on strong lithological contrasts; (2) small erosion scars (10-3 to 10-2 m3) aggregate in clusters within a radius of 5 to 10 m, which suggests some sort of attraction or focused causative process, and disperse above this critical distance; (3) on the contrary, larger erosion scars (10-2 to 101 m3) tend to disperse above a radius of 1 to 5 m, possibly due to the spreading of successive failures across the cliff face; (4) large scars significantly occur albeit moderately, where previous large rockfalls have occurred during preceding winter; (5) this temporal trend is not apparent for small events. In conclusion, this study shows, with a worked example, how spatial point process summary statistics are a tool to test and quantify the significance of geomorphological observation organisation.

Linking earth science informatics resources into uninterrupted digital value chains

NASA Astrophysics Data System (ADS)

Woodcock, Robert; Angreani, Rini; Cox, Simon; Fraser, Ryan; Golodoniuc, Pavel; Klump, Jens; Rankine, Terry; Robertson, Jess; Vote, Josh

2015-04-01

The CSIRO Mineral Resources Flagship was established to tackle medium- to long-term challenges facing the Australian mineral industry across the value chain from exploration and mining through mineral processing within the framework of an economically, environmentally and socially sustainable minerals industry. This broad portfolio demands collaboration and data exchange with a broad range of participants and data providers across government, research and industry. It is an ideal environment to link geoscience informatics platforms to application across the resource extraction industry and to unlock the value of data integration between traditionally discrete parts of the minerals digital value chain. Despite the potential benefits, data integration remains an elusive goal within research and industry. Many projects use only a subset of available data types in an integrated manner, often maintaining the traditional discipline-based data 'silos'. Integrating data across the entire minerals digital value chain is an expensive proposition involving multiple disciplines and, significantly, multiple data sources both internal and external to any single organisation. Differing vocabularies and data formats, along with access regimes to appropriate analysis software and equipment all hamper the sharing and exchange of information. AuScope has addressed the challenge of data exchange across organisations nationally, and established a national geosciences information infrastructure using open standards-based web services. Federated across a wide variety of organisations, the resulting infrastructure contains a wide variety of live and updated data types. The community data standards and infrastructure platforms that underpin AuScope provide important new datasets and multi-agency links independent of software and hardware differences. AuScope has thus created an infrastructure, a platform of technologies and the opportunity for new ways of working with and integrating disparate data at much lower cost. An early example of this approach is the value generated by combining geological and metallurgical data sets as part of the rapidly growing field of geometallurgy. This not only provides a far better understanding of the impact of geological variability on ore processing but also leads to new thinking on the types and characteristics of data sets collected at various stages of the exploration and mining process. The Minerals Resources Flagship is linking its research activities to the AuScope infrastructure, exploiting the technology internally to create a platform for integrated research across the minerals value chain and improved interaction with industry. Referred to as the 'Early Access Virtual Lab', the system will be fully interoperable with AuScope and international infrastructures using open standards like GeosciML. Secured access is provided to allow confidential collaboration with industry when required. This presentation will discuss how the CSIRO Mineral Resources Flagship is building on the AuScope infrastructure to transform the way that data and data products are identified, shared, integrated, and reused, to unlock the benefits of true integration of research efforts across the minerals digital value chain.

Exploring the theory, barriers and enablers for patient and public involvement across health, social care and patient safety: a protocol for a systematic review of reviews.

PubMed

Ocloo, Josephine; Garfield, Sarah; Dawson, Shoba; Dean Franklin, Bryony

2017-10-24

The emergence of patient and public involvement (PPI) in healthcare in the UK can be traced as far back as the 1970s. More recently, campaigns by harmed patients and their relatives have emerged as a result of clinical failings in the NHS, challenging paternalistic healthcare, which have led to a new focus on PPI in quality and safety, nationally and internationally. Evidence suggests that PPI within patient safety is often atheoretical and located within a biomedical discourse. This review will explore the literature on PPI across patient safety, healthcare and social care to identify theory, barriers and enablers that can be used to develop PPI in patient safety. Systematic searches of three electronic bibliographic databases will be conducted, using both MeSH and free-text terms to identify empirical literature published from database inception to May 2017. The screening process will involve input from at least two researchers and any disagreement will be resolved through discussion with a third reviewer. Initial inclusion and exclusion criteria have been developed and will be refined iteratively throughout the process. Data extraction from included articles will be conducted by at least two researchers using a data extraction form. Extracted information will be analysed using a narrative review approach, which synthesises data using a descriptive method. No ethical approval is required for this review as no empirical data were collected. We believe that the findings and recommendations from this review will be particularly relevant for an audience of academics and policymakers. The findings will, therefore, be written up and disseminated in international peer-reviewed journals and academic conferences with a health focus. They will also be disseminated to leading health policy organisations in the NHS, such as NHS England and NHS Improvement and national policy bodies such as the Health Foundation. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Teaching Practise Utilising Embedded Indigenous Cultural Standards

ERIC Educational Resources Information Center

Gilbert, Stephanie

2017-01-01

The Wollotuka Institute, University of Newcastle, New South Wales, is the first university or organisation to enter into the accreditation process with the World Indigenous Higher Education Consortium (WINHEC). Part of that process includes identifying the local cultural standards and protocols that drive and shape our work as a cultural entity.…

Using Knowledge Management to Revise Software-Testing Processes

ERIC Educational Resources Information Center

Nogeste, Kersti; Walker, Derek H. T.

2006-01-01

Purpose: This paper aims to use a knowledge management (KM) approach to effectively revise a utility retailer's software testing process. This paper presents a case study of how the utility organisation's customer services IT production support group improved their test planning skills through applying the American Productivity and Quality Center…

Assessment Relationships in Higher Education: The Tension of Process and Practice

ERIC Educational Resources Information Center

Crook, Charles; Gross, Harriet; Dymott, Roy

2006-01-01

It is argued that the auditing demands of quality assurance have encouraged a greater proceduralisation of university coursework assessment. Interviews with academics from a cross-section of Psychology departments illustrated how assessment had acquired the tightly scripted character of an organisational process. Yet undergraduate focus group…

Didactic Restrictions on the Teacher's Practice: The Case of Limits of Functions in Spanish High Schools

ERIC Educational Resources Information Center

Barbe, Joaquim; Bosch, Marianna; Espinoza, Lorena; Gascon, Josep

2005-01-01

The Anthropological Theory of Didactics describes mathematical activity in terms of "mathematical organisations" or "praxeologies" and considers the teacher as the "director of the didactic process" the students carry out, a process that is structured along six dimensions or "didactic moments." This paper…

Implementing a Complex Intervention to Support Personal Recovery: A Qualitative Study Nested within a Cluster Randomised Controlled Trial

PubMed Central

Leamy, Mary; Clarke, Eleanor; Le Boutillier, Clair; Bird, Victoria; Janosik, Monika; Sabas, Kai; Riley, Genevieve; Williams, Julie; Slade, Mike

2014-01-01

Objective To investigate staff and trainer perspectives on the barriers and facilitators to implementing a complex intervention to help staff support the recovery of service users with a primary diagnosis of psychosis in community mental health teams. Design Process evaluation nested within a cluster randomised controlled trial (RCT). Participants 28 interviews with mental health care staff, 3 interviews with trainers, 4 focus groups with intervention teams and 28 written trainer reports. Setting 14 community-based mental health teams in two UK sites (one urban, one semi-rural) who received the intervention. Results The factors influencing the implementation of the intervention can be organised under two over-arching themes: Organisational readiness for change and Training effectiveness. Organisational readiness for change comprised three sub-themes: NHS Trust readiness; Team readiness; and Practitioner readiness. Training effectiveness comprised three sub-themes: Engagement strategies; Delivery style and Modelling recovery principles. Conclusions Three findings can inform future implementation and evaluation of complex interventions. First, the underlying intervention model predicted that three areas would be important for changing practice: staff skill development; intention to implement; and actual implementation behaviour. This study highlighted the importance of targeting the transition from practitioners' intent to implement to actual implementation behaviour, using experiential learning and target setting. Second, practitioners make inferences about organisational commitment by observing the allocation of resources, Knowledge Performance Indicators and service evaluation outcome measures. These need to be aligned with recovery values, principles and practice. Finally, we recommend the use of organisational readiness tools as an inclusion criteria for selecting both organisations and teams in cluster RCTs. We believe this would maximise the likelihood of adequate implementation and hence reduce waste in research expenditure. Trial Registration Controlled-Trials.com ISRCTN02507940 PMID:24875748

Implementing a complex intervention to support personal recovery: a qualitative study nested within a cluster randomised controlled trial.

PubMed

Leamy, Mary; Clarke, Eleanor; Le Boutillier, Clair; Bird, Victoria; Janosik, Monika; Sabas, Kai; Riley, Genevieve; Williams, Julie; Slade, Mike

2014-01-01

To investigate staff and trainer perspectives on the barriers and facilitators to implementing a complex intervention to help staff support the recovery of service users with a primary diagnosis of psychosis in community mental health teams. Process evaluation nested within a cluster randomised controlled trial (RCT). 28 interviews with mental health care staff, 3 interviews with trainers, 4 focus groups with intervention teams and 28 written trainer reports. 14 community-based mental health teams in two UK sites (one urban, one semi-rural) who received the intervention. The factors influencing the implementation of the intervention can be organised under two over-arching themes: Organisational readiness for change and Training effectiveness. Organisational readiness for change comprised three sub-themes: NHS Trust readiness; Team readiness; and Practitioner readiness. Training effectiveness comprised three sub-themes: Engagement strategies; Delivery style and Modelling recovery principles. Three findings can inform future implementation and evaluation of complex interventions. First, the underlying intervention model predicted that three areas would be important for changing practice: staff skill development; intention to implement; and actual implementation behaviour. This study highlighted the importance of targeting the transition from practitioners' intent to implement to actual implementation behaviour, using experiential learning and target setting. Second, practitioners make inferences about organisational commitment by observing the allocation of resources, Knowledge Performance Indicators and service evaluation outcome measures. These need to be aligned with recovery values, principles and practice. Finally, we recommend the use of organisational readiness tools as an inclusion criteria for selecting both organisations and teams in cluster RCTs. We believe this would maximise the likelihood of adequate implementation and hence reduce waste in research expenditure. Controlled-Trials.com ISRCTN02507940.

A network approach to policy framing: A case study of the National Aboriginal and Torres Strait Islander Health Plan.

PubMed

Browne, Jennifer; de Leeuw, Evelyne; Gleeson, Deborah; Adams, Karen; Atkinson, Petah; Hayes, Rick

2017-01-01

Aboriginal health policy in Australia represents a unique policy subsystem comprising a diverse network of Aboriginal-specific and "mainstream" organisations, often with competing interests. This paper describes the network structure of organisations attempting to influence national Aboriginal health policy and examines how the different subgroups within the network approached the policy discourse. Public submissions made as part of a policy development process for the National Aboriginal and Torres Strait Islander Health Plan were analysed using a novel combination of network analysis and qualitative framing analysis. Other organisational actors in the network in each submission were identified, and relationships between them determined; these were used to generate a network map depicting the ties between actors. A qualitative framing analysis was undertaken, using inductive coding of the policy discourses in the submissions. The frames were overlaid with the network map to identify the relationship between the structure of the network and the way in which organisations framed Aboriginal health problems. Aboriginal organisations were central to the network and strongly connected with each other. The network consisted of several densely connected subgroups, whose central nodes were closely connected to one another. Each subgroup deployed a particular policy frame, with a frame of "system dysfunction" also adopted by all but one subgroup. Analysis of submissions revealed that many of the stakeholders in Aboriginal health policy actors are connected to one another. These connections help to drive the policy discourse. The combination of network and framing analysis illuminates competing interests within a network, and can assist advocacy organisations to identify which network members are most influential. Copyright © 2016 Elsevier Ltd. All rights reserved.

Does the engagement of clinicians and organisations in research improve healthcare performance: a three-stage review.

PubMed

Boaz, Annette; Hanney, Stephen; Jones, Teresa; Soper, Bryony

2015-12-09

There is a widely held assumption that engagement by clinicians and healthcare organisations in research improves healthcare performance at various levels, but little direct empirical evidence has previously been collated. The objective of this study was to address the question: Does research engagement (by clinicians and organisations) improve healthcare performance? An hourglass-shaped review was developed, consisting of three stages: (1) a planning and mapping stage; (2) a focused review concentrating on the core question of whether or not research engagement improves healthcare performance; and (3) a wider (but less systematic) review of papers identified during the two earlier stages, focusing on mechanisms. Of the 33 papers included in the focused review, 28 identified improvements in health services performance. Seven out of these papers reported some improvement in health outcomes, with others reporting improved processes of care. The wider review demonstrated that mechanisms such as collaborative and action research can encourage some progress along the pathway from research engagement towards improved healthcare performance. Organisations that have deliberately integrated the research function into organisational structures demonstrate how research engagement can, among other factors, contribute to improved healthcare performance. Current evidence suggests that there is an association between the engagement of individuals and healthcare organisations in research and improvements in healthcare performance. The mechanisms through which research engagement might improve healthcare performance overlap and rarely act in isolation, and their effectiveness often depends on the context in which they operate. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

School health promotion providers' roles in practice and theory: results from a case study.

PubMed

Teutsch, Friedrich; Gugglberger, Lisa; Dür, Wolfgang

2015-01-01

Implementation is critical to the success of health promotion (HP) in schools, but little is known about how schools can best be assisted during this process. This article focuses on Austrian HP providers and aspects their roles incorporate. To investigate the providers' role in the practice of HP implementation and how it differs from its official description. On the basis of these findings, implications are suggested. The data were gathered within the framework of an explorative case study of complex HP interventions. We draw on four interviews with HP organisation staff, five documents from the providers' organisations and seven interviews with school staff from three schools. In practice, providers took up different responsibilities, e.g., acting as emotional support to school staff and supporting the documentation of projects, guided more by the schools' needs than by the programmes they are helping to implement. Providers focused mostly on the implementation of single activities and did little to emphasize the necessity of organisational change. Our findings suggest that providers' background in health should be complemented by a deeper understanding of the importance of organisational change to further support HP implementation. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Highly organised and dense vertical silicon nanowire arrays grown in porous alumina template on <100> silicon wafers

PubMed Central

2013-01-01

In this work, nanoimprint lithography combined with standard anodization etching is used to make perfectly organised triangular arrays of vertical cylindrical alumina nanopores onto standard <100>−oriented silicon wafers. Both the pore diameter and the period of alumina porous array are well controlled and can be tuned: the periods vary from 80 to 460 nm, and the diameters vary from 15 nm to any required diameter. These porous thin layers are then successfully used as templates for the guided epitaxial growth of organised mono-crystalline silicon nanowire arrays in a chemical vapour deposition chamber. We report the densities of silicon nanowires up to 9 × 109 cm−2 organised in highly regular arrays with excellent diameter distribution. All process steps are demonstrated on surfaces up to 2 × 2 cm2. Specific emphasis was made to select techniques compatible with microelectronic fabrication standards, adaptable to large surface samples and with a reasonable cost. Achievements made in the quality of the porous alumina array, therefore on the silicon nanowire array, widen the number of potential applications for this technology, such as optical detectors or biological sensors. PMID:23773702

Outsourcing critical financial system operations.

PubMed

Cox, Nora; Pilbauer, Jan

2018-01-01

Payments Canada provides Canada's national payments systems and is responsible for the clearing and settlement infrastructure, processes and rules that underpin the exchange of billions of dollars each day through the Canadian economy. Strategic sourcing is a reality for this small organisation with a broad scope of national regulations and global standards to comply with. This paper outlines Payments Canada's approach to outsourcing its critical financial system operations, which centres on four key principles: strong relationship management; continuous learning, recording and reporting; evaluating the business landscape; and a commitment to evolving the organisation to greater resilience. This last point is covered in detail with an exploration of the organisation's resilience and security strategy as well as its risk appetite. As Payments Canada progresses to its future state, which includes modernising its core payment systems, underlying rules and standards, risk management for the industry as a whole will remain at the forefront of its collective mind. The expectation is that outsourcing will remain a fundamental element of its operating model in future, a strategy that will ensure the organisation can focus on its core business competencies and eliminate the need to develop and support in-house expertise in commodity areas.

Prioritising sexuality education in Mississippi and Nigeria: The importance of local actors, policy windows and creative strategy.

PubMed

Sullivan Robinson, Rachel; Kunnuji, Michael; Shawar, Yusra Ribhi; Shiffman, Jeremy

2018-03-20

Mississippi and Nigeria are two socially conservative places unlikely to prioritise sexuality education. Nonetheless, Mississippi passed a bill in 2011 mandating all school districts to offer sexuality education, and Nigeria approved a national sexuality education curriculum in 2001. To identify the factors that drove the process of prioritisation of sexuality education in each context, we conducted more than 70 semi-structured interviews with nongovernmental organisations/nonprofits, donor organisations and federal and state ministries involved in the prioritisation and implementation of sexuality education in Mississippi and Nigeria. Prioritisation of sexuality education occurred for similar reasons in both Mississippi and Nigeria: (1) local individuals and organisations committed to sexuality education and supported by external actors; (2) the opening of a policy window that made sexuality education a solution to a pressing social problem (teen pregnancy in Mississippi and HIV/AIDS in Nigeria) and (3) strategic action on the part of proponents. We conclude that promoting sexuality education in challenging contexts requires fostering committed local individuals and organisations, identifying external resources to support implementation costs and building on existing relationships of trust between actors, even if those relationships are unrelated to sexuality education.

Implementing care programmes for frail older people: a project management perspective.

PubMed

Bindels, Jill; Cox, Karen; Abma, Tineke A; van Schayck, Onno C P; Widdershoven, Guy

2015-01-01

To examine the issues that influenced the implementation of programmes designed to identify and support frail older people in the community in the Netherlands. Qualitative research methods were used to investigate the perspectives of project leaders, project members and members of the steering committee responsible for the implementation of the programmes. Interviews were conducted in 2009 (n = 10) and in 2012 (n = 13) and a focus group was organised in 2012 (n = 5). The interviews revealed that the implementation was influenced by the extent and quality of collaboration between organisations, adaptation to existing structures, future funding for the programmes and project leadership. A good relationship between participating organisations and professionals is required for successful implementation. A lack of clear project leadership and structural funding hampers the implementation of complex programmes in primary care settings. The findings of this study are useful for organisations and professionals who are planning to implement complex programmes. Identifying barriers concerning institutional collaboration, adaptation to existing structures, leadership and continuation of financial support at an early stage of the implementation process can support practitioners in overcoming them. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Re-conceptualising holism in the contemporary nursing mandate: from individual to organisational relationships.

PubMed

Allen, Davina

2014-10-01

Over the last forty years, nursing's claim to professional expertise has been expressed in terms of its care-giving function. Informed by a distinctive 'holistic' approach, models of nursing identify therapeutic relationships as the cornerstone of practice. While 'knowing the patient' has been central to clinicians' occupational identity, research reveals that nurses not only experience significant material constraints in realising these ideals, their contribution to healthcare extends far beyond direct work with patients. Amidst growing concern about healthcare quality, a body of critical commentary has emerged proposing that the contemporary nursing mandate, with its exclusive focus on care-giving, is no longer serving the interests of the profession or the public. Drawing on an ethnographic study of UK hospital nurses' 'organising work' and insights from practice-based approaches and actor network theory, this paper lays the foundations for a re-conceptualisation of holism within the nursing mandate centred on organisational rather than therapeutic relationships. Nurses can be understood as obligatory passage points in health systems and through myriad processes of 'translational mobilisation' sustain the networks through which care is organised. Copyright © 2014 Elsevier Ltd. All rights reserved.

Lack of integration governance in ERP development: a case study on causes and effects

NASA Astrophysics Data System (ADS)

Kähkönen, Tommi; Smolander, Kari; Maglyas, Andrey

2017-09-01

The development of an enterprise resource planning (ERP) system starts actually after it has been implemented and taken into use. It is necessary to integrate ERP with other business information systems inside and outside the company. With the grounded theory, we aim to understand how integration challenges emerged in a large manufacturing enterprise when the long-term ERP system reached the beginning of its retirement. Structural changes, an information technology governance model, lack of organisational vision, having no architectural descriptions, lack of collaboration, cost cutting, and organisational culture made integration governance troublesome. As a consequence, the enterprise suffered from several undesired effects, such as complex integration scenarios between internal systems, and failing to provide its customers the needed information. The reduction of costs strengthened the organisational silos further and led to unrealised business process improvements. We provide practitioners with four recommendations. First, the organisational goals for integration should be exposed. Second, when evaluating the needs and impacts of integration, a documented architectural description about the system landscape needs to be utilised. Third, the role of IT should be emphasised in development decision-making, and fourth, collaboration is the core ingredient for successful integration governance.

Registered nurses' perceptions of conditions for patient education - focusing on organisational, environmental and professional cooperation aspects.

PubMed

Bergh, Anne-Louise; Karlsson, Jan; Persson, Eva; Friberg, Febe

2012-09-01

To describe nurses' perceptions of conditions for patient education, focusing on organisational, environmental and professional cooperation aspects, and to determine any differences between primary, municipal and hospital care. Although patient education is an important part of daily nursing practice, the conditions for this work are unclear and require clarification. A stratified random sample of 701 (83%) nurses working in primary, municipal and hospital care completed a 60-item questionnaire. The study is part of a larger project. The study items relating to organisation, environment and professional cooperation were analysed using descriptive statistics, non-parametric tests and content analysis. Conditions for patient education differ. Nurses in primary care had better conditions and more managerial support, for example in the allocation of undisturbed time. Conditions related to organisation, environment and cooperation need to be developed further. In this process, managerial support is important, and nurses must ask for better conditions in order to carry through patient education. Managerial support for the development of visible patient education routines (e.g. allocation of time, place and guidelines) is required. One recommendation is to designate a person to oversee educational work. © 2012 Blackwell Publishing Ltd.

Health activism and the logic of connective action. A case study of rare disease patient organisations

PubMed Central

Vicari, Stefania; Cappai, Franco

2016-01-01

ABSTRACT This exploratory work investigates the role of digital media in expanding health discourse practices in a way to transform traditional structures of agency in public health. By focusing on a sample of rare disease patient organisations as representative of contemporary health activism, this study investigates the role of digital communication in the development of (1) bottom-up sharing and co-production of health knowledge, (2) health public engagement dynamics and (3) health information pathways. Findings show that digital media affordances for patient organisations go beyond the provision of social support for patient communities; they ease one-way, two-way and crowdsourced processes of health knowledge sharing, exchange and co-production, provide personalised routes to health public engagement and bolster the emergence of varied pathways to health information where experiential knowledge and medical authority are equally valued. These forms of organisationally enabled connective action can help the surfacing of personal narratives that strengthen patient communities, the bottom-up production of health knowledge relevant to a wider public and the development of an informational and eventually cultural context that eases patients’ political action. PMID:27499676

Strong leadership: the case for global connections.

PubMed

Rosser, Elizabeth A; Scammell, Janet; Bevan, Ann; Hundley, Vanora A

2017-04-01

To identify how nurse leaders view and experience the opportunities offered by one of the largest global nursing organisations Sigma Theta Tau International. Worldwide, nursing leadership is challenged with addressing the complex issues impacting on care delivery. International nursing organisations are a means to bring together individuals to promote leadership and scholarship for nursing practice to promote patient safety and quality care. The newly established all-England chapter of Sigma Theta Tau International is a recent addition to the society in terms of nurse leadership in Europe, as such faces challenges as it establishes its identity and seeks to interpret the organisational vision: to advance world health through nursing leadership and scholarship. Moving forward, members views were sought on the goals of the chapter and how they may be enacted. In July 2013, all chapter members at that time had been nominated on the basis of achievement in nurse leadership; all were invited to participate in an online survey. The online questionnaire contained a series of closed and open questions. Most respondents joined because they believed in the vision and networking opportunities Sigma Theta Tau International provides. Three themes were extracted from the data: the value of networking and communication, leadership and the development of culturally sensitive organisations and the need for shared scholarship for nursing practice. Findings indicate the growth of effective leadership at all levels of nursing could be harnessed through successful collaboration and keen support for robust connections between practice and education to promote quality care. Whilst challenging, globalisation presents an opportunity for a nursing society such as Sigma Theta Tau International to work collaboratively to address healthcare issues. A nursing society that explores and resolves its own complex issues by actively promoting leadership and collaborative scholarship reveals a potential to empower the profession to share our collective solutions towards enhancing clinical practice. © 2016 John Wiley & Sons Ltd.

Building effective service linkages in primary mental health care: a narrative review part 2

PubMed Central

2011-01-01

Background Primary care services have not generally been effective in meeting mental health care needs. There is evidence that collaboration between primary care and specialist mental health services can improve clinical and organisational outcomes. It is not clear however what factors enable or hinder effective collaboration. The objective of this study was to examine the factors that enable effective collaboration between specialist mental health services and primary mental health care. Methods A narrative and thematic review of English language papers published between 1998 and 2009. An expert reference group helped formulate strategies for policy makers. Studies of descriptive and qualitative design from Australia, New Zealand, UK, Europe, USA and Canada were included. Data were extracted on factors reported as enablers or barriers to development of service linkages. These were tabulated by theme at clinical and organisational levels and the inter-relationship between themes was explored. Results A thematic analysis of 30 papers found the most frequently cited group of factors was "partnership formation", specifically role clarity between health care workers. Other factor groups supporting clinical partnership formation were staff support, clinician attributes, clinic physical features and evaluation and feedback. At the organisational level a supportive institutional environment of leadership and change management was important. The expert reference group then proposed strategies for collaboration that would be seen as important, acceptable and feasible. Because of the variability of study types we did not exclude on quality and findings are weighted by the number of studies. Variability in local service contexts limits the generalisation of findings. Conclusion The findings provide a framework for health planners to develop effective service linkages in primary mental health care. Our expert reference group proposed five areas of strategy for policy makers that address organisational level support, joint clinical problem solving, local joint care guidelines, staff training and supervision and feedback. PMID:21435273

Deepening our Understanding of Quality in Australia (DUQuA): a study protocol for a nationwide, multilevel analysis of relationships between hospital quality management systems and patient factors

PubMed Central

Taylor, Natalie; Clay-Williams, Robyn; Hogden, Emily; Pye, Victoria; Li, Zhicheng; Groene, Oliver; Suñol, Rosa; Braithwaite, Jeffrey

2015-01-01

Introduction Despite the growing body of research on quality and safety in healthcare, there is little evidence of the association between the way hospitals are organised for quality and patient factors, limiting our understanding of how to effect large-scale change. The ‘Deepening our Understanding of Quality in Australia’ (DUQuA) study aims to measure and examine relationships between (1) organisation and department-level quality management systems (QMS), clinician leadership and culture, and (2) clinical treatment processes, clinical outcomes and patient-reported perceptions of care within Australian hospitals. Methods and analysis The DUQuA project is a national, multilevel, cross-sectional study with data collection at organisation (hospital), department, professional and patient levels. Sample size calculations indicate a minimum of 43 hospitals are required to adequately power the study. To allow for rejection and attrition, 70 hospitals across all Australian jurisdictions that meet the inclusion criteria will be invited to participate. Participants will consist of hospital quality management professionals; clinicians; and patients with stroke, acute myocardial infarction and hip fracture. Organisation and department-level QMS, clinician leadership and culture, patient perceptions of safety, clinical treatment processes, and patient outcomes will be assessed using validated, evidence-based or consensus-based measurement tools. Data analysis will consist of simple correlations, linear and logistic regression and multilevel modelling. Multilevel modelling methods will enable identification of the amount of variation in outcomes attributed to the hospital and department levels, and the factors contributing to this variation. Ethics and dissemination Ethical approval has been obtained. Results will be disseminated to individual hospitals in de-identified national and international benchmarking reports with data-driven recommendations. This ground-breaking national study has the potential to influence decision-making on the implementation of quality and safety systems and processes in Australian and international hospitals. PMID:26644128

Identifying an outcome measure to assess the impact of Mobility Dogs.

PubMed

Mudge, Suzie; Rewi, Dallas; Channon, Alexis

2017-01-01

Mobility Dogs® trains dogs to work with people with physical disabilities to increase independence, confidence, self-esteem and participation. Mobility Dogs® seeks to critically evaluate and improve its services as it grows. This study aimed to identify and implement a standardised outcome measure into practice at Mobility Dogs®. Based on the Consolidated Framework for Implementation Research and guided by a steering group of key stakeholders, a three-phase approach was developed to identify and assess an outcome measure. The steering group highlighted the organisation's specific needs, selected participation as the assessment domain and identified core utility requirements of the measure. A comprehensive review of evidence was undertaken to identify and rank potential measures according to the specified needs. Of the seven participation outcome measures that met inclusion criteria, the three highest ranked measures were critically evaluated by the steering group to determine suitability against the organisation's needs. The Impact on Participation and Autonomy (IPA) was selected for implementation into practice at Mobility Dogs®. Use of the IPA is an important first step for Mobility Dogs® to test the benefits of trained service dogs. This process could be replicated by other service dog organisations to identify outcome measures to assess their own services. Implications for Rehabilitation Service dogs (such as Mobility Dogs® in New Zealand) assist people living with physical impairments by performing tasks, however there is limited evidence on outcomes. The process for selecting an appropriate outcome measure for Mobility Dogs® involving partnership between Mobility Dogs® personnel and academics was an effective way to steer the project by determining important properties of the measure, before a search of the literature was undertaken. While the IPA was selected as the most appropriate outcome measure for use at Mobility Dogs®, it was the process that is valuable to replicate if other organisations wish to select an outcome measure for use in their own practice.

Implementation of a disability management policy in a large healthcare employer: a quasi-experimental, mixed-methods evaluation

PubMed Central

Mustard, Cameron A; Skivington, Kathryn; Lay, Morgan; Lifshen, Marni; Etches, Jacob; Chambers, Andrea

2017-01-01

Objective This study describes the process and outcomes of the implementation of a strengthened disability management policy in a large Canadian healthcare employer. Key elements of the strengthened policy included an emphasis on early contact, the training of supervisors and the integration of union representatives in return-to-work (RTW) planning. Design The study applied mixed methods, combining a process evaluation within the employer and a quasi-experimental outcome evaluation between employers for a 3-year period prior to and following policy implementation in January 2012. Participants Staff in the implementation organisation (n=4000) and staff in a peer group of 29 large hospitals (n=1 19 000). Outcomes Work disability episode incidence and duration. Results Both qualitative and quantitative measures of the implementation process were predominantly positive. Over the 6-year observation period, there were 624 work disability episodes in the organisation and 8604 in the comparison group of 29 large hospitals. The annual per cent change in episode incidence in the organisation was −5.6 (95% CI −9.9 to −1.1) comparable to the annual per cent change in the comparison group: −6.2 (-7.2 to –5.3). Disability episode durations also declined in the organisation, from a mean of 19.4 days (16.5, 22.3) in the preintervention period to 10.9 days (8.7, 13.2) in the postintervention period. Reductions in disability durations were also observed in the comparison group: from a mean of 13.5 days (12.9, 14.1) in the 2009–2011 period to 10.5 days (9.9, 11.1) in the 2012–2014 period. Conclusion The incidence of work disability episodes and the durations of work disability declined strongly in this hospital sector over the 6-year observation period. The implementation of the organisation’s RTW policy was associated with larger reductions in disability durations than observed in the comparison group. PMID:28624757

Conceptualising and creating a global learning health system.

PubMed

Friedman, Charles; Rigby, Michael

2013-04-01

In any country the health sector is important in terms of human wellbeing and large in terms of economics. The health sector might therefore be expected to be a finely tuned enterprise, utilising corporate knowledge in a constant process of critically reviewing and improving its activities and processes. However, this is seldom the case. Health systems and practice are highly variable and lag behind research discovery. This contrasts strongly with commercial bodies, and particularly service industries, where the concept of the learning organisation is strongly seen as the key to optimisation. A learning organisation accesses for analytic purposes operational data, which though captured and recorded for day-to-day transactions at the customer level, become also the basis of understanding changes in both demand and delivery process. In health care, the concept of the learning organisation is well grounded ethically. Anything which can improve health, including understanding of optimal care delivery processes and how to improve longer term outcomes, should be seized upon to drive service improvement - but currently this occurs haphazardly. The limitations of paper-based systems, priority given to digitalization of financial transactions, concerns about electronic data insecurity, and other factors have inhibited progress towards organisational learning at a national scale. But in recent years, new means of capturing, managing, and exchanging data have created new opportunities, while ever increasing pressures on health systems have produced strengthened incentive. In the United States, the current policy and investment impetus to electronic health records and concomitantly their 'meaningful use' create opportunities to build the foundations for data re-use for corporate learning - and thus for societal gain. In Europe and other settings there are islands of innovation, but not yet a coherent culture or impetus to build foundations for a learning health system. This paper considers how to move forward, in the light of the urgent need for smarter health systems where experience becomes the fuel for rapid improvement, and best practices are routinely identified and applied. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

[26th Conference of the Spanish Society of Quality in Healthcare: a good balance between quality, innovation, science and participation].

PubMed

Astier-Peña, M P; Barrasa-Villar, I; García-Mata, J R; Aranaz-Andrés, J; Enriquez-Martín, N; Vela-Marquina, M L

2010-01-01

The experience and learning process of preparing a scientific conference programme, organising and conducting a conference ccompletes the quality circle with the quantitative and qualitative assessment of the process and results. The transmission of this experience and learning process through this paper will improve the performance of committees of future conference venues, partners and participants and collaborators. The method for performing this evaluation is the assessment of the activities of both the scientific and organising committees of the XXVI Conference of the Spanish Society of Quality Healthcare in October 2008 in Zaragoza. The methodology evaluated the observance of the timetable and tasks assigned to the committees in the Congress Manual of the society along with the presentation of final results of the congress concerning scientific participation and overall satisfaction. There were a total of 1211 communications with a rejection rate of 9.1%. Of the total, 577 communications were presented in oral format and 544 in poster format. Aragon was the community of origin of 24% of communications. By subject areas, those of most interest were patient safety, organisational and management processes, and patient perspectives. A total of 83 participants attended 7 of the 11 workshops offered. The average attendance for each workshop was 12 people. The response rate to the assessment of workshops questionnaire was 54.2% with an average score of 4 (scale of 1 to 5). A total of 1131 people attended the conference of which 17% (193) were SECA associates. Out of a total of 1075 overall satisfaction conference questionnaires distributed there was a response rate of 9.30% (100). The scientific content was assessed with an average score of 3.6 and the organization with 3.87, both on a total score of 5 points. According to the number of abstracts received, number of conferences, level of satisfaction with the scientific program and organisation, we can conclude that the XXVI Conference of the Society has been a success, although we are still in our continuous quality improvement circle that will make conferences even better. Copyright © 2010 SECA. Published by Elsevier Espana. All rights reserved.

Exploring drivers and challenges in implementation of health promotion in community mental health services: a qualitative multi-site case study using Normalization Process Theory.

PubMed

Burau, Viola; Carstensen, Kathrine; Fredens, Mia; Kousgaard, Marius Brostrøm

2018-01-24

There is an increased interest in improving the physical health of people with mental illness. Little is known about implementing health promotion interventions in adult mental health organisations where many users also have physical health problems. The literature suggests that contextual factors are important for implementation in community settings. This study focused on the change process and analysed the implementation of a structural health promotion intervention in community mental health organisations in different contexts in Denmark. The study was based on a qualitative multiple-case design and included two municipal and two regional provider organisations. Data were various written sources and 13 semi-structured interviews with 22 key managers and frontline staff. The analysis was organised around the four main constructs of Normalization Process Theory: Coherence, Cognitive Participation, Collective Action, and Reflexive Monitoring. Coherence: Most respondents found the intervention to be meaningful in that the intervention fitted well into existing goals, practices and treatment approaches. Cognitive Participation: Management engagement varied across providers and low engagement impeded implementation. Engaging all staff was a general problem although some of the initial resistance was apparently overcome. Collective Action: Daily enactment depended on staff being attentive and flexible enough to manage the complex needs and varying capacities of users. Reflexive Monitoring: During implementation, staff evaluations of the progress and impact of the intervention were mostly informal and ad hoc and staff used these to make on-going adjustments to activities. Overall, characteristics of context common to all providers (work force and user groups) seemed to be more important for implementation than differences in the external political-administrative context. In terms of research, future studies should adopt a more bottom-up, grounded description of context and pay closer attention to the interplay between different dimensions of implementation. In terms of practice, future interventions need to better facilitate the translation of the initial sense of general meaning into daily practice by active local management support that occurs throughout the implementation process and that systematically connects the intervention to existing practices.

From Real Life to Real Life: Bringing "Double Awareness" from Action Learning Programmes into Organisational Reality

ERIC Educational Resources Information Center

Svalgaard, Lotte

2017-01-01

In Action Learning programmes, it is held central to work on real business challenges (task) while learning about team and self (process); staying mindful aware of the process is referred to in this paper as "double awareness", and emphasises noticing and acting on process cues while working on the task. As business challenges within…

Supporting Reflective Practices in Social Change Processes with the Dynamic Learning Agenda: An Example of Learning about the Process towards Disability Inclusive Development

ERIC Educational Resources Information Center

van Veen, Saskia C.; de Wildt-Liesveld, Renée; Bunders, Joske F. G.; Regeer, Barbara J.

2014-01-01

Change processes are increasingly seen as the solution to entrenched (social) problems. However, change is difficult to realise while dealing with multiple actors, values, and approaches. (Inter)organisational learning is seen as a way to facilitate reflective practices in social change that support emergent changes, vicarious learning, and…

How nurse leaders can foster a climate of good governance.

PubMed

Bassett, Sally; Westmore, Kathryn

2012-09-01

This article is the first in a series of four examining the components of good corporate governance. Poor governance can result in patients receiving poor quality care; all healthcare professionals, therefore, have a role in ensuring effective governance. This article discusses how an organisation's culture and leadership can contribute to good corporate governance. Nurse leaders can influence the culture of effective governance by building trust and respect and challenging the behaviours that led to poor quality care. The next article in this series will look at how an organisation's systems and processes can affect the effectiveness of its governance.

[Improving the CMP appointment waiting time for children and adolescents].

PubMed

Cani, Pascale

2014-01-01

The increasing activity of mental health centres for children and adolescents and longer waiting times in obtaining a first appointment have led an area of child psychiatry to question the organisation of new consultation applications. Two CMP in the sector had a waiting period of over 40 days for half of the patients. Two improvement actions were implemented:the implementation of organisation and reception nurses and the development of a new applications management process. The evaluation after one year showed a decrease of half of the appointment waiting time without changing the non showed up rate.

Using personal narrative to deepen emotional awareness of practice.

PubMed

Edwards, Sharon L

2014-08-19

Storytelling is intrinsic to human beings, and stories can explain events, stances taken and actions engaged in. When experience is represented as story it can become more organised and be used for analysis, critique and learning. Experience is important in nursing, as it is in many other practice-based professions, and it can contribute much to nurses' learning. Through a process of sharing and engaging with the author's personal stories, this article encourages nurses to begin to organise their own experiences in story form for use in learning and as part of their personal and professional development.

Airline business continuity and IT disaster recovery sites.

PubMed

Haji, Jassim

2016-01-01

Business continuity is defined as the capability of the organisation to continue delivery of products or services at acceptable predefined levels following a disruptive incident. Business continuity is fast evolving to become a critical and strategic decision for any organisation. Transportation in general, and airlines in particular, is a unique sector with a specialised set of requirements, challenges and opportunities. Business continuity in the airline sector is a concept that is generally overlooked by the airline managements. This paper reviews different risks related to airline processes and will also propose solutions to these risks based on experiences and good industry practices.

Dental hygienists in Korea.

PubMed

Kim, S-H

2003-05-01

The purpose of this paper is to give basic information about the status of dental hygienists in Korea. This paper examines the changing process of the dental hygiene education system in Korea, from its start in 1965 until the present, 2003, the composition of dental personnel in Korea, the specialised areas and roles of dental hygienists after they receive their licenses, employment of dental hygienists, dental hygiene-related organisations, and the status and direction of dental hygienists in Korea. This paper shows the organisational, educational, governmental and individual efforts to increase the level of professionalism, education and quality of care delivered to Korean citizens nationwide.

Beyond vertical integration--Community based medical education.

PubMed

Kennedy, Emma Margaret

2006-11-01

The term 'vertical integration' is used broadly in medical education, sometimes when discussing community based medical education (CBME). This article examines the relevance of the term 'vertical integration' and provides an alternative perspective on the complexities of facilitating the CBME process. The principles of learner centredness, patient centredness and flexibility are fundamental to learning in the diverse contexts of 'community'. Vertical integration as a structural concept is helpful for academic organisations but has less application to education in the community setting; a different approach illuminates the strengths and challenges of CBME that need consideration by these organisations.

The school environment and student health: a systematic review and meta-ethnography of qualitative research

PubMed Central

2013-01-01

Background There is increasing interest in promoting young people’s health by modifying the school environment. However, existing research offers little guidance on how the school context enables or constrains students’ health behaviours, or how students’ backgrounds relate to these processes. For these reasons, this paper reports on a meta-ethnography of qualitative studies examining: through what processes does the school environment (social and physical) influence young people’s health? Methods Systematic review of qualitative studies. Sixteen databases were searched, eliciting 62, 329 references which were screened, with included studies quality assessed, data extracted and synthesized using an adaptation of Noblit and Hare’s meta-ethnographic approach. Results Nineteen qualitative studies were synthesised to explore processes through which school-level influences on young people’s health might occur. Four over-arching meta-themes emerged across studies focused on a range of different health issues. First, aggressive behaviour and substance use are often a strong source of status and bonding at schools where students feel educationally marginalised or unsafe. Second, health-risk behaviours are concentrated in unsupervised ‘hotspots’ at the school. Third, positive relationships with teachers appear to be critical in promoting student wellbeing and limiting risk behaviour; however, certain aspects of schools’ organisation and education policies constrain this, increasing the likelihood that students look for a sense of identity and social support via health-risk behaviours. Fourth, unhappiness at school can cause students to seek sources of ‘escape’, either by leaving school at lunchtime or for longer unauthorized spells or through substance use. These meta-themes resonate with Markham and Aveyard’s theory of human functioning and school organisation, and we draw on these qualitative data to refine and extend this theory, in particular conceptualising more fully the role of young people’s agency and student-led ‘systems’ in constituting school environments and generating health risks. Conclusion Institutional features which may shape student health behaviours such as lack of safety, poor student-staff relationships and lack of student voice are amenable to interventions and should be the subject of future investigation. Future qualitative research should focus on health behaviours which are under-theorised in this context such as physical activity, sexual and mental health. PMID:24007211

Trust in management, communication and organisational commitment: Factors influencing readiness for change management in organisation

NASA Astrophysics Data System (ADS)

Ahmad, Mohd Hafis; Ismail, Syuhaida; Rani, Wan Nurul Mardiah Wan Mohd; Wahab, Mohammad Hussaini

2017-10-01

Organisational change occurs when an organisation makes a transition from its current state to some desired future state in minimising employee resistance and cost to the organisation while simultaneously maximising the effectiveness of the change effort. This paper, aims at appraising the change management of organisation in Malaysia since limited research has been done to examine readiness for change by the employees in the organisation. This paper is materialising its objectives of (1) investigating the current practice of organisation and employees in the organisation towards change management and (2) assessing the factors influencing readiness of organisation and employees in the organisation towards change management. It is found via literature review that change management is a structured approach for ensuring that changes are thoroughly and smoothly implemented to transitioning individuals, teams, and organisations to a desired future state by focusing on the wider impacts of change, particularly on people, where change does not happen in isolation and it impacts the whole organisation. Furthermore, it is found that current practice of organisation and employees in the organisation towards change management involved in three main factors, namely trust in management, communication and organisational commitment; with the factor for trust in management is the positive vision for the future by management team, meanwhile for communication, it is found that there is good communication between supervisors and employees about the organisation's policy toward the changes. The factor found in organisational commitment is employees enjoying discussing about their organisation with outsiders. The findings of this paper provide a positive impact on change management planning, which ultimately help in ensuring more effective change programme implementation in the organisation in Malaysia.

Effectiveness of implementation interventions in improving physician adherence to guideline recommendations in heart failure: a systematic review

PubMed Central

Shanbhag, Deepti; Graham, Ian D; Harlos, Karen; Haynes, R. Brian; Gabizon, Itzhak; Connolly, Stuart J; Van Spall, Harriette Gillian Christine

2018-01-01

Background The uptake of guideline recommendations that improve heart failure (HF) outcomes remains suboptimal. We reviewed implementation interventions that improve physician adherence to these recommendations, and identified contextual factors associated with implementation success. Methods We searched databases from January 1990 to November 2017 for studies testing interventions to improve uptake of class I HF guidelines. We used the Cochrane Effective Practice and Organisation of Care and Process Redesign frameworks for data extraction. Primary outcomes included: proportion of eligible patients offered guideline-recommended pharmacotherapy, self-care education, left ventricular function assessment and/or intracardiac devices. We reported clinical outcomes when available. Results We included 38 studies. Provider-level interventions (n=13 studies) included audit and feedback, reminders and education. Organisation-level interventions (n=18) included medical records system changes, multidisciplinary teams, clinical pathways and continuity of care. System-level interventions (n=3) included provider/institutional incentives. Four studies assessed multi-level interventions. We could not perform meta-analyses due to statistical/conceptual heterogeneity. Thirty-two studies reported significant improvements in at least one primary outcome. Clinical pathways, multidisciplinary teams and multifaceted interventions were most consistently successful in increasing physician uptake of guidelines. Among randomised controlled trials (RCT) (n=10), pharmacist and nurse-led interventions improved target dose prescriptions. Eleven studies reported clinical outcomes; significant improvements were reported in three, including a clinical pathway, a multidisciplinary team and a multifaceted intervention. Baseline assessment of barriers, staff training, iterative intervention development, leadership commitment and policy/financial incentives were associated with intervention effectiveness. Most studies (n=20) had medium risk of bias; nine RCTs had low risk of bias. Conclusion Our study is limited by the quality and heterogeneity of the primary studies. Clinical pathways, multidisciplinary teams and multifaceted interventions appear to be most consistent in increasing guideline uptake. However, improvements in process outcomes were rarely accompanied by improvements in clinical outcomes. Our work highlights the need for improved research methodology to reliably assess the effectiveness of implementation interventions. PMID:29511005

Effectiveness of implementation interventions in improving physician adherence to guideline recommendations in heart failure: a systematic review.

PubMed

Shanbhag, Deepti; Graham, Ian D; Harlos, Karen; Haynes, R Brian; Gabizon, Itzhak; Connolly, Stuart J; Van Spall, Harriette Gillian Christine

2018-03-06

The uptake of guideline recommendations that improve heart failure (HF) outcomes remains suboptimal. We reviewed implementation interventions that improve physician adherence to these recommendations, and identified contextual factors associated with implementation success. We searched databases from January 1990 to November 2017 for studies testing interventions to improve uptake of class I HF guidelines. We used the Cochrane Effective Practice and Organisation of Care and Process Redesign frameworks for data extraction. Primary outcomes included: proportion of eligible patients offered guideline-recommended pharmacotherapy, self-care education, left ventricular function assessment and/or intracardiac devices. We reported clinical outcomes when available. We included 38 studies. Provider-level interventions (n=13 studies) included audit and feedback, reminders and education. Organisation-level interventions (n=18) included medical records system changes, multidisciplinary teams, clinical pathways and continuity of care. System-level interventions (n=3) included provider/institutional incentives. Four studies assessed multi-level interventions. We could not perform meta-analyses due to statistical/conceptual heterogeneity. Thirty-two studies reported significant improvements in at least one primary outcome. Clinical pathways, multidisciplinary teams and multifaceted interventions were most consistently successful in increasing physician uptake of guidelines. Among randomised controlled trials (RCT) (n=10), pharmacist and nurse-led interventions improved target dose prescriptions. Eleven studies reported clinical outcomes; significant improvements were reported in three, including a clinical pathway, a multidisciplinary team and a multifaceted intervention. Baseline assessment of barriers, staff training, iterative intervention development, leadership commitment and policy/financial incentives were associated with intervention effectiveness. Most studies (n=20) had medium risk of bias; nine RCTs had low risk of bias. Our study is limited by the quality and heterogeneity of the primary studies. Clinical pathways, multidisciplinary teams and multifaceted interventions appear to be most consistent in increasing guideline uptake. However, improvements in process outcomes were rarely accompanied by improvements in clinical outcomes. Our work highlights the need for improved research methodology to reliably assess the effectiveness of implementation interventions. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

IEC80001 and Future Ramifications for Health Systems not currently classed as Medical Devices

NASA Astrophysics Data System (ADS)

Harrison, Ian

Traditionally a medical device is viewed as a standalone hospital system with a carefully segregated private network running on specialist bespoke equipment, managed by highly skilled medical technicians. The regulations in force implementing the Medical Devices Directive support this view. The emerging reality in the modern health organisation is a patient-centric shared electronic record, networked over the organisation's local area network, with medical devices hanging as endpoints off that shared network and contributing to the central pool of patient data - all the time reliant on the shared network services. The IEC80001 standard has been developed to provide guidance on the measures that the medical devices community considers are required best practice in order to ensure that the integrity and safety of the interconnected medical device is not compromised. This in itself is both a laudable and pragmatic action. The question that it immediately prompts for those left with the new and very real task of 'compliance' with the new standards - primarily the over worked health organisation's IT department, is 'what impact does this have on me?'. A number of papers exist prepared from a health-system-supplier standpoint. This paper is principally focused on examining the ramifications of IEC80001 from a health organisation stand point. This paper seeks to identify the areas where a health organisation may expect to have their business-as-usual IT processes impacted, and offers a simple framework to address these challenges.

Quality management standards for facility services in the Italian health care sector.

PubMed

Cesarotti, Vittorio; Di Silvio, Bruna

2006-01-01

Health care, one of the most dynamic sectors in Italy, is studied with a particular focus on outsourcing non-core activities such as facility management (FM) services. The project's goals are to define national standards to balance and control facility service evolution, and to drive FM services towards organisational excellence. The authors, in cooperation with a pool of facility service providers and hospitals managers, studied cleaning services--one of the most critical areas. This article describes the research steps and findings following definition and publication of the Italian standard and its application to an international benchmarking process. The method chosen for developing the Italian standard was to merge technical, strategic and organisational aspects with the goal of standardising the contracting system, giving service providers the chance to improve efficiency and quality, while helping healthcare organisations gain from a better, more reliable and less expensive service. The Italian standard not only improved services but also provided adequate control systems for outsourcing organisations. In this win-win context, it is hoped to continually drive FM services towards organisational excellence. This study is specific to the Italian national healthcare system. However, the strategic dynamics described are common to many other contexts. A systematic method for improving hospital FM services is presented. The authors believe that lessons learned from their Italian case study can be used to better understand and drive similar services in other countries or in other FM service outsourcing sectors.

Factors predicting change in hospital safety climate and capability in a multi-site patient safety collaborative: a longitudinal survey study.

PubMed

Benn, Jonathan; Burnett, Susan; Parand, Anam; Pinto, Anna; Vincent, Charles

2012-07-01

The study had two specific objectives: (1) To analyse change in a survey measure of organisational patient safety climate and capability (SCC) resulting from participation in the UK Safer Patients Initiative and (2) To investigate the role of a range of programme and contextual factors in predicting change in SCC scores. Single group longitudinal design with repeated measurement at 12-month follow-up. Multiple service areas within NHS hospital sites across England, Wales, Scotland and Northern Ireland. Stratified sample of 284 respondents representing programme teams at 19 hospital sites. A complex intervention comprising a multi-component quality improvement collaborative focused upon patient safety and designed to impact upon hospital leadership, communication, organisation and safety climate. A survey including a 31-item SCC scale was administered at two time-points. Modest but significant positive movement in SCC score was observed between the study time-points. Individual programme responsibility, availability of early adopters, multi-professional collaboration and extent of process measurement were significant predictors of change in SCC. Hospital type and size, along with a range of programme preconditions, were not found to be significant. A range of social, cultural and organisational factors may be sensitive to this type of intervention but the measurable effect is small. Supporting critical local programme implementation factors may be an effective strategy in achieving development in organisational patient SCC, regardless of contextual factors and organisational preconditions.

Nurse practitioner integration: Qualitative experiences of the change management process.

PubMed

Lowe, Grainne; Plummer, Virginia; Boyd, Leanne

2018-04-30

The aim of this qualitative research was to explore perceptions of organisational change related to the integration of nurse practitioners from key nursing stakeholders. The ongoing delivery of effective and efficient patient services is reliant upon the development and sustainability of nurse practitioner roles. Examination of the factors contributing to the underutilization of nurse practitioner roles is crucial to inform future management policies. A change management theory is used to reveal the complexity involved. Qualitative interviews were undertaken using a purposive sampling strategy of key stakeholders. Thematic analysis was undertaken and key themes were correlated to the theoretical framework. The results confirm the benefits of nurse practitioner roles, but suggest organisational structures and embedded professional cultures present barriers to full role optimization. Complicated policy processes are creating barriers to the integration of nurse practitioner roles. The findings increase understanding of the links between strategic planning, human resource management, professional and organisational cultures, governance and politics in change management. Effective leadership drives the change process through the ability to align key components necessary for success. Sustainability of nurse practitioners relies on recognition of their full potential in the health care team. The results of this study highlight the importance of management and leadership in the promotion of advanced nursing skills and experience to better meet patient outcomes. The findings reinforce the potential of nurse practitioners to deliver patient centred, timely and efficient health care. © 2018 John Wiley & Sons Ltd.

Latin American Universities and the Bologna Process: From Commercialisation to the "Tuning" Competencies Project

ERIC Educational Resources Information Center

Aboites, Hugo

2010-01-01

Through the "Tuning-Latin America" competencies project, Latin American universities have been incorporated into the Bologna Process. In 2003 the European Commission approved an initiative of this project for Latin America and began to promote it among ministries, university presidents' organisations and other institutions in Latin…